Authorization To Withhold Money From Trust Fund Accounts {AP-013}

STATE OF WISCONSIN SUPREME COURT ­ COURT OF APPEALS, DISTRICT For Official Use Authorization to Withhold Money From Trust Fund Accounts I, _____________________________________________________________________________________, (Print appellant's or petitioner's name and I.D. number, e.g. DOC. No.) wish to pursue an action in the: Wisconsin Court of Appeals Wisconsin Supreme Court described as follows: Appeal number, if known: _____________________________________________ Name(s) or respondent(s): _____________________________________________________________ Pursuant to Wis. Stats. §814.29(1m)(c)2, I authorize the agency having custody of my prison trust fund account to forward payments from my account to the clerk of court each time the amount in the account exceeds $10 until the costs and fees are paid in full. Signature of Appellant or Petitioner Date A copy of this form must accompany Supreme Court ­ Court of Appeals form number AP-011 or AP-012, Prisoner's Petition for Waiver of Fees/Affidavit of Indigency. Please file the original of this form with the institution custodian. Custodian: Give inmate a copy after he or she signs it. AP-013, 09/04 Authorization to Withhold Money From Trust Fund Accounts Wis. Stats. §814.29(1m)(c)2 American LegalNet, Inc. www.FormsWorkFlow.com