COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTYJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)FIRST JUDICIAL DISTRICTCIVIL TRIAL DIVISION:TERM, 20::::. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NO:ORD E RTHE PEOPLE OF THE STATE OF NEW YORK TOANDNOW,thisday of ,20,upon considerationofthePetition toCompromise Wrongful Death and Survival Action filed on , 20, it is hereby ORDERED and DECREED that Petitioner is authorized to enter into a settlement with Defendant(s) , in the gross sum of ($) Dollars. Defendant(s) shall forward all settlement drafts or checks to Petitioner's counsel for proper distribution.IT IS FURTHER ORDERED and DECREED that the settlement proceeds are allocated as follows:GREETINGS:1.Wrongful Death Claim$WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,2.Survival Claim$located at County ofIT IS FURTHER ORDERED and DECREED that the settlement proceeds be distributed as follows:o'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in room1.To: , Esquire $ For CostsYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.2.To: , Esquire $ For Counsel Fees3.The Wrongful Death Claim in the sum of$shall be paid as follows:, one of the Justices of theCourt in Witness, Honorableday of, 20 County,a. To: Spouse; and/or$b. Adult Child(ren);* and/or$(Attorney must sign above and type name below)$c. To: Minor Child(ren)+as provided hereunderAttorney(s) for* In the event the beneficiary is an incapacitated person, appropriate changes are to be made. + In the event part of the settlement proceeds are payable through the purchase of an annuity, the terms of the annuity shall be setOffice and P.O. Addressforth in the Order.Telephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.OPTION 1JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)To: , Guardian of the Estate of , a minor; provided, however, that no payment shall be made to the guardian until the guardian has posted additional security as may be required by the Orphans' Court Division of County pursuant to 20 Pa.C.S. §5121, et seq. An appropriate Petition shall be filed with the Orphans' Court within thirty (30) days.OPTION 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Counsel is hereby authorized to execute all documentation necessary to purchase saving certificate(s), from federally insured banks or savings institutions having an office in Philadelphia County, in the sum of $, each not to exceed the insured amount, with the funds payable to the minor upon majority. The certificate shall be titled in the name of the minor and shall be restricted as follows:THE PEOPLE OF THE STATE OF NEW YORK TONot to be redeemed except for renewal in its entirety, not to be withdrawn, assigned, negotiated, or, otherwise alienated before the minor attains majority, except upon prior Order of Court.Counsel shall open a savings account in the sum of $ in the name of the minor. The savings account shall be restricted as follows:Not to be withdrawn before the minor attains majority, except for the payment of city, state, and federal income taxes on the interest earned by the savings certificate and savings account, or upon prior Order of Court.GREETINGS:d. To: Parent(s)$WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,4.The Survival Claim in the sum of$located at County ofshall be paid to , Administrator/Executor of the Estate of , Deceased; provided, however, that counsel shall not distribute any funds to the said Administrator/Executor until additional security as may be required by the Register of Wills of County pursuant to 20 Pa.C.S. §3323(b)(3) is posted.o'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.Within sixty (60) days from the date of this final Order, counsel shall file with the office of Civil Administration an Affidavit from counsel certifying compliance with this Order. Counsel shall attach to the Affidavit a copy of the Certificate of Deposit and/or bank account containing the required restrictions., one of the Justices of theBY THE COURT:Court in Witness, Honorableday of, 20 County,J.ORPHANS' COURT DIVISION(Attorney must sign above and type name below)cc: Register of Wills of County.Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com
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