Free Model Order Approving Settlement and Distribution - Pennsylvania


File Size: 38.8 kB
Pages: 2
Date: March 27, 2003
File Format: PDF
State: Pennsylvania
Category: Court Forms - Local
Word Count: 559 Words, 4,754 Characters
Page Size: Letter (8 1/2" x 11")
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http://fjd.phila.gov/pdf/forms/orphans/model_order_approving_settlement_and_distribution.pdf

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Civil Division

Forms

IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY FIRST JUDICIAL DISTRICT : : : : : CIVIL TRIAL DIVISION TERM, 20____ No.

ORDER APPROVING SETTLEMENT AND ORDER FOR DISTRIBUTION AND NOW, this ______ day of __________________, 20____, upon consideration of the Petition For Leave to Compromise A Minor's Action, filed _____________________________________ it is hereby ORDERED and DECREED that Petitioner is authorized to enter into a settlement with Defendant(s) _____________________________ in the gross sum of ____________________________________ ($___________) Dollars. Defendant(s) shall forward all settlement drafts or checks to Petitioners' counsel for proper distribution. IT IS FURTHER ORDERED and DECREED that the settlement proceeds be allocated as follows: 1. To: Minor Plaintiff(s)
NAME DATE OF BIRTH SOCIAL SECURITY #

__________________________ __________________________ 2. To: Adult Plaintiff(s)

_____________________ _____________________

__________________ __________________

$ _____________ $ _____________

_______________________________________ _______________________________________

$____________________ $____________________

IT IS FURTHER ORDERED and DECREED that the settlement proceeds be distributed as follows: 1. Minor Plaintiff*
NAME DATE OF BIRTH SOCIAL SECURITY #

__________________________ __________________________ a. b. c. d.

_____________________ _____________________

__________________ __________________ $____________________ $____________________ $____________________

$ _____________ $ _____________

To: ________________________________ , Esquire Reimbursement of Costs To: _______________________________________ Costs To: ________________________________ , Esquire Counsel Fees

The balance, the sum of $___________, payable to ________________________, a minor, shall be distributed as follows+:

* The share of each minor Plaintiff shall be separately distributed.
+

In the event a portion of the settlement is payable through the purchase of an annuity, set forth the credit rating of the entity which assumes responsibility for future payments, the present cost of the annuity, as well as the periodic and lump sum payments.

225

Forms

Civil Division

OPTION 1 To: _______________________________________ , Guardian of the Estate of _______________________, a minor; provided, however, that no payment shall be made to the guardian until the guardian has posted additional security as required by the Orphans' Court Division of ____________________County pursuant to 20 Pa.C.S. §5121, et seq. An appropriate Petition shall be filed with the Orphans' Court within thirty (30) days. OPTION 2 Counsel is hereby authorized to execute all documentation necessary to purchase saving certificate(s), from federally insured banks or savings institutions having an office in Philadelphia County, in the sum of $___________, each not to exceed the insured amount, with the funds payable to the minor upon majority. The certificate shall be titled and restricted as follows: ___________________________, a minor, not to be redeemed except for renewal in its entirety, not to be withdrawn, assigned, negotiated, or, otherwise alienated before the minor attains majority, except upon prior Order of Court. Counsel shall open a savings account in the sum of $___________ in the name of the minor. The savings account shall be titled and restricted as follows: ___________________________, a minor, not to be withdrawn before the minor attains majority, except for the payment of city, state, and federal income taxes on the interest earned by the savings certificate and savings account, or upon prior Order of Court.

2. Adult Plaintiff* The portion of the settlement payable to ________________________, an Adult Plaintiff named in the Complaint, shall be distributed as follows: To: ________________________________, Esquire Reimbursement for Costs To: _______________________________________ Costs To: ________________________________, Esquire Counsel Fees To: _______________________________________ Plaintiff $____________________

$____________________

$____________________

$____________________

Pursuant to Phila. Civ. R. #2039.1(I), counsel shall file with the office of Civil Administration within sixty (60) days from the date of this final Order, proof of the establishment of the accounts as required herein, by Affidavit from counsel certifying compliance with this Order. Counsel shall attach to the Affidavit a copy of the Certificate of Deposit and/or bank account containing the required restrictions. BY THE COURT: _______________________________________ J. ORPHANS' COURT DIVISION
*The share of each adult plaintiff shall be separately distributed.

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