Fill and Sign the Petition Compromise Form

IN THE CHANCERY COURT OF       , MISSISSIPPI IN THE MATTER OF THE ESTATE OF       , A MINOR       , PETITIONER CAUSE NO:       vs.       PETITION FOR AUTHORITY TO COMPROMISE AND SETTLE MINOR'S CLAIM FOR DAMAGES Comes now       , a minor, by and through       , natural father/mother of the minor, and files this petition pursuant to Miss. Code Ann. §93 - 13 - 211, and would show unto the Court the following: (1)       is a minor whose date of birth is       . He/She resides with his/her natural mother and father,       and       , at       ,       , Mississippi       , which is located in       County, Mississippi. (2) The estate of the minor consists of a claim for damages against a school bus driver,       , and the       County School District with regard to an incident that occurred on       , which resulted in injuries to the minor. Specifically, the minor's clothing was caught in the door of his/her school bus as it closed before he/she boarded the bus and the minor was dragged for approximately a quarter of a mile before the bus stopped to pick - up additional students, at which time the minor was released, boarded the bus and was returned home with minor injuries. Miraculously, the incident caused only minor physical injuries consisting of cuts and bruises, but resulted in some degree of emotional distress for which the minor has been treated with success. (3) The petitioner contends that the aforesaid accident and injuries of the minor were the result of the negligence of       , the driver of the school bus. (4) The insurance carrier for the       County School District has offered to compromise and settle the claim of the minor for the total sum of       ($       ) in addition to all medical and psychological expenses of the minor which have previously been paid. This offer of settlement is conditioned upon the requirement that a good and valid acquittance, indemnification and release is given, releasing and discharging       , the       County School District, its agents and employees and insurance carrier, 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 hereafter accrue as a result of the above described accident involving the minor, and for any personal injuries, damages, death and expenses of any nature or type whatsoever sustained or arising as a result of the injuries received by the minor. (5) Petitioner contends that this matter would be hazardous and highly uncertain as to the ultimate outcome and that it would be in the best personal interest of the minor for the compromise settlement to be approved and concluded by the Chancery Court of       County, Mississippi. (6) Petitioner would show that in order to consummate this settlement, it will be necessary for       , as the natural father/mother and guardian of the minor, to be authorized in the name of, for and on behalf of, and as the act and deed of the minor, to execute a good and valid release and indemnifying agreement, discharging and acquitting       , the       County School District, their insurance carrier(s), and any and all other persons, firms or corporations 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 hereafter accrue on account of the accident above described arising as a result of the injuries of the minor. (7) This settlement cannot be made without the approval of this court and the petitioner requests the court to authorize and empower him to accept the settlement payable to       , on behalf of       , minor, and that he be authorized and directed to execute a good and valid release, indemnification and acquittance attached as Exhibit “       ”, releasing the parties from any and all claims, demands, actions, causes of action, damages, cost and expenses, which the minor, or any other person, firm or entity may now or hereafter have on account of, arising out of, resulting from, or in any way connected with the accident of       , which instrument shall be an acknowledgement of full and complete compromise, settlement, accord and satisfaction of any claim, including any and all claims and damages of every kind or nature whatsoever which the minor, or his/her parents, may have. (8) The petitioner would show that the minor's medical and psychological expenses incurred as a result of the accident are as follows:       Hospital (emergency room treatment and examinations) $             $       Family Doctors       Clinic (       visits) $             (counseling) $       TOTAL $       This expenses, plus a payment of $       to the minor's parents for loss time from work, have been paid by the insurance carrier for the       County School District and there are no outstanding expenses incurred as a result of the accident. (9) In the event the court approves the settlement, the balance of the minor's fund, being $       , shall be deposited in an interest bearing account at a federally insured banking institution, with withdrawals from the account to be for the use and benefit of the minor. PRAYER WHEREFORE, PREMISES CONSIDERED, petitioner prays that the court will receive and upon a hearing and full investigation of the facts of this accident which resulted in personal injuries to the minor, will adjudicate and find that this is a doubtful and disputed claim and that it would be in the best personal interest of the minor for the compromise settlement previously described to be approved and concluded in full, complete and final settlement and satisfaction of all claims and demands, past, present and future and known and unknown on account of the accident described herein, which resulted in personal injuries to the minor. The petitioner would further pray that an order be entered authorizing, empowering and directing him to accept the settlement in the sum of $       on behalf of the minor, to be deposited into a federally insured bank account for and on behalf of the minor, for use in connection with future maintenance, care and support and for any other future needs of the minor. The petitioner further prays that he/she be authorized, empowered and directed to execute and deliver a full, complete and final release, discharge, acquittance, indemnification and covenant in the form attached as Exhibit "       " to this petition. Petitioner prays for such other relief, both general and special as in equity he may be entitled, as in duty bound he/she will ever pray. Respectfully submitted, _______________________________________       Attorney for       Of Counsel:                         Telephone:       MSB #       Attorney for