Form Mc 355 is a two-part form used to document the determination of an individual's employment eligibility in the United States. The form is used by employers, employees, and government officials to confirm an individual's status as a U.S. citizen or non-citizen national, lawful permanent resident, refugee or asylee, temporary visitor with work authorization, or alien authorized to work until a specific date. The form can be used to determine if someone is authorized to work in the United States and for what duration.
| Question | Answer |
|---|---|
| Form Name | Form Mc 355 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | mc355 spanish, fillable form mc 355, mc 355 form for medical, mc 355 medi cal |
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): |
FOR COURT USE ONLY |
TELEPHONE NO.: |
FAX NO. (Optional): |
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ATTORNEY FOR (Name): |
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SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
CASE NAME:
CASE NUMBER:
ORDER TO DEPOSIT MONEY INTO BLOCKED ACCOUNT
1. The petition of (name): |
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as (specify capacity): |
to deposit funds in a blocked account or |
blocked accounts came on for hearing on (date): |
at (time): |
in Dept.: |
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THE COURT ORDERS
2.Money that belongs to (name):
shall be deposited in an
3.Each account shall indicate the name of the minor or other person who owns the account.
4.The total amount authorized for deposit, including any accrued interest, is: $
5.Withdrawals (check a or b):
a.
No withdrawals of principal or interest shall be made from the blocked account or accounts without a written order under this case name and number, signed by a judge, and bearing the seal of this court. The money on deposit is not subject to escheat.
b.
The blocked account or accounts belong to a minor. The minor was born on (date):
No withdrawals of principal or interest shall be made from the blocked account or accounts without a written order under this case name and number, signed by a judge, and bearing the seal of this court, until the minor attains the age of 18 years. When the minor attains the age of 18 years, the depository, without further order of this Court, is authorized and directed to pay by check or draft directly to the former minor, upon proper demand, all moneys including interest deposited under this order. The money on deposit is not subject to escheat.
6.The petitioner and the petitioner's attorney, if any, shall deliver a copy of this order to each depository in which funds are deposited under this order. The depository's acknowledgment of receipt of the order and the funds shall be filed with this court within 15 days of deposit.
Date:
JUDGE OF THE SUPERIOR COURT
Page 1 of 1
Form Adopted for Mandatory Use
Judicial Council of California
ORDER TO DEPOSIT MONEY INTO BLOCKED
ACCOUNT
Code of Civil Procedure, § 372; Probate Code, § 3600, et seq.; Cal. Rules of Court, rules 3.1384, 7.953 www.courtinfo.ca.gov