Fill and Sign the Order Approving Compromise Form

––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– –– ––––– –– ––––– ––––– ––––– ––––– –– –– –– –– –– ––––– –– –– ––––– –– ––––– ––––– –– –––––––––– MC-351 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): FOR COURT USE ONLY TELEPHONE NO. FAX NO. (Optional): E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS MAILING ADDRESS CITY AND ZIP CODE BRANCH NAME CASE NAME: ORDER APPROVING COMPROMISE OF CLAIM CASE NUMBER MINO R INCOMPETENT PERSON 1 - Petitioner (name): has petitioned for the approval of the proposed compromise of claim. This matter came on for hearing on (date): at (time): in Dept.: 2. Relationship to claimant Petitioner is claimant's: a . Pare nt. b . Guardian ad litem. c . Guardia n. d . Conservato r. e . Other (specify): 3. Claimant (name): a . is a minor. b . is an incompetent person. 4. Defendant The claim to be compromised is asserted against (name of settling defendant or defendants (the 'payer')): THE COURT ORDERS 5. The petition is granted and the compromise is approved. 6. The payer shall disburse the proceeds of the settlement approved by this order in the following manner: a. Payment of fees and expenses Fees and expenses shall be paid by one or more checks or drafts, drawn payable to the order of the petitioner and the petitioner's attorney, if any, or directly to those entitled to receive payment, for the following items of expense or damage, which are hereby authorized to be paid out of the proceeds of settlement: ( 1 ) Attorney's fees in the amount of: $ Payable to (specify): ( 2 ) Reimbursement for medical and other expenses paid by the petitioner in the amount of: $ payable to the petitioner. Page 1 of 3 Form Adopted for Mandatory Use Judicial Council of California MC-351 [Rev. January 1, 2007] Code of Civil Procedure, § 372 et seq., ORDER APPROVING COMPROMISE OF CLAIM Probate Code, § 3500 et seq., Cal. Rules of Court, rules 3.1384, 7.953electronic form ã 2001-7 WWW.LawCA.com Law Publishers ––––– ––––– –– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– –– –– ––––– –– ––––– ––––– –– –– ––––– ––––– –––––CASE NAME: CASE NUMBER 6 . a . ( 3 ) Medical, hospital, ambulance, nursing, and other like expenses in the total amount of: $ payable as follows: (i) Payee (name): (iii) Payee (name): (a) Address: (a) Address: (b) Amount: (b) Amount: (ii) Payee (name): (iv) Payee (name): (a) Address: (a) Address: (b) Amount: (b) Amount: Continued (if there are additional payees, a list of such payees must be attached to this form as Attachment 6a(3).) ( 4 ) Other authorized payments (specify): ( 5 ) Total allowance for fees and expenses: $ b. Balance The balance of the settlement proceeds shall be disbursed as follows: ( 1 ) drawn payable toBy one or more checks or drafts in the total amount of (specify): $ the order of the petitioner as trustee for the claimant. Each such check or draft shall bear an endorsement on the face or reverse that it is for deposit in an interest-bearing, federally insured account in the name of the petitioner as trustee for the claimant, and no withdrawals shall be made from the account without a written court order (a ''blocked account''). ( 2 ) By the following method (specify): If the method involves the payment of money to a special needs trust, all statutory liens in favor of the State Department of Mental Health, the State Department of Developmental Services, and any city and county in California must first be satisfied by the following method (specify): 7 . Blocked accounts If the court orders distribution of the balance into a blocked account or accounts under item 6b(l), it further orders: a. Within 48 hours of receipt of a check or draft described in item 6b(l), the petitioner and the petitioner's attorney, if any, must deposit the check or draft in the petitioner's name as trustee for the claimant in a blocked account at (specify name, branch, and address of each depositoty): b. The petitioner and the petitioner's attorney, if any, must deliver to each depository at the time of deposit three copies of the Order to Deposit Money Into Blocked Account (''Order'), which is signed contemporaneously with this order, and three copies of the Receipt and Acknowledgment of Order to Deposit Money Into Blocked Account ("Receipt'). The petitioner or the petitioner's attorney must file a copy of the Receipt with this court within 15 days of the deposit. The sole responsibilities of the petitioner are to place the balance in a blocked account or accounts and to timely file a copy of the Receipt. Page 2 of 3 MC-351 [Rev. January 1, 2007] ORDER APPROVING COMPROMISE OF CLAIM MC-351 –––––––––– ––––– –– –– ––––– –– –– –– ––––– –– –– ––––– ––––– ––––– ––CASE NAME: CASE NUMBER 7 . c. The balance of the settlement proceeds deposited in a blocked account under item 6b(l) may be withdrawn only as follows (check only (1) or (2)): ( 1 ) No withdrawals of principal or interest may 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. ( 2 ) The blocked account or accounts belong to a minor. The minor was born on (date): No withdrawals of principal or interest may 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. 8 . Authorization to execute settlement documents The petitioner is authorized to execute settlement documents as follows (check only one): a . Upon receipt of the full amount of the settlement sum approved by this order and the deposit of funds, the petitioner is authorized and directed to execute and deliver to the payer a full, complete, and final release and discharge of any and all claims and demands of the claimant by reason of the accident or incident described in the petition and the resultant injuries to the minor, and a properly executed dismissal with prejudice. b . The petitioner is authorized and directed to execute any and all documents reasonably necessary to carry out the terms of the settlement. c . The petitioner is authorized and directed (specify): 9 . Bond is waive d fixed in the amount of: $ 10. A copy of this order shall be served on the payer forthwith. 11. Other (specify): Dat e: JUDGE OF THE SUPERIOR COURT SIGNATURE FOLLOWS LAST ATTACHMENT Page 3 of 3 MC-351 [Rev. January 1, 2007] ORDER APPROVING COMPROMISE OF CLAIM MC-351