IN THE CIRCUIT COURT OF THE TWENTY-SECOND JUDICIAL CIRCUIT McHENRY COUNTY, ILLINOIS Probate Division In the Matter of the Estate of ) ) _________________________________________ ) Minor ) Case Number_______________________________ ORDER TO SETTLE CAUSE OF ACTION ­ MINOR'S ESTATE On the verified petition of _____________________________________________________________________, guardian of the estate of _____________________________________________________________, a minor; to settle cause of action for injury, the Court having considered the evidence, IT IS ORDERED THAT: 1. The cause of action be settled for $_________________________________, and, upon receiving the sum, the guardian execute and deliver to the party against whom the cause of action lies a release and discharge from all liability or covenant not to sue on account of the injuries; 2. The guardian distribute the proceeds of the settlement as follows: $__________________ To_________________________________________________________ for hospitalization To_________________________________________________________ for medical treatment $__________________ To_________________________________________________________ for bond premium To_________________________________________________________ for court costs $__________________ $__________________ To_________________________________________________________ for_______________ $__________________ To_________________________________________________________ for_______________ $__________________ To_________________________________________________________ for legal services as to this settlement and distribution ( ___________% of settlement) _________________________________ (Name of Depository) $__________________ To____________________________________________ for deposit to the account of the minor until he reaches majority on ____________________________, 20_____, or until further order of court $__________________ To ___________________________________________________________________________, (Name of Guardian, Parent or Relative) ___________________________________________ for benefit of the minor. $__________________ TOTAL DISBURSEMENTS $__________________ 3. 4. 5. The guardian is excused from filing an inventory and a final account; The court costs shall be $_______________________________________________; The guardian shall be discharged from further duty and the guardian and the surety on his bond shall be released from further obligation and the estate closed upon approval of a report of distribution or presentation of vouchers of disbursement in accordance with this order on or before _____________________________________, 20___; PR-ORD12: Revised 12/01/06 Page 1 of 2 Minor Guardianship American LegalNet, Inc. www.FormsWorkflow.com 6. If the guardian fails to present his report of distribution or vouchers, without cause shown the order ____________________________________________ costs and allowing the attorney's fee shall be vacated (releasing or retaxing) and a rule shall issue against the guardian requiring him to show cause why he should not be adjudged in contempt of court. Dated__________________________________, 20___ ENTERED: _____________________________________________ Judge Name_______________________________________________ Attorney for Petitioner__________________________________ Address______________________________________________ City, State Zip_________________________________________ Telephone____________________________________________ PR-ORD12: Revised 12/01/06 Page 2 of 2 Minor Guardianship American LegalNet, Inc. www.FormsWorkflow.com