PROBATE COURT OF ________________ COUNTY, OHIO
________________, JUDGE
ESTATE OF____________________________________________________, DECEASED
CASE NO. _______________________
ENTRY APPROVING SETTLEMENT AND DISTRIBUTION OF
WRONGFUL 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 $ _______________________________.
Orders payment of $ ________________________________ to be applied to decedent's funeral and burial
expenses.
Orders payment of $ _______________________ to the fiduciary for services rendered with respect to the
wrongful death and survival claims.
Orders payment of $ _____________________ to the attorney for reimbursement of case expenses and $
____________________________ for attorney fees for services rendered with respect to the wrongful death
and survival claims.
Orders that the net proceeds of $ __________________________ be allocated $ ______________ to the
wrongful death claim and $ _________________________ to the survival claim. The amount allocated to the
survival claim shall be considered an asset of the estate and shall be reflected in the fiduciary's account of the
administration of the estate.
Finds all of the beneficiaries of the wrongful death claim are on an equal degree of consanguinity, are adults,
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 due regard for
the injury and loss to each beneficiary resulting from the death and for the age and condition of the
beneficiaries.
Name
Residence
Relationship
Birthdate
Amount
Address
to Decedent
of Minor
FORM 14.2 - ENTRY APPROVING SETTLEMENT AND DISTRIBUTION OF
WRONGFUL DEATH AND SURVIVAL CLAIMS
Amended: September 1, 2011
Discard all previous versions of this form