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Application To Approve Settlement And Distribution Of Wrongful Death And Survival Claims - Ohio
| Application To Approve Settlement And Distribution Of Wrongful Death And Survival Claims Form. This is a Ohio form and can be used in Estates Probate Cuyahoga County (Court Of Common Pleas) . |
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Probate Court of Cuyahoga County, Ohio John J. Donnelly, Presiding Judge John E. Corrigan, Judge ESTATE OF ________________________________________________________, DECEASEDCASE NUMBER: ______________________________________ APPLICATION TO APPROVE SETTLEMENT AND DISTRIBUTION OF WRONGFUL DEATH AND SURVIVAL CLAIMS [R.C. 2117.05, 2125.02, 2125.03, Civ. R. 19.1 and Sup. R. 70] The fiduciary states: [Check whichever of the following are applicable, strike inapplicable wo rds, and incorporate all attachments into a single statement.] 9 There is an offer of (full)(partial) settlement without suit being filed. 9 There is an offer of (full)(partial) settlement after suit was file d. The style of the case, the Court, and the case number is _______________________________________________________________________ . 9 A judgement has been recovered for damages for decedents wrongful de ath (and personal injury and property damage arising out of the same act and which survive the decedent). 9 The amount of the settlement or judgement is $ _________________________ ___________ . 9 This is a partial settlement and therefore the estate must remain open p ending final disposition of the claims. 9 The offer includes, or the judgement sets forth separately, reasonable f uneral and burial expenses in the amount of $ _________________________________________. 9 Reasonable compensation for the fiduciarys service is $ ___________ __________________ and an itemization of such services is attached. 9 A reasonable attorney fee for the attorneys services is $ __________ ___________________ and reimbursement to the attorney for case expenses is $ ____________________________. A copy of the attorneys fee contract that (has) (has not) received prior approval of this Court, subject to modification, an d an itemization of case expenses are attached. 9 The net proceeds of $ ____________________ should be allocated $________ _____________ to the wrongful death action and $__________________________ to the survival action. A statem ent in support thereof is attached. 9 A statement of the proffered settlement is attached. 9 All of the beneficiaries of the wrongful death action are on an equal de gree of consanguinity, are adults, and have agreed how the net proceeds are to be distributed. 9 All of the beneficiaries of the wrongful death action are on not on an e qual degree of consanguinity, or one or more of the beneficiaries is a minor, or the beneficiaries have not agreed how the n et proceeds are to be distributed. form 14.0 APPLICATION TO APPROVE SETTLEMENT AND DISTRIBUTION OF WRONGFUL DEATH AND SURVIVAL CLAIMS 10/1/98 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 9 The surviving spouse, children, and parents of the decedent and other ne xt of kin who have suffered damages by reason of the wrongful death are as follows and the distribution should be as foll ows: ________________________________________________________________________ __________________________ Name Residence Relationship Birthdate Amount Address to Decedent of Minor ________________________________________________________________________ __________________________ ________________________________________________________________________ __________________________ ________________________________________________________________________ __________________________ ________________________________________________________________________ __________________________ ________________________________________________________________________ __________________________ 9 The survival claim beneficiaries are as follows: ________________________________________________________________________ _________________________ Name Residence Relationship Birthdate Amount Address to Decedent of Minor ________________________________________________________________________ _________________________ ________________________________________________________________________ _________________________ ________________________________________________________________________ _________________________ ________________________________________________________________________ _________________________ ________________________________________________________________________ _________________________ The fiduciary requests that the Court approve the application and author ize the fiduciary to execute a (complete)(partial) release whichupon payment of the settlement shall be a (complete)(partial) discha rge of the claim. ____________________________________________ ________________________________________Attorney for fiduciary Fiduciary Attorney Registration No. ____________________________ ENTRY SETTING HEARING AND ORDERING NOTICE The Court sets __________________________ at _____________ oclock __ __ . M. as the date and time for hearing the aboveapplication and orders notice to be given by the fiduciary, as provided in the Rules of Civil Procedure, to the wrongful death andsurvival claim beneficiaries who have not waived notice. _______________________________________ Probate Judge American LegalNet, Inc. www.USCourtForms.com
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