) ) SS COUNTY OF _________________ ) IN THE CIRCUIT COURT OF THE NINETEETH JUDICIAL CIRCUIT _______________ COUNTY, ILLINOIS ESTATE OF ) ) ) ___________________________________ ) MINOR STATE OF ILLINOIS NO. ___________________ ORDER AUTHORIZING SETTLEMENT OF PERSONAL INJURY CLAIM OF A MINOR This cause coming to be heard on the verified Petition of ________________________ _________________, as parent and next friend of _____________________________, a minor, and it appearing to the Court that the petitioner has made a claim for damages for personal injuries sustained by the aforesaid minor arising out of an occurrence which took place as described in the Petition to authorize settlement. It is further appearing to the Court an offer of settlement of the claim for damages for personal injuries to the minor plaintiff has been made in the sum of ____________________ DOLLARS in exchange for a properly executed release of any and all claims and that the Petitioner has recommended that the offer be accepted. IT IS THEREFORE ORDERED that the petitioner is authorized to accept the offer of _____________________ DOLLARS in full and final settlement of the claim for damages for personal injuries to __________________________, a minor, and that the petitioner shall execute a release of any and all claims in consideration of said offer of settlement. IT IS FURTHER ORDERED that _________________________ be appointed guardian of the Estate of ___________________________, a minor. Rule 14.21 171-304P Rev. 10/01 Page 1 of 2 2002 © American LegalNet, Inc. IT IS FURTHER ORDERED that: a. The sum of ____________________ DOLLARS paid as attorney's fees to the Law Office of ___________________________________. b. The sum of ____________________ DOLLARS be paid the Law Office of _____________________ for reimbursement for investigation and court costs. c. The sum of ____________________ DOLLARS be deposited in the __________________________ (here insert the name of financial institution) in the name of the aforesaid appointed guardian for the benefit of the Estate of ______________________, a minor; no part of said sum to be withdrawn without approval by Court Order or until the minor shall reach his/her majority on the _____ day of _____________, ______. IT IS FURTHER ORDERED that the appointed guardian of the Estate of the aforesaid minor shall file a bond in the amount of _____________________ DOLLARS pending a proper deposit of the minor's funds in the aforesaid financial institution acknowledging receipt of the aforesaid sum and a copy of this Order of the Court approving settlement at which time the aforesaid bond may be cancelled. DATED this ________ day of _________________, ______. ENTER: __________________________________ Rule 14.21 171-304P Rev. 10/01 Page 2 of 2 2002 © American LegalNet, Inc.