American LegalNet, Inc. www.FormsWorkFlow.com MC-350EX FOR COURT USE ONLY CASE NUMBER: CASE NAME: EXPEDITED PETITION TO APPROVE: Person With a DisabilityMinor Petitioner (name):Claimant (name):Address:Date of birth:Page 1 of 8 Form Adopted for Alternative Mandatory Use Judicial Council of California MC-350EX [New January 1, 2010]EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY(Miscellaneous)FAX NO. (Optional):SUPERIOR COURT OF CALIFORNIA, COUNTY OFATTORNEY (Name, State Bar number, and address):Code of Civil Procedure 247 372 et seq.; Probate Code, 247 3500 et seq.;Cal. Rules of Court, rules 3.1384, 7.101, 7.950, 7.950.5, 7.951www.courtinfo.ca.govTELEPHONE NO.:E-MAIL ADDRESS (Optional):ATTORNEY FOR (Name):STREET ADDRESS:MAILING ADDRESS:CITY AND ZIP CODE:BRANCH NAME: COMPROMISE OF DISPUTED CLAIM COMPROMISE OF PENDING ACTIONDISPOSITION OF PROCEEDS OF JUDGMENT1. 2. a. b. No hearing date is requested. HEARING DATE:DEPT.:TIME: You must use this form if you wish to request expedited court approval of certain (1) compromises of disputed claims of a minor, (2) compromises of pending actions or proceedings in which a minor or a person with a disability (including a conservatee) is a party, or (3) dispositions of the proceeds of judgments for a minor or person with a disability. (See Code Civ. Proc., 247 372; Prob. Code, 247 3500 et seq.) You may use this form if (1) you are represented by an attorney; (2) the statements in items 3a, 3b, 3c, 3d, 3e, 3f, and either 3g(1) or 3g(2) below are true; and (3) the court does not otherwise order. If you qualify and choose to use this form, the court may consider and act on your petition without a hearing. If your compromise or judgment does not qualify for expedited treatment or you choose not to use this form, you must use the Petition to Approve Compromise of Disputed Claim or Pending Action or Disposition of Proceeds of Judgment for Minor or Person With a Disability (form MC-350), and the court will schedule a hearing. See Cal. Rules of Court, rules 7.950, 7.950.5, and 7.951.3.Expedited petitiona. The judgment for the claimant described in item 5c (exclusive of interest and costs) or the total of the settlement described in items 12 and 13 payable to the claimant and all other persons named in item 13 is in the amount of $50,000 or less; orb. The settlement described in item 12 represents payment of the single-person policy limits of all liability insurance policies covering the defendants named in that item. The investigation described in Attachment 3 shows that all of those defendants are judgment proof outside of their insurance coverage. (Describe investigation and results in c.No portion of the net proceeds of the judgment or settlement in favor of the claimant is to be placed in a trust.d.The claimant's claim or action is not for damages for the death of a person caused by the wrongful act or neglect of another.NOTICE TO PETITIONERS Petitioner's attorney did not become involved with this matter, directly or indirectly, at the request of a party against whom the claim is asserted or a party's insurance carrier. e. Petitioner's attorney is not representing, employed by, or associated with a defendant in this matter or an insurance carrier. (1) (2) Attachment 3.)g. There are no unresolved disputes concerning liens to be satisfied from the proceeds of the judgment or settlement.f. All defendants that have appeared in a pending action on the claim are participating in the proposed compromise or the court has finally determined that all settling parties entered into the settlement in good faith. Age:Sex:c. d. e. Minor Person with a disabilityf. CASE NAME:CASE NUMBER: Page 2 of 8 MC-350EX [New January 1, 2010]EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY(Miscellaneous)RelationshipPetitioner's relationship to the claimant (check all applicable boxes): a.b.c.d.e.f. ParentGuardian ad litemGuardianConservatorg.Disabled adult claimant is a petitioner. (See instructions for items 4e and 4f below.) Disabled adult claimant's express consent to the relief requested in this petition is provided on Attachment 4f. Other relationship (specify):4. 5. Nature of claimc. Case no.: Trial date:(Complete items 6?23.)(Attach a copy of the (proposed) judgment as Attachment 5c and complete items 14?23.)Name of court:Is not the subject of a pending action or proceeding. (Complete items 6?23.)Is the subject of a pending action or proceeding that will be compromised without a trial on the merits of the claim. The claim of the minor or adult person with a disability:The judgment was filed on (date): is the subject of a pending action or proceeding that has been or will be reduced to a judgment for the claimant against the defendants named below in the total amount (exclusive of interest and costs) of (specify): $Defendants (names) : Additional defendants listed on Attachment 5.Nature of incident or accident The facts, events, and circumstances of the incident or accident are (describe): Continued on Attachment 7.7. Place:Persons involved (names):6. Continued on Attachment 6. a.Date : b. c. Incident or accidentThe incident or accident occurred as follows: Time:(If you checked item 4e or 4f, state facts on Attachment 4e or 4f showing that the claimant has capacity under Probate Code section 812 to petition or consent to a petition. Only an adult claimant who has sufficient capacity and who does not have aconservator of the estate may petition or consent to a petition. See Probate Code section 3613.)a.b.MC-350EXCASE NAME:CASE NUMBER: Page 3 of 8 MC-350EX [New January 1, 2010]EXPEDITED PETITION TO APPROVE COMPROMISE OF DISPUTED CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY(Miscellaneous) Continued on Attachment 9.9. TreatmentThe claimant received the following care and treatment for the injuries described in item 8 (describe):The claimant has not recovered completely from the effects of the injuries described in item 8, and the following injuries from which the claimant has not recovered are permanent (describe the permanent injuries): c. Continued on Attachment 10c. a.The claimant has not recovered completely from the effects of the injuries described in item 8, and the following injuries from which the claimant has not recovered are temporary (describe the remaining injuries): b. Continued on Attachment 10b.10. The claimant has recovered completely from the effects of the injuries described in item 8, and there are no permanent injuries.Extent of injuries and recovery11.Petitioner has made a careful and diligent inquiry and investigation to ascertain the facts relating to the incident or accident in which the claimant was injured; the responsibility for the incident or accident; and the nature, extent, and seriousness of the claimant's injuries. Petitioner fully understands that if the compromise proposed in this petition is approved by the court and is consummated, the claimant will be forever barred from seeking any further recovery of compensation from the settling defendants named below even though the claimant's injuries may in the future appear to be more serious than they are now thought to be. Amount and terms of settlement By way of settlement, the defendants named below have offered to pay the following sums to the claimant:Amounts Defendants (names) The terms of settlement are described on Attachment 12. (If the settlement is to be paid in installments, both the total amount and the present value of the settlement must be included.)12. Additional defendants and amounts offered are listed on Attachment 12. $$$$a. b. The total amount offered by all defendants named below is (specify): $The defendants and amounts offered by each are as follows (specify):c. Continued on Attachment 8.8. InjuriesThe following injuries were sustained by the claimant as a result of the incident or accident (describe): MC-350EX(An original or a photocopy of all doctors' reports contai