MC-350 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CASE NAME: CASE NUMBER: PETITION TO APPROVE: COMPROMISE OF DISPUTED CLAIM COMPROMISE OF PENDING ACTION DISPOSITION OF PROCEEDS OF JUDGMENT Minor Person With a Disability HEARING DATE: DEPT.: TIME: NOTICE TO PETITIONERS: Except as noted below, you must use this form to request court approval of (1) the compromise of a disputed claim of a minor, (2) the compromise of a pending action or proceeding in which a minor or a person with a disability (including a conservatee) is a party, or (3) the disposition of the proceeds of a judgment for a minor or person with a disability. (See Code Civ. Proc., § 372; Prob. Code, § 3600 et seq.) You and the minor or disabled person must attend the hearing on this petition unless the court for good cause dispenses with a personal appearance. The court may require the presence and testimony of witnesses, including the attending or examining physician, and other evidence relating to the merits of the claim and the nature and extent of the injury, care, treatment, and hospitalization. The court may consider on an expedited basis without a hearing requests for approval of the compromises of certain claims and actions or the disposition of the proceeds of certain judgments. If your claim, action, or judgment qualifies for expedited consideration and you want to request it, you must use form MC-350EX for your request. See Cal. Rules of Court, rule 7.950.5. 1. Petitioner (name): 2. Claimant (name): a. Address: b. Date of birth: a. b. c. d. e. f. c. Age: d. Sex: e. Minor Person with a disability 3. Relationship Petitioner's relationship to the claimant (check all applicable boxes): Parent g. Other relationship (specify:) Guardian ad litem Guardian Conservator Disabled adult claimant is a petitioner. (See instructions for items 3e and 3f below.) Disabled adult claimant's express consent to the relief requested in this petition is provided on Attachment 3f. (If you checked item 3e or 3f, state facts on Attachment 3e or 3f 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 a conservator of the estate may petition or consent to a petition. See Probate Code section 3613.) 4. Nature of claim The claim of the minor or adult person with a disability: Has not been filed in an action or proceeding. (Complete items 5­23.) a. Is the subject of a pending action or proceeding that will be compromised without a trial on the merits of the claim. b. Name of court: Case no.: Form Adopted for Alternative Mandatory Use Judicial Council of California MC-350 [Rev. January 1, 2011] Trial date: (Complete items 5­23.) Page 1 of 10 Code of Civil Procedure, § 372 et seq.; Probate Code, § 3500 et seq.; Cal. Rules of Court, rules 3.1384, 7.101, 7.950, 7.951 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com PETITION TO APPROVE COMPROMISE OF DISPUTED CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous) MC-350 CASE NAME: CASE NUMBER: The claim of the minor or adult person with a disability: 4. Nature of claim c. 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 below): $ Defendants (names) Additional defendants listed on Attachment 4. 5. Incident or accident a. Date and time: b. Place: c. Persons involved (names): The judgment was filed on (date): (Attach a copy of the (proposed) judgment as Attachment 4c and complete items 13­23.) The incident or accident occurred as follows: Continued on Attachment 5. 6. Nature of incident or accident The facts, events, and circumstances of the incident or accident are (describe): Continued on Attachment 6. 7. Injuries The following injuries were sustained by the claimant as a result of the incident or accident (describe): Continued on Attachment 7. 8. Treatment The claimant received the following care and treatment for the injuries described in item 7 (describe): Continued on Attachment 8. MC-350 [Rev. January 1, 2011] PETITION TO APPROVE COMPROMISE OF DISPUTED CLAIM OR PENDING ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY (Miscellaneous) Page 2 of 10 MC-350 CASE NAME: CASE NUMBER: 9. Extent of injuries and recovery (An original or a photocopy of all doctors' reports containing a diagnosis of and prognosis for the claimant's injuries, and a report of the claimant's present condition, must be attached to this petition as Attachment 9. A new report is not necessary so long as a previous report accurately describes the claimant's current condition.) a. b. The claimant has recovered completely from the effects of the injuries described in item 7, and there are no permanent injuries. The claimant has not recovered completely from the effects of the injuries described in item 7, and the following injuries from which the claimant has not recovered are temporary (describe the remaining injuries): Continued on Attachment 9b. c. The claimant has not recovered completely from the effects of the injuries described in item 7, and the following injuries from which the claimant has not recovered are permanent (describe the permanent injuries): Continued on Attachment 9c. 10. 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: a. The total amount offered by all defe