COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.PROBATE COURT OF STARK COUNTY, OHIOCalendar No.ESTATE OFIDECEASEDJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)CASE NO.ENTRY APPROVING SETTLEMENT AND DISTRIBUTION OFWRONGFUL DEATH AND SURVIVAL CLAIMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Upon hearing the application to approve settlement and distribution of the wrongful death and survival claims, the Court:Approves the proffered settlement of $THE PEOPLE OF THE STATE OF NEW YORK TOto be applied to decedent's funeral and burialOrders payment of $expenses.to the fiduciary for services rendered with respectOrders payment of $to the wrongful death and survival claims.GREETINGS:to the attorney for reimbursement of case expensesOrders payment of $WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorablefor attorney fees for services rendered with respect to theand $ wrongful death and survival claims.,located at County ofbe allocated $Orders that the net proceeds of $ to the wrongful death claim and $ allocated to the survival claim shall be considered an asset of the estate and shall be reflected in theo'clock in the day ofnoon, and at any recessed in room, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of theto the survival claim. The amountfiduciary's account of the administration of the estate.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.Finds all of the beneficiaries of the wrongful death claim are on an equal degree of consanguinity, areadults, and have agreed how the net proceeds allocated to the wrongful death claim are to be distributed.Orders distribution of the net proceeds allocated to the wrongful death claim to the surviving spouse, children, parents and other next of kin, in the equitable shares shown below, fixed by the Court having, one of the Justices of theCourt in Witness, Honorableday of, 20 County,due regard for the injury and loss to each beneficiary resulting from the death and for the age and condition of the beneficiaries.(Attorney must sign above and type name below)AmountBirthdateRelationshipNameResidenceof Minorto DecedentAddressAttorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:FORM 14.2 -ENTRY APPROVING SETTLEMENT AND DISTRIBUTION OF WRONGFUL DEATH AND SURVIVAL CLAIMSAmerican LegalNet, Inc. www.USCourtForms.com4/97COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.Orders that the share of:JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)a minor(s) be deposited inlieu of bond pursuant to R.C. 21 11.05.a minor(s) be paid to the0guardian of the estate of such minor.0a child(ren) be deposited in. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .a trust for the benefit of the child(ren) until twenty-five years of age.Authorizes the fiduciary to execute a release which, upon payment, shall be a discharge of the claim.THE PEOPLE OF THE STATE OF NEW YORK TOOrders the fiduciary and the attorney to report the distribution of the proceeds within thirty days of the date of this Entry.Further ordersGREETINGS: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 roomApproved: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.Robert D. Horowitz -Probate JudgeAttorney for Fiduciary, one of the Justices of theAttorney Registration No.Court in Witness, Honorableday of, 20 County,Date(Attorney must sign above and type name below)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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