Form CC 16:2.19 Application for Withdrawal of Funds - Nebraska

Form CC16:2.19 or the "Application For Withdrawal Of Funds" is a form issued by the Nebraska Judicial Branch.

The form was last revised in March 1, 2016 and is available for digital filing. Download an up-to-date Form CC16:2.19 in PDF-format down below or look it up on the Nebraska Judicial Branch Forms website.

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Nebraska State Court Form
REQUIRED
APPLICATION FOR
WITHDRAWAL OF FUNDS
CC 16:2.19 Rev. 03/16
IN THE COUNTY COURT OF ________________COUNTY, NEBRASKA
Case No. ____________________
IN THE MATTER OF THE
GUARDIANSHIP/CONSERVATORSHIP OF
APPLICATION FOR
___________________________
WITHDRAWAL OF FUNDS
Ward/Incapacitated Person/Protected Person
I,
, the guardian/conservator, request from the court
approval to withdraw $
from the assets of the ward/incapacitated
person/protected person for the following reason(s):
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
The full amount will be spent on behalf of the ward/incapacitated person/protected person. This
expenditure is necessary and for the best interests of the ward/incapacitated person/protected person,
considering all the circumstances of the ward/incapacitated person/protected person and those liable
for his/her support.
I acknowledge that I will receive a Notice of Hearing when I file my application. After I receive the
Notice of Hearing from the county court, it is my responsibility to send a copy of this
Application for Withdrawal of Funds and the Notice of Hearing to all interested persons.
I further acknowledge that I must file a Certificate of Mailing for both this Application for
Withdrawal of Funds and the Notice of Hearing with the county court proving that I have given
notice of the hearing date to all interested persons.
I, the undersigned guardian/conservator, swear or affirm, under the penalties of perjury, that I have
examined the above documents, and to the best of my knowledge and belief, they are true, correct and
complete.
Date
Signature(s) of Guardian(s) and/or Conservator(s)
Print or Type Name of Guardian(s) and/or Conservator(s)
Street Address/P.O. Box of Guardian(s) and/or Conservator(s)
Bar Number and Firm Name (attorneys only)
City/State/ZIP Code of Guardian(s) and/or Conservator(s)
Phone(s)
E-mail Address(es)
Page 1 of 1
Application for Withdrawal of Funds
CC 16:2.19 Rev 03/16
Nebraska State Court Form
REQUIRED
APPLICATION FOR
WITHDRAWAL OF FUNDS
CC 16:2.19 Rev. 03/16
IN THE COUNTY COURT OF ________________COUNTY, NEBRASKA
Case No. ____________________
IN THE MATTER OF THE
GUARDIANSHIP/CONSERVATORSHIP OF
APPLICATION FOR
___________________________
WITHDRAWAL OF FUNDS
Ward/Incapacitated Person/Protected Person
I,
, the guardian/conservator, request from the court
approval to withdraw $
from the assets of the ward/incapacitated
person/protected person for the following reason(s):
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
The full amount will be spent on behalf of the ward/incapacitated person/protected person. This
expenditure is necessary and for the best interests of the ward/incapacitated person/protected person,
considering all the circumstances of the ward/incapacitated person/protected person and those liable
for his/her support.
I acknowledge that I will receive a Notice of Hearing when I file my application. After I receive the
Notice of Hearing from the county court, it is my responsibility to send a copy of this
Application for Withdrawal of Funds and the Notice of Hearing to all interested persons.
I further acknowledge that I must file a Certificate of Mailing for both this Application for
Withdrawal of Funds and the Notice of Hearing with the county court proving that I have given
notice of the hearing date to all interested persons.
I, the undersigned guardian/conservator, swear or affirm, under the penalties of perjury, that I have
examined the above documents, and to the best of my knowledge and belief, they are true, correct and
complete.
Date
Signature(s) of Guardian(s) and/or Conservator(s)
Print or Type Name of Guardian(s) and/or Conservator(s)
Street Address/P.O. Box of Guardian(s) and/or Conservator(s)
Bar Number and Firm Name (attorneys only)
City/State/ZIP Code of Guardian(s) and/or Conservator(s)
Phone(s)
E-mail Address(es)
Page 1 of 1
Application for Withdrawal of Funds
CC 16:2.19 Rev 03/16

Download Form CC 16:2.19 Application for Withdrawal of Funds - Nebraska

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