New York Codes, Rules and Regulations
Title 22 - JUDICIARY
Subtitle D - Forms
Chapter VII - Surrogate's Court Forms
Subchapter A - Forms Authorized By Section 207.52
Surrogate's Forms
Form G-8 - Petition for withdrawal of infant's property for support and education
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF ________
________X
In the Matter of the Guardianship of
PETITION FOR WITHDRAWAL
OF INFANT'S PROPERTY FOR
SUPPORT AND EDUCATION
An Infant. File No. ________
________X
TO THE SURROGATE'S COURT, COUNTY OF ________
The petition of the guardian respectfully alleges:
1. Name of guardian: ________ Phone Number: ____________
Permanent Address: ____________
Relation to infant: ________ Present Occupation: ____________
Name of infant: ____________
Permanent Address: ____________
Date of birth: ____________
2. Date Letters of Guardianship were issued: ________
[Check one] [ ] Person and Property [ ] Property only
The name and address of depository or depositories in which funds of the infant are deposited is or are: [List all, attach additional sheet if needed]
Name: ________
Address: ________
Amount on deposit at date of this petition $ ________
4. The property and income of the infant is set forth in the annexed Schedule A summarized as follows:
Yearly Income $ ________
Value of infant's property $ ________
5. Petitioner requests authorization for withdrawal of the following amounts for the support or education of the infant:
(a) A lump sum of $ ____________
(b) A sum of $ ________ by periodic withdrawals of $ ________ each month for a period of ________ months beginning ________ and ending ________.
The funds are needed and are to be used for the following reasons and purposes: [Complete Schedule B]
____________
____________
____________
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G-8 (9/00)
6. The parent or parents of the infant are: [if deceased, state date of death]
Father: ____________
Permanent Address: ____________
Mother: ____________
Permanent Address: ____________
The income and resources of infant's parent or parents are as set forth in Schedule C hereto annexed.
7. The reason the parent(s) of the infant cannot provide for the support or education of the infant is:
____________
____________
The estimated yearly household expenditures of infant's parent or parents are as set forth in Schedule D hereto annexed.
8. The funds of the infant withdrawn during the past calendar year of ________ are as follows: [If "NONE", must so state]
Date of order: ________
Amount authorized to be withdrawn $ ________
Total withdrawn and spent $ ________
Amount unexpended, if any $ ________
[Attach additional sheets as needed]
9. No previous application has been made for the relief now sought.
WHEREFORE, petitioner requests:
2. That the court authorize the withdrawal from funds of the infant on deposit in the name of the guardian in the ____________
____________
____________
____________
[Insert name and address of Depository]
for the support, maintenance and education of the infant as follows:
a. The sum of $ ________
b. The sum of $ ________, by periodic withdrawals of not over $ ________ each month for one year beginning with the month of ________and ending with the month of ________ provided that any monthly sum not withdrawn for one month may be withdrawn during any succeeding month during the year.
c. That petitioner may have such other or further relief as may be proper.
Dated: ________
______________
(Signature of Petitioner)
______________
(Print Name)
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STATE OF ________)
COUNTY OF ________) ss.:
I, ________, the petitioner named in the foregoing petition, being duly sworn, say:
I have read the foregoing petition subscribed by me and know the contents thereof, and the same is true of my own knowledge, except as to the matters therein stated to be alleged on information and belief and as to these matters, I believe it to be true.
______________
(Signature of Petitioner)
Sworn to before me this
________ day of ________, ________
______________
(Print Name)
______________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
NOTE: 1. Withdrawal is subject to guardian filing any required annual account.
2. Court may require additional information relative to circumstances of parents or other facts justifying use of infant's funds.
3. Infant 14 years and over must join in and sign consent to petition, otherwise must be given notice as Court directs.
4. Generally periodic withdrawals will be limited to a period of 12 months or less.
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CONSENT OF INFANT TO WITHDRAWAL
I, ________, the infant named in the foregoing petition, being over the age of fourteen years, do hereby join in the petition and ask that the withdrawal be made as therein requested.
Dated: ________
______________
(Signature of Infant)
______________
(Print Name)
STATE OF ________)
COUNTY OF ________) ss.:
________ being duly sworn, says that: I have read the foregoing petition, and the same is true of my own knowledge, except as to the matters therein stated to be alleged on information and belief, as to those matters, I believe them to be true.
Sworn to before me this
______________
(Signature of Infant)
________ day of ________
______________
(Print Name)
________
Notary Public
Commission Expires:
(Affix Stamp or Seal)
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SCHEDULE A (PARAGRAPH 4)
(Income & Property of Infant)
Annual Income- Interest on bank deposits $ ________
Social Security benefits $ ________
Veterans benefits $ ________
Wages $ ________
Other income $ ________
Total $ ________
Property: Bank Deposits (Name Bank)
________ $ ________
________ $ ________
Other Property (Describe-State Value)
________ $ ________
________ $ ________
Total $ ________
SCHEDULE B (PARAGRAPH 5)
(List items for which funds are requested and amount, e.g. tuition-name school and attach bill; for medical, name doctor and amount.)
Item Amount
________ $ ________
________ $ ________
________ $ ________
________ $ ________
________ $ ________
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SCHEDULE C (PARAGRAPH 6)
Income and Resources of Parents:
Mother Father
Earnings: Salary and Wages $ ________ $ ________
Income from dividends, interest, etc. $ ________ $ ________
Social Security (for Parent) $ ________ $ ________
Social Security (for all infants) $ ________ $ ________
Rents, Business income, etc. $ ________ $ ________
Total: $ ________ $ ________
Assets: $ ________ $ ________
Bank accounts and securities $ ________ $ ________
Real estate (Home) $ ________ $ ________
Real estate (Other) $ ________ $ ________
Total: $ ________ $ ________
Indebtedness: $ ________ $ ________
Mortgages $ ________ $ ________
Other debts $ ________ $ ________
Total: $ ________ $ ________
Names and ages of any dependents:
NAME RELATIONSHIP AGE
________ ________ ________
________ ________ ________
________ ________ ________
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SCHEDULE D (PARAGRAPH 7)
Parents' Household
Estimated yearly household expenditures: $ ________
a. Home: Taxes, Mortgages, Insurance $ ________
Heat, Light, Water, Repairs $ ________
Rent $ ________
Other home costs $ ________
b. Family Maintenance:
Food $ ________
Clothing $ ________
Medical $ ________
Income Taxes $ ________
All Other $ ________
Total number of persons in household ________
Are infant's funds to be used toward paying any of the above expenses? If so, state which and how much:
________ $ ________
________ $ ________
________ $ ________
Signature of Attorney: ____________
Print Name: ____________
Firm Name: ________ Tel. No.: ____________
Address of Attorney: ____________
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