Minn. Gen. R. Prac. Form 145.2

State of Minnesota District Court

County of __________ __________ Judicial District

Case Type: _______________

_

Plaintiff/Petitioner Case No. _________________

and COMBINED MOTION AND ORDER

FOR RELEASE OF

MINOR SETTLEMENT FUNDS

_ (Pursuant to Rule 145 of the

Defendant/Respondent Minnesota General Rules of Practice)

1. _______________ ("Movant") requests an order of permitting withdrawal of funds now held in a restricted account pursuant to a minor settlement approved in this action on _______________. Movant brings this Motion as the

________ (Minor, now past the age of majority-Date of Birth ________________)

or

________ ______ to minor. (Specify whether trustee, custodian, parent, legal guardian, conservator, or other specified role).

2. Funds are now held on behalf of _______________ in the following account:

Name of Depository: _

Branch Name: _

Branch Address: _

_

Account Number: ____(Place on separate form 11.1*)___

Date Account Opened: _

Current Balance: $ _

* = As required by Rule 11.2 of the Minnesota General Rules of Practice

3. Previous withdrawals from the account, each of which was approved by the Court, are as follows:

______ None

or

______ $__________ on __________ for the purpose of _____________

$__________ on __________ for the purpose of _____________

$__________ on __________ for the purpose of _____________

□ Check if additional space is necessary, and attach a separate sheet with that information.

4. Movant seeks the release of funds in the amount of $_______________ for the following reason:

______ Minor has reached the age of 18 and this is a final distribution

or

______ The funds will be used for the benefit of the minor in the following way:

_

_

_ .

□ Check if additional space is necessary, and attach a separate sheet with that

information.

5. Funds should be disbursed as follows:

$ _ to _

$ _ to _

$ _ to _

□ Check if additional space is necessary, and attach a separate sheet with that information.

I declare under oath and penalty of perjury under the laws of the State of Minnesota that the foregoing is true and correct and that any funds released pursuant to this request will be used for the benefit of the minor and in the way stated.

Dated: ______________. Type or Print Name _

Signature: _

(sign only in front of notary public or court administrator)

Sworn / affirmed before me this

___________ day of __________,__________

(DATE) ___________ (MONTH) __________ (YEAR)

_

Notary Public / Deputy Court Administrator

ORDER APPROVING RELEASE OF FUNDS

Pursuant to the foregoing Motion,

IT IS HEREBY ORDERED that

1. Movant is authorized to withdraw funds to be made payable as follows:

$ _ to _

$ _ to _

2. _ This is a final distribution of funds from this account and the account may accordingly be closed following this final distribution

or

_ This is not a final distribution of funds and this account must be maintained as to the remaining funds and subject to all restrictions on distribution previous ordered.

3. Other provisions: _

_

Dated: _____________.

_

Judge of District Court