Fillable Petition For Leave To Settle Or Compromise Minors Action (Page 2 of 9) in pdf

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_______________________________________________________________________________

8) A Complaint was filed against defendant(s) as follows: _________________________________

_______________________________________________________________________________.

9) Attached hereto is a report by Dr. ________________________________ dated ___________

which sets forth the present condition of the minor.

10) Attached hereto is a statement, under oath, of the minor's parents and/or guardian and/or

guardian ad litem certifying the physical and/or mental condition of the minor, as well as the

parents' and/or guardian's and/or guardian ad litem's approval of the proposed settlement and

distribution.

11) Attached hereto is the written approval of the proposed settlement and distribution by the minor,

who is sixteen (16) years of age or older.

12) The following settlement has been proposed:

_______________________________________

_______________________________________________________________________________

______________________________________________________________________________.

(If additional space is needed, please continue on separate page).

13) Counsel is of the professional opinion that the proposed settlement is reasonable due to the

following: _______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________.

(If additional space is needed, please continue on separate page).

14) Counsel has incurred the following expenses for which reimbursement is sought (please set

forth in detail)____________________________________________________________________

_______________________________________________________________________________.

(If additional space is needed, please continue on separate page).

15) The following costs have been incurred by or on behalf of the minor and must be paid from the

proceeds of the settlement: _________________________________________________________

Phila. Civ. R. 2039 (D)(5)(f) provides that if there is to be an allocation between adults and minors or among

minors, the amounts allocated to each party and specific reasons for such allocation must be set forth. Additionally, if

more than one plaintiff is involved, whether minor, adult or incapacitated, Petitioner must set forth the amount each will

receive and shall provide justification for the requested allocation. In the event a portion of the settlement is payable

through the purchase of an annuity, set forth the credit rating of the entity which assumes responsibility for future

payments, the present cost of the annuity, as well as the periodic and lump sum payments.

Petition For Leave To Settle Or Compromise Minors Action Page 2