District Court Denver Probate Court ___________________________________ County, Colorado Court Address: _______________________________________ In the Interest of:
COURT USE ONLY
________________________________________ Protected Person/Minor
Case Number:_______________
Division: ______ Courtroom: ______
ORDER ALLOWING WITHDRAWAL OF FUNDS FROM RESTRICTED ACCOUNT
This matter comes before the Court on the Motion to Withdraw Funds from Restricted Account filed on _______________________ (date). The Court, having reviewed the Motion and supporting documentation, if attached, and any responses received from interested persons, enters the following Orders:
The Motion is GRANTED.
The Conservator is authorized to withdraw $_____________ from the account(s) specified in the Motion and as identified below: Account Number (last 4-digits only) Amount to Withdraw from Account $ $
Name and Address of Financial Institution
Total
The Conservator is required to file a copy of the receipt(s) for the purchase with the Court within ten days. Note: All Conservators are required to keep all original receipt(s). The Motion is DENIED for the following reasons:
The Court further Orders:
Date: _____________________________ Judge Magistrate
CERTIFICATION
I certify that this is a true and correct copy of the original in my custody.
Date: __________________________________
______________________________________ Probate Registrar/(Deputy)Clerk of Court
JDF 869
R4/09
ORDER ALLOWING WITHDRAWAL OF FUNDS FROM RESTRICTED ACCOUNT