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Rev. 4/25 REPORT FOR RELEASE OF FUNDS LR29-PR00-716.50 FORM PR00-14 STATE OF INDIANA ) IN THE HAMILTON SUPERIOR COURT ) SS: COUNTY OF HAMILTON ) CAUSE NO. IN THE MATTER OF THE GUARDIANSHIP OF: , A MINOR. REQUEST FOR RELEASE OF FUNDS Comes now the guardian of the minor and requests a release of the minor’s funds as follows: 1. Minor who is the owner of the funds: A. Name: B. Address: C. Date of birth: 2. Person requesting release of funds: A. Name: B. Address: C. Relationship to Minor: 3. Description of Account: A. Bank or other financial institution where funds are on deposit: B. Present balance in account: C. Account Number: 4. Amount of withdrawal requested: 5. Purpose of withdrawal: 6. State why parent is unable to provide funds: 7. Date of last withdrawal: ---PAGE BREAK--- Rev. 4/25 I affirm under the penalties for perjury that the foregoing representations are true and accurate. Date Guardian’s Signature SIGN