IN THE CIRCUIT COURT OF THE TWENTY-SECOND JUDICIAL CIRCUIT McHENRY COUNTY, ILLINOIS Probate Division ) ) _________________________________________ ) Minor ) In the Matter of the Estate of Case Number_______________________________ PETITION TO SETTLE CAUSE OF ACTION ­ MINOR'S ESTATE ______________________________________________________________________________, guardian of the estate of __________________________________________________________________________, a minor, on oath states: 1. The minor has a cause of action against__________________________________________________________ for injury to him on ____________________________________, 20______, by reason of (briefly describe accident) _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 2. The injuries were: ____________________________________________________________________________ _________________________________________________________________________________________________ 3. The minor was treated at__________________________________________________ hospital and attended by Dr. _________________________________________, whose certificate is attached. 4. Suit _______________ been filed as Case Number ____________________ in ___________________________ (has or has not) (Court) 5. 6. A settlement of $________________________ has been offered and petitioner recommends that it be accepted. The only charges against the proceeds are: for hospitalization for medical treatment for medical treatment for medical treatment for court costs for bond premium $__________________ $__________________ $__________________ $__________________ $__________________ $__________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ for________________ $__________________ for________________ $__________________ for legal services $__________________ (_____% of settlement) PR-PET7: Revised 12/01/06 Page 1 of 2 Minor Guardianship American LegalNet, Inc. www.FormsWorkflow.com For attorney's disbursements (itemize) ________________________________________________________________________for ________________________________________________________________________for ________________________________________________________________________for ________________________________________________________________________for TOTAL 7. $__________________ $__________________ $__________________ $__________________ $__________________ A reasonable amount to be paid to _______________________________________________________________ (Name of Guardian, Parent or Relative, stating relationship) _________________________________________________________________________________________________ for the benefit of the minor is $____________________________________________________. 8. _______________________________________________________________________ is a qualified depository for $__________________________, the balance of the settlement proceeds, to be held for the account of the minor until he reaches majority on _________________________________________, 20_________, or until further order of court. Petitioner asks leave to settle the cause of action for the sum offered, to distribute the proceeds and to be discharged as guardian. Signed and sworn to before me ______________________________________, 20________ _________________________________________________ Notary Public _____________________________________________ CERTIFICATE OF ATTORNEY I certify that I have examined the facts of this case and the applicable law and in my opinion the proposed settlement is just and proper and that my disbursements were necessary and reasonable. _____________________________________________ Attorney Name_______________________________________________ Attorney for Petitioner__________________________________ Address______________________________________________ City, State Zip_________________________________________ Telephone____________________________________________ PR-PET7: Revised 12/01/06 Page 2 of 2 Minor Guardianship American LegalNet, Inc. www.FormsWorkflow.com