Fill and Sign the Order Authorizing Settlement of Small Claim Mississippi Form

IN THE CHANCERY COURT OF       COUNTY, MISSISSIPPI EX PARTE       , A MINOR, BY AND THROUGH       , FATHER/MOTHER AND NEXT FRIEND ORDER AUTHORIZING SETTLEMENT OF SMALL CLAIM This cause came on to be and was heard on the sworn petition of       , petitioner, father/mother and next friend of       , a minor, seeking authority for and approval of a settlement as set out and the Court finds as follows:       , minor petitioner,       date of birth is             ,       , has at all times since his/her birth resided with his/her father/mother ,       , both the minor and his/her father/mother reside in       , Mississippi, at       ,       , Mississippi.       , the father/mother of said minor, is       . On or about             ,       , said minor was a passenger in a vehicle driven by       and owned by       . Said driver allegedly lost control of said vehicle causing a collision and overturning, which resulted in injuries to said minor. As a result of the said accident,       , by and through his/her father/mother ,       , your petitioner herein, desired to make and has made a claim for damages against said       ,       and       Insurance Companies. Negotiations have been undertaken for a compromise settlement of said claim, and said minor, by and through your petitioner herein, as agreed to accept, subject to the approval of the court, and the agents of       ,       and       Insurance Companies has agreed to pay the total sum of       ($       ), plus payment of additional medical bills of Dr.       in the amount of $       and the       in the amount of $       , as a full and final compromise settlement of all claims arising out of the aforesaid accident. It is understood and agreed that said agents have already paid the following medical bills on behalf of said minor and petitioner:       $       ,       $       ,       $       , and       $       . Said minor and his/her father/mother , your petitioner herein, has shown that it would be in the best interest of said minor that he/she be authorized to accept the stated sum on behalf of said minor and for the use and benefit of said minor as proposed in full and complete payment of any and all claims arising out of the aforedescribed accident.       , your petitioner herein, has shown that he/she is competent and willing to receive these funds on behalf of and for the exclusive use and benefit of said minor, and that he/she will disburse these funds exclusively for the use and benefit of said minor, being aware that he/she remains amenable to this Court for the proper disposition of said funds. The proceeds of the above - described settlement on behalf of said       , a minor, constitute the sum total of the estate of said minor and will be subsequently distributed for his/her exclusive use and benefit pursuant to the authority of this Court. The petitioner herein requests that       , a federally insured depository, be designated the depository of the above - stated settlement proceeds, and therefore ask that a bond herein be waived pursuant to Miss. Code Ann. §93 - 13 - 17 (Supp. 1986), as amended. The value of the claim of said minor is unliquidated, is of a doubtful nature and cannot be readily collected. Under all of these circumstances, said settlement of the claim of said minor would be in his best interest and benefit. The sum to be paid to said minor by and through your petitioners herein for the exclusive use and benefit of said minor is not in excess of the sum of $       and therefore guardianship is not necessary pursuant to Miss. Code Ann. §93 - 13 - 211, as amended. Petitioner requests that the Court will grant him/her authority to pay, out of the settlement proceeds as described above, all outstanding medical expenses incurred by       , a minor, as a result of the injuries he/she suffered in the aforedescribed accident on             ,       . The Court, having fully investigated this matter and having satisfied itself by evidence or otherwise, is of the opinion that the proposed sum of money to be paid is a fair settlement of the claims of said minor and that it is in the best interest of said minor that said settlement be made. This Court has jurisdiction over the parties and the subject matter herein. IT IS, THEREFORE, ORDERED that the compromise settlement proposed in the petition should be and the same is hereby approved as being in the best interest of said minor. IT IS FURTHER ORDERED that       ,       and       and       Insurance Companies or their agents shall pay to       for the exclusive use and benefit of       , a minor, the sum of       ($       ) and pay the outstanding medical bills to Dr.       in the amount of $       and to       in the amount of $       , and that said sum shall be accepted on behalf of said minor. IT IS FURTHER ORDERED that petitioner is authorized to pay, out of said settlement proceeds, all outstanding medical expenses incurred by       , a minor, as set forth hereinabove as a result of the injuries       , suffered in the aforedescribed accident on             ,       . IT IS FURTHER ORDERED that       and       , as parents and next friends of       , a minor, are authorized to pay to       , Esq., their attorney, out of the proceeds of this settlement, a fee in the amount of $       . IT IS FURTHER ORDERED that the       , a federally insured depository, be and is hereby designated the depository for the settlement proceeds in the amount of       ($       ) payable to       , as father/mother of       , a minor, and that, therefore, said       shall not be required to post a bond. Said funds shall remain on deposit on said depository until further orders of this Court. IT IS FURTHER ORDERED that upon the payment of said sum,       ,       and       and       Insurance Companies and any and all other persons, firms, and corporations who may be in any manner whatsoever liable therefore shall stand acquitted and discharged of any other or further liability to said minor for the injuries sustained by the said minor on             ,       , and the petitioner herein is authorized and empowered to execute any release, receipt or other installment required by said parties to evidence their complete release, acquaintance, and discharge herein. ALL OF WHICH IS ORDERED, this the       day of       ,       . _______________________________________ CHANCELLOR