Application To Settle A Minors Claim {MST22.0}

<document>COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE:::::::Index No.Calendar No.IN THE MATTER OF THE MINOR SETTLEMENT OF CASE NO. JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)APPLICATION TO SETTLE A MINOR'S CLAIM (R.C. 2111.05, R.C. 2111.18, SUP. R. 67 AND 68)(Check applicable boxes, complete applicable blanks, strike inapplicable language, and attach supporting documentation.) The applicant states that: is an unemancipated minor, born , , residing at in this county who on or about , 20, suffered personal injury (and damage to this minor's property) by wrongful act, neglect, or default that entitles this minor to maintain an action to recover damages. A copy of the birth certificate is attached. Attached is a narrative statement in support of the proffered settlement setting forth a description of the occurrence, the injury or damage, the treatment progress and current prognosis by the treating physicians, and other proposed or actual settlements resulting from the same occurrence being paid to persons other than this minor. Counsel will advise at the hearing as to liability and collectability. . There is no legal guardian of the estate, and the Court may authorize the settlement without the appointment of a guardian. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .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 roomis the legal guardian of the estate. Case No...is (are) the parent(s) and natural guardian(s).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..is the person by whom the minor is maintained.. There is a (full) (partial) settlement offer of $, one of the Justices of thewithout suit being filed.Court in Witness, Honorableday of, 20 County,. There is a (full) (partial) settlement offer of $after suit was filed; the style of the case, court, and case number being .(Attorney must sign above and type name below). The proffered settlement should be approved. . Unreimbursed medical and other expenses of $ have been incurred. Attached is a list of such expenses and proposed payees. . A reasonable attorney fee for the attorney's services is $ and reimbursement to the attorney for suit expenses is $ . A copy of the attorney's fee contract that has (has not) received prior approval of this Court, subject to modification, and an itemization of suit expenses are attached. «ntu33/1?-Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:10/1/98PAGE 1 OF FORM 22.0 APPLICATION TO SETTLE A MINOR'S CLAIM AND ENTRY SETTING HEARINGAmerican LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.CASE NO. Calendar No.. The parent(s), , claim $ for damages on account of loss of service of this minor and that claim is included in this settlement offer. . This is a structured settlement. All necessary documents, including a statement of the present value of the settlement, are filed herewith. The applicant requests that: . The Court authorize the applicant to execute a release which shall be effective upon payment of the settlement. . The Court order payment of the above expenses and order that the net amount of $ for the benefit of the minor be: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 room. Deposited in the name of the minor with , a financial institution, and not to be released until the minor attains the age of majority or upon further order of this Court. . Delivered to the legal guardian. . Delivered to , parent(s) and natural guardian(s). . Delivered to , the person by whom the minor is maintained. . Structured as set forth in the attached documents. . Supplemental forms required by local rule of Court are attached.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.Attorney for ApplicantApplicantTyped or Printed NameTyped or Printed Name, one of the Justices of theCourt in Witness, Honorableday of, 20 County,AddressAddress(Attorney must sign above and type name below)Phone Number (include area code)Phone Number (include area code)Attorney Registration No.Attorney(s) for«FTIW-ENTRY SETTING HEARING AND ORDERING NOTICEOffice and P.O. AddressThe Court sets, ato'clock.m. as the date and time for hearing the above application and orders notice to be given by the applicant, as provided in the Rules of Civil Procedure, to the parents who have not waived notice (and further orders that the minor and parent(s) attend the hearing).Telephone No.: Facsimile No.: E-Mail Address:Judge Jack R. PuffenbergerMobile Tel. No.:PAGE 2 OF FORM 22.0 APPLICATION TO SETTLE A MINOR'S CLAIM AND ENTRY SETTING HEARINGAmerican LegalNet, Inc. www.USCourtForms.com</document>