Fill and Sign the Petition Small Claim Form

IN THE CHANCERY COURT OF       COUNTY, MISSISSIPPI EX PARTE       , A MINOR, BY AND THROUGH       , FATHER/MOTHER AND NEXT FRIEND PETITION FOR AUTHORITY TO SETTLE SMALL CLAIM Come now       , petitioner, as father/mother and next friend of       , a minor, and would show unto this Court the following, to - wit: I.       , minor petitioner herein, whose date of birth is       , has at all times since his/her birth resided in the home of his/her father/mother ,       , both the minor and his/her father/mother reside in       County, Mississippi, at       ,       , Mississippi.       , the father/mother of said minor, is       . II. 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. III. As a result of the said accident,       , by and through his/her father/mother ,       , your petitioner herein, desires to make and has made a claim for damages against said       ,       and       . 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 have 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       $       . IV. Said minor and his/her father/mother , your petitioner herein, would show 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. V.       , your petitioner herein, would show 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 petitioners herein request 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. Section 93 - l3 - l7 (Supp. 1986) as amended. VI. 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/her 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. Section 93 - l3 - 2ll, as amended. VII. Petitioner requests that the Court will grant his/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             ,       . AND NOW YOUR PETITIONERS RESPECTFULLY PRAY: That this petition be received and filed, that an immediate hearing will be held thereon, that the Court will inquire into the aforesaid claim of said minor and fully investigate said matter, and that the Court shall satisfy itself by the evidence or otherwise that the payment of the proposed sum of       ($       ) to       , a minor, payable to       , petitioner herein, for the exclusive use and benefit of said minor, plus payment of the specific medical bills set forth above, constitutes a fair and reasonable settlement of the claim of said minor and petitioners as set forth herein and that it is in the best interest of said minor that the proposed settlement be consummated. Your petitioners further pray that the Court will enter an order that there be paid to       as father/mother and next friend of       , a minor, the sum of       ($       ) for the exclusive use and benefit of said minor. Your petitioners further pray that, upon approval of proposed settlement by this Court, they be authorized to execute and deliver a full, complete and final release, discharge and satisfaction, fully, completely and finally releasing, discharging and acquitting       ,       and       their insurers, and any and all other persons, firms, and corporations, who may in any manner whatsoever be liable wherefore from any and all claims, demands, actions, suits, damages and causes of action which said minor or your petitioners herein may now or hereafter have on account of the injuries of       sustained on or about             ,       , and to acknowledge full and complete compromise, settlement, accord and satisfaction therefore. Petitioners further pray that they be authorized to pay out of the proceeds of said settlement all outstanding medical expenses incurred by       as a result of the accident on             ,       , as specifically set forth hereinabove. And your petitioners pray for general relief. Respectfully submitted, _______________________________________       Attorney for       Of Counsel:                         Telephone:       MSB #       Attorney for