PETITION FOR WITHDRAWAL FROM BLOCKED ACCOUNT 226 04/01 226 pg 1 IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON FOR THE COUNTY OF KING In the Settlement/ Guardianship/ Estate of: ) ) Cause N260 ) ) PETITION & DECLARATION ) FOR WITHDRAWAL FROM ) BLOCKED ACCOUNT ) 1. Identity of Petitioner, Funds to Be Withdrawn and Reason for Withdrawal. 250 I am the court-appointed Guardian or Guardian ad Litem in this action. I am the custodian of the funds of the above-named Incapacitated Person. At this time I am seeking a court order authorizing a withdrawal from account No. held at the following named financial institution: in the amount of $ for the following reason or purpose(s): or 250 The Incapacitated Person named above reached became 18 years old on (date). 250 I am the person named above or 250 I am the court-appointed Guardian or Guardian ad Litem. I am seeking to have the blocked account funds distributed and to have the Guardianship terminated. I am attaching a copy of a current account statement. American LegalNet, Inc. www.FormsWorkFlow.com PETITION FOR WITHDRAWAL FROM BLOCKED ACCOUNT 226 04/01 226 pg 2 2. Documents Required to Be Submitted with Petition for Withdrawal for Any Reason Other than the Incapacitated Person Reaching Age 18: I understand that according to law [RCW 11.92.040(3)], I am required to provide an Inventory and Accounting prior to the court's considering this withdrawal. Attached to this application is: (1) An Inventory of Assets which came into my hands at the time I was appointed in this proceeding; (2) An Accounting of all income, receipts, and expenditures received or made from the date of the Inventory or the date of the last Accounting. (3) If the person requesting the withdrawal is the parent of the Incapacitated Person who is a minor and the reason for the withdrawal is other than because the minor reached 18 years of age, also attach a Financial Statement of my spouse and myself, which demonstrates why we are not able to pay for the item or service for which we are seeking this withdrawal. 3. Statement Regarding Repayment. The funds withdrawn 250 shall not be subject to repayment, or 250 shall be repaid according to the following terms: . I declare under penalty of perjury, according to the laws of Washington State that the foregoing is true and correct. Date signed: City or County in which this document was signed: , Washington. Signature Printed Name Address Telephone No American LegalNet, Inc. www.FormsWorkFlow.com