Free District Court Denver Probate Court - Colorado

District Court Denver Probate Court _________________________________ County, Colorado Court Address:
___________________________________________

In the Interest of: _________________________________________ Protected Person/Minor Attorney or Party Without Attorney (Name and Address): Phone Number:_________________ E-mail: ___________________ FAX Number:___________________ Atty. Reg. #:_______________

COURT USE ONLY Case Number:__________________

Division_______ Courtroom _______

MOTION TO WITHDRAW FUNDS FROM RESTRICTED ACCOUNT
I, withdraw $ (name of Conservator(s)), respectfully request authority to , on deposit in the restricted account(s) listed below:

Attach current bank statement. Name and Address of Financial Institution Account Number (last 4-digits only) Current Balance in Account $ $

Total

The funds are requested for the following purchase/reasons(s): Attach supporting documentation for your request.

Signature of Conservator and/or Attorney Date Address City, State and Zip Code Check if new address Date: _______________________

Signature of Conservator and/or Attorney Date Address City, State and Zip Code Check if new address _______________________________________ Signature of Minor if 12 years of age or over

Certificate of Service
I certify that on _________________________ (date) a copy of this Motion to Withdraw Funds from Restricted Account was served on each of the following:
Name of Person to Whom You are Sending this Document (Interested Persons) Relationship to Protected Person Address Manner Service* of

*Insert one of the following:

Hand Delivery, First-Class Mail, Certified Mail, E-Served or Faxed.

_____________________________________________
Signature

JDF 868 R4/09

MOTION TO WITHDRAW FUNDS FROM RESTRICTED ACCOUNT