Plaintiff or Filing Attorney Information: Name NJ Attorney ID Number Address Telephone Number Guardian ad Litem, , a minor by his/her and , individually, , Plaintiff, v. Superior Court of New Jersey Division County Part Docket No: Civil Action , Defendant. Judgment Approving Minor's Settlement and Directing the [Deposit] [Investment] of Funds This matter having come before the Court in accordance with R.4:44-3 on ________________ [insert hearing date], and _____________________________ , attorney for the plaintiff, and ________________________, attorney for the defendant, appearing, and the attorneys for the parties having reported to the court that they have arrived at a settlement of the minor plaintiff's claim between the plaintiff and the defendant(s), and the Court having reviewed the physician reports and taken proofs on the record concerning the minor's injuries, disabilities and medical expenses and being satisfied that the settlement amount(s) is/are fair and reasonable and in the minor's best interest. IT IS on this _______ day of _______________, 20__, ORDERED and ADJUDGED that: 1. Litem, in Judgment is entered on behalf of _________________, a minor by his/her Guardian ad the gross amount of $_________________ against the defendant(s) ______________________________ without costs and/or interest. 2. The following deductions shall be made from the gross settlement and paid by the defendant(s) in separate drafts as follows: Revised 11/01/2013, Promulgated by Directive #9-08 (05/19/2008), CN 10520-English Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com a. $_______________ to be paid to the plaintiff's attorney(s) which reimburses $_____________ for actual disbursements, costs and expenses and satisfies the attorneys' contingent fees of $____________; and $________________ for medical bills from the minor's recovery to be paid as follows: Payee Amount _______________________________ _______________________________ _______________________________ $ ____________________ $ ____________________ $ ____________________ b. 3. [Insert the Guardian ad Litem's name] shall immediately apply to the Surrogate of [EN1] _____________ County minor. [EN2] pursuant to R. 4:81 for the appointment of a guardian of the estate of the It shall be the responsibility of the attorney for the plaintiff to see that this appointment is completed. ALTERNATIVE 1 -- DEPOSIT NET FUNDS WITH SURROGATE -STRIKE OUT IF NOT APPLICABLE 4. Pursuant to R. 4:48A the net recovery of $_______________, payable for the benefit of the minor plaintiff, shall be paid by or on behalf of the defendant(s) by check payable to the "Surrogate of ___________ County Intermingled Trust Fund F/B/O of [insert minor's name], a minor," within ____ days of this Judgment. It is and shall be the responsibility of the attorney for the plaintiff to see that this deposit is completed. 5. Upon payment of the minor's net recovery into the Surrogates' Intermingled Trust Fund, the posting of a bond by the person applying to be guardian of the minor's estate is dispensed with pursuant to N.J.S.A. 3B:15-16. 6. Monies may be withdrawn from said account only upon further order of the Superior Court of New Jersey, Chancery Division, Probate Part, pursuant to N.J.S.A. 3B:15-17, or upon the minor attaining majority pursuant to N.J.S.A. 3B:15-17.l. 7. The Guardian ad Litem shall provide the Surrogate with the minor's Social Security Number and a copy of the minor's birth certificate. Personal identifying information shall be redacted Revised 11/01/2013, Promulgated by Directive #9-08 (05/19/2008), CN 10520-English Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com from said documents and the same shall not be released to or made available for public scrutiny unless ordered to do so by the Superior Court. ALTERNATIVE 2 -- GUARDIAN CONTROLS AND INVESTS NET FUNDS - STRIKE OUT IF NOT APPLICABLE 4. The guardian of the minor's estate, shall qualify according to law, and shall, as a condition of qualifying, enter into a surety bond unto the Superior Court of New Jersey in the amount of $_____________, which bond shall contain the conditions set forth N.J.S.A. 3B:15-7 and R. 1:13-3. The bond shall be approved by the court as to form and sufficiency. 5. Pursuant to R. 4:44 the minor's net recovery of $________________ shall be paid by or on behalf of the defendant(s) by check payable to the duly qualified guardian of the estate of __________________, a minor. 6. The defendant(s) shall immediately make payment to the guardian of the minor's estate upon receiving proof that the Letters of Guardianship have been issued by the Surrogate. 7. Upon qualifying, the guardian of the minor's estate be and hereby is authorized to invest and reinvest the minor's settlement estate in such investments as the guardian of the estate deems advisable and prudent, subject, however, to all limitations or restrictions concerning the investment, use or expenditure of funds held by fiduciaries that are now in force or that may be hereafter established, and subject further to the duty of the guardian of the minor's estate to deliver the estate to the minor upon his/her attaining majority, or to his/her estate should the minor die before reaching his/her majority. INCLUDED IN ALL ORDERS, REGARDLESS OF WHETHER ALTERNATIVE 1 OR 2 IS CHOSEN 8. The guardian of the minor's estate is not authorized to receive any additional funds or property on behalf of the minor, except upon application to the Superior Court, Chancery Division, Probate Part, where the terms or conditions for the receipt of additional funds or property may be fixed. Pursuant to N.J.S.A. 3B:12-37, said limitation shall be stated in the Letter of Guardianship certificates hereinafter issued by the Surrogate. Revised 11/01/2013, Promulgated by Directive #9-08 (05/19/2008), CN 10520-English Page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com 9. Upon qualifying, the Surrogate of __________________ County shall issue Letters of Guardianship for the Estate of __________, a minor, and thereupon said person appointed guardian be and hereby is authorized to perform all the duties and responsibilities of a guardian as allowed by law, except as limited herein. 10. The attorney for the plaintiff shall deliver a copy of this Judgment to all parties and the Surrogate of _____________ County within ____ days of the date hereof. INSERT IF PARENT''S CLAIM IS SIMULTANEOUSLY SETTLED -STRIKE OUT IF NOT APPLICABLE 11.