Ohio > Statewide > Probate > Wrongful Death Proceeds
Application To Approve Settlement And Distribution Of Wrongful Death And Survival Claims 14.0 - Ohio
| Application To Approve Settlement And Distribution Of Wrongful Death And Survival Claims Form. This is a Ohio form and can be used in Wrongful Death Proceeds Probate Statewide . |
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PROBATE COURT OF ESTATE OF CASE NO. COUNTY, OHIO , DECEASED 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 words, and incorporate all attachments into a single statement.] There is an offer of (full) (partial) settlement without suit being filed. There is an offer of (full) (partial) settlement after suit was filed. The style of the case, the court and the case number . being A judgment has been recovered for damages for decedent's wrongful death (and personal injury and property damage arising out of the same act and which survive the decedent). The amount of the settlement or judgment is $ . This is a partial settlement and therefore the estate must remain open pending final disposition of the claims. The offer includes, or the judgment sets forth separately, reasonable funeral and burial expenses in the amount of . $ Reasonable compensation for the fiduciary's services is $ attached. and an itemization of such services is Reasonable attorney fees for the attorney's services is $ and reinbursement to the attorney for . A copy of the attorney's fee contract that (has) (has not) received prior case expenses is $ approval of this court subject to modification, and an itemization of case expenses are attached. The net proceeds of $ should be allocated; $ to the wrongful death action and $ to the survival action. A statement in support thereof is attached. A statement in support of the proffered settlement is attached. Supplemental forms required by local rule of court are attached. All of the beneficiaries of the wrongful death action are on an equal degree of consanguinity, and are adults and have agreed how the net proceeds are to be distributed. The beneficiaries of the wrongful death action are not on an equal degree of consanguinity, or one or more of the beneficiaries is a minor, or the beneficiaries have not agreed how the net proceeds are to be distributed. FORM 14.0 - APPLICATION TO APPROVE SETTLEMENT AND DISTRIBUTION WRONGFUL DEATH AND SURVIVAL CLAIMS 10-01-98 American LegalNet, Inc. www.FormsWorkflow.com CASE NO. The surviving spouse, children and parents of the decedent and other next of kin who have suffered damages by reason of the wrongful death are as follows and the distribution should be, as follows: Name Residence Address Relationship to Decedent Birthdate of Minor Amount The survival claim beneficiaries are as follows: Residence Address Relationship to Decedent Birthdate of Minor Name The fiduciary requests that the Court approve the application and authorize the fiduciary to execute a (complete) (partial) release which upon payment of the settlement shall be a (complete) (partial) discharge of the claim. Attorney for Fiduciary Fiduciary Attorney Registration No. ENTRY SETTING HEARING AND ORDERING NOTICE The Court sets at o'clock .M. as the date and time for hearing the above application and orders notice to be given by the fiduciary, as provided in Rules of Civil Procedure, to the wrongful death and survival claim beneficiaries who have not waived notice. Judge American LegalNet, Inc. www.FormsWorkflow.com
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