PROBATE COURT OF________________ COUNTY, OHIO
_____________
, JUDGE
_________________________________________________
IN THE MATTER OF
____________________
CASE NO.
ENTRY APPROVING SETTLEMENT OF A CLAIM OF AN ADULT WARD
Upon hearing the application to approve and distribute the settlement of the claim of the adult ward, the
Court: [check whichever of the following are applicable.]
□
Approves the proffered settlement of $___________________________;
□
Orders payment of $_______________________ for medical and other expenses, as follows:
__________________________________________________________________________
__________________________________________________________________________;
□
Orders payment of $_______________________ for attorney fees for service rendered and
$__________________ to the attorney for reimbursement of suit expenses with respect to this
matter;
□
Authorizes the applicant to execute a release which shall be effective upon payment of the
settlement;
□
Orders that the net amount of $____________________, for the benefit of the ward be:
□
Deposited in the name of the ward with _________________________________, a
financial institution, in a restrictive account and not be released without written order
of this Court with Form ______ Verification of Receipt and Deposit filed with the
Court;
□
Delivered to the guardian of the estate;
□
Structured as set forth in the documents attached to the application;
□
Other:___________________________________________________________.
□
Orders the applicant and the attorney to report on their distribution of the proceeds within thirty days
of the date of this entry;
□
Further orders ________________________________________________________________.
____________________________
___________________________________
Date
__________________, PROBATE JUDGE
FORM 22.6 - ENTRY APPROVING SETTLEMENT OF CLAIM OF AN ADULT WARD
Effective Date: January 1, 2015