COURT COUNTY OFPROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.IN THE MATTER OF THE MINOR SETTLEMENT OF CASE NO. JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)«NTUqspq)-PROPOSAL FOR MINOR SETTLEMENTAgeName of parents Attorney for plaintiffPhone No. Attorney for defendantPhone No. InjuryNature of accident Policy limits $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Was suit filed?Verdict? Did the parents receive money in this or a related case?ExplainTHE PEOPLE OF THE STATE OF NEW YORK TOEXPENSES TO BE DEDUCTED FROM THE SETTLEMENT What is the offer of settlement?$ Medical/Hospital Expense$ To Parents$ Attorney Fee$%) Attorney Expenses(GREETINGS:$ Net to Minor$WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,If yes, please attach a copy of the structure to the proposal.Is settlement structured?located at County ofRating of annuity underwriter Will the minor be present at the hearing?If structured, what is the present value?o'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomWill both parents be present? Will the doctor's discharge letter or emergency room report be presented?If no, please have the check at the time of hearing.Will the tortfeasor's attorney be present at the hearing?Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.Will the funds be impounded?If yes, please make sure the minor has a social security number. If no, will a guardianship be established?, one of the Justices of theCommentsCourt in Witness, Honorableday of, 20 County,Name of attorney submitting proposal/Supreme Court NumberDate proposal submittedApproved by Magistrate assigned to case . Costs paid(Attorney must sign above and type name below)/ . Delayed per (check one and initial)Attorney(s) for«ftiI-JUDGMENT ENTRYOffice and P.O. AddressIt is the order of the Court that the above entitled matter shall be set for hearing before the assigned Magistrate on , 20 at M. at the Lucas County Probate Court.Telephone No.: Facsimile No.: E-Mail Address:DateJudge Jack R. Puffenberger ByMarina Cooper, Assignment CommissionerMobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comFORM MST22-MSP -MINOR SETTLEMENT PROPOSAL