STATE OF MAINE SUPERIOR COURT , ss Docke No. DISTRICT COURT Location Docket No.
Plaintiff v. REQUEST FOR WITHDRAWAL (MINOR'S SETTLEMENT)
Defendant TO: (Justice, Superior Court) (Judge, District Court), of the State of Maine. I respectfully ask for the approval of the court to withdraw the sum of $ from Account No. in the name of now in the Financial Institution of at for the following reason(s):
,
Date: By: Next Friend / Petitioner
ORDER The withdrawal of $ from the above account for the above described purpose is approved (on condition that ). The withdrawal of $ from the above account is not approved for the following reason:
Date: Judge / Justice
CV-060, Rev. 09/97