4‐14‐16
FIRST JUDICIAL DISTRICT OF PENNSYLVANIA
COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY
1
Trial Division - Civil
PLAINTIFF
:
TERM, 20
:
v.
:
:
DEFENDANT
:
NO:
PETITION FOR LEAVE TO SETTLE OR
2
COMPROMISE MINOR'S ACTION
To The Honorable, the Judges of the Said Court:
The Petition of ________________________, a minor, by his Guardian (see Pa. R.C.P. No.
2028), by his attorney, ___________________________, Esquire respectfully requests:
1) Petitioner is (see Pa. R.C.P. No. 2026):______________________________________________.
2) The minor was born on _______________________, and his/her social security number is
__________________________.
3) The minor resides with ___________________________________ at the following address:
______________________________________________________________________________.
4) A guardian (was) (was not) appointed for the minor as follows:
______________________________________________________________________________.
A copy of the Order is attached.
5) The minor’s parents are _________________________________________________________
who reside at the following address:
_______________________________________________________________________________.
6) The defendant is _________________________ who resides or whose principal place of
business at all relevant times was ____________________________________________________.
7) On __________________________ at the following location ___________________________,
the minor sustained the following injuries (set forth in detail):
_______________________________________________________________________________
1
In the event the Petition is filed in the Orphans’ Court Division, the caption must comply with Pa.O.C. 3.2.
2
In the event the Petition involves an Incapacitated Person, appropriate changes are to be made. See Pa.R.C.P. No.
2051, et seq. and Phila, Civ. R. 2064.