Waiver And Consent To Settle Minors Claim {22.1}

Lorain County Probate Court Judge James T. Walther IN THE MATTER OF ___________________________________________________ CASE NO. ___________________ WAIVER AND CONSENT TO SETTLE MINOR'S CLAIM The undersigned, waive all claims for damages on account of loss of services of said minor, waive notice of the hearing, and consent to and approve the Form 22.0, Application To Settle Minor's Claim, a copy of which is attached hereto. ________________________________________ ________________________________________ Typed or Printed Name ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ _______________________________________ _______________________________________ Typed or Printed Name _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ FORM 22.1 - WAIVER AND CONSENT TO SETTLE MINOR'S CLAIM 4/1/97 American LegalNet, Inc. www.FormsWorkFlow.com