COURT COUNTY OFPROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.PROPOSAL FOR WRONGFUL DEATH SETTLEMENTJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)CASE NO. Decedent's Name:AgeFiduciary's Name: Attorney's Name (Plaintiff): Attorney's Name (Tortfeasor): Is settlement final as to all defendants? Was Suit filed?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Court:Case #:THE PEOPLE OF THE STATE OF NEW YORK TONature of Claims:ExpensesGREETINGS:Offer of Settlement$Last Illness$WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the HonorableConscious Pain Suffering $Structured?,Funeral Expenses$Present Value$located at County ofo'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 roomAttorney Fee (%) $Best rating of annuity underwriterAttorney Expenses$Net for Distribution$Your 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.Consentual DistributionNameRelationshipAge, one of the Justices of theAmount $$$$$Court in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Attorney(s) forTotal Distributed $Office and P.O. AddressDateJudge Jack R. PuffenbergerTelephone No.: Facsimile No.: E-Mail Address:[Details of Structure on Reverse Side]«QXET2J -Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comPAGE 1 OF FORM PWDS1 PROPOSAL FOR WRONGFUL DEATH SETTLEMENTCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .CASE NO. :::::::Index No.Details of StructureCalendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TOGREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'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., one of the Justices of theCourt in Witness, Honorableday of, 20 County,(Attorney must sign above and type name below)Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:PAGE 2 OF FORM PWDS1 PROPOSAL FOR WRONGFUL DEATH SETTLEMENTMobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com
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