Fill and Sign the Authority Minor Form

IN THE CHANCERY COURT OF       COUNTY, MISSISSIPPI IN THE MATTER OF       , A MINOR CAUSE NUMBER       BY:       AND       , NATURAL PARENTS AND NEXT FRIENDS OF       , A MINOR PETITIONERS PETITION FOR AUTHORITY TO COMPROMISE AND SETTLE CLAIM OF A MINOR WITHOUT GUARDIANSHIP COMES NOW       , a Minor, by and through       AND       , Natural Parents and Next Friends of said Minor, and file this their Petition pursuant to the language and legislative intent of Miss. Code Ann. Sec. 93 - 13 - 211 (1994), seeking a Decree authorizing them to compromise and settle a doubtful claim and for payment of money to them for said Minor's use and benefit without guardianship. In support hereof, Petitioners respectfully show unto the Court as follows: 1. Petitioners,       and       , are adult resident citizens of       County, Mississippi, and they are the natural parents and next friends of       , a Minor, their       (       ) year old son/daughter whose date of birth is             ,       . Said Minor resides with his/her natural parents at their residence located at       ,       , Mississippi. 2. The Court has jurisdiction over the parties and the subject matter of these proceedings. 3.       , a Minor, has a contingent and unliquidated claim for personal injuries and damages against       and       on account of an accident which occurred on or about             ,       , in       , Mississippi. Said accident occurred       . As a result of this accident, the minor was injured. 4. The Minor was examined, diagnosed with a       , treated and eventually released by physicians at       and       . As a result, the Minor incurred medical bills in the following amounts:       $             $             $             $             $             $             $             $             $             $       $       Some portion of these bills has been paid by the minor's parents while a portion has been paid by the parents' group carrier,       . The parents, who have negotiated a settlement of their own with       , have agreed to reimburse       out of their own settlement funds. Also, any outstanding balance on the minor's medical bills will be paid by the minor's natural parents. There are no liens other than that asserted against the parents by       . 5. Petitioners,       and       , have heretofore contracted for services on behalf of said Minor with       , Esq. to handle the claim of said Minor as set out herein. Said attorney has rendered good and valuable services and his/her attorney's fee will be paid by       , in addition to the minor's settlement funds. 6. Petitioners represent that       is legally obligated to pay sums to the Minor as a result of the injuries described above, with said legal liability being disputed and denied. Due to the hazards of litigation inherent in any lawsuit and the unpredictability of a jury verdict under the circumstances in question, the claims of said Minor are of a doubtful nature. 7.       has offered to pay       Dollars ($       ) in full and final settlement of any and all liability on account of the personal injuries and other damages allegedly sustained by       , a minor, in the accident of             ,       . 8. Petitioners request that they be allowed to accept the amount offered by       in full and final settlement of the claims of the Minor child resulting from the above described accident. Petitioners further request that they be authorized, empowered, and directed to hold the settlement funds for the use and benefit of       , a Minor, remaining amenable to this Court for their disposition of such funds. 9. The said offer of settlement to the Minor,       , is conditioned upon and cannot be completed without the approval of said settlement by this Court; authorization for the payment by       of the settlement amount; acceptance of said settlement by       and       , with Petitioners being allowed to hold said funds for the use and benefit of said Minor; execution by Petitioners of a full, complete, and sufficient Release and Indemnity Agreement, a copy of which is attached to the Petition as Exhibit "       ", being made a part hereof as if fully copied at length herein, discharging, acquitting, and indemnifying       and       , and their associated companies of and from any and all claims, demands, losses, damages, actions, causes of action or suits at law or equity of whatsoever kind or nature that may now exist or may hereafter accrue based upon the alleged injuries to       , a Minor, on account of the accident described above. 10. Petitioners recommend to this Court that the settlement be approved and state that they are of the opinion that it is in the best interest and welfare of       , a Minor, that said settlement be consummated as set forth hereinabove. WHEREFORE, PREMISES CONSIDERED, Petitioners pray that: 1. This Court will make a full and complete investigation into the facts pertaining to the accident in which       was injured; 2. If upon investigation this Court is satisfied that the proposed offer of settlement is a fair and reasonable offer and that it is in the best interest and welfare of said Minor that the settlement be made, a decree be granted accordingly, approving and authorizing such settlement; 3. Petitioners be authorized to receive and accept the settlement in the sum of       Dollars ($       ). Petitioners be further authorized, empowered and directed to receive and hold the settlement funds for the use and benefit of said Minor; 4. The Court will approve the proposed Release and Indemnity Agreement attached hereto as Exhibit "       " and upon payment and/or tender of said settlement funds to       and       that they be authorized, empowered and directed to execute in favor of       and       a complete and binding Release of all claims based upon injuries and damages sustained by       on account of the above described accident in the form of the document attached hereto as Exhibit "       " and no other; 5. Bond, inventory and annual accounting be waived until such further order of this Court; and 6. If mistaken in the relief herein prayed for, then your said Petitioners pray for such other, further and more general relief as appears to a Court of equity to be both mete and proper, as in duty bound your Petitioners will ever pray. RESPECTFULLY SUBMITTED,       day of       ,       . ________________________________________       , Natural Mother and Next Friend of       ,a Minor ________________________________________       , Natural Father and Next Friend of       , a Minor STATE OF MISSISSIPPI COUNTY OF       THIS DAY personally appeared before me, the undersigned authority at law in and for the state and county aforesaid, the within named       , who being by me first duly sworn, stated on oath that the facts and matters set forth in the above and foregoing Petition are true and correct as therein stated. SWORN TO AND SUBSCRIBED BEFORE ME on this the       day of       , 20       . ________________________ NOTARY PUBLIC My Commission Expires:       STATE OF MISSISSIPPI COUNTY OF       THIS DAY personally appeared before me, the undersigned authority at law in and for the state and county aforesaid, the within named       , who being by me first duly sworn, stated on oath that the facts and matters set forth in the above and foregoing Petition are true and correct as therein stated. SWORN TO AND SUBSCRIBED BEFORE ME on this the       day of       20       . ___________________________ NOTARY PUBLIC My Commission Expires:       READ AND APPROVED: ___________________________________ ATTORNEY FOR PETITIONERS