ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS): TELEPHONE NO.: FOR COURT USE ONLY ATTORNEY(S) FOR (NAME): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO 351 North Arrowhead Avenue, San Bernardino, CA 92415-0210 8303 Haven Avenue, Rancho Cucamonga, CA 91730 14455 Civic Drive, Victorville, CA 92392 235 East Mountain View, Barstow, CA 92311 6527 White Feather Road, Star Route 1, Box 60, Joshua Tree, CA 92252 TITLE OF CASE (ABBREVIATED) IN THE MATTER OF THE DISPUTED CLAIM OF , A Minor ORDER APPROVING COMPROMISE OF MINOR'S CLAIM (Under Section 3500 Pr. C.) The Petition of for approval of the proposed compromise of the claim of the above-named minor against CASE NUMBER: , hereinafter called "petitioner," , hereinafter called "payor," came on regularly for hearing in Dept. of the above-entitled court. Upon the evidence introduced, the court finds that the facts set forth in said petition are true and that it is for the best interests of the minor that said claim be compromised and settled for the amount hereinafter stated and that the proceeds of such settlement be paid and used in the manner hereinafter specifically provided; IT IS THEREFORE ORDERED: A. That said compromise be and it is hereby approved and that upon payment of the sum of $ (being the total amount of the settlement sum herein approved) in the manner herein provided, the payor shall be and forever released and discharged of and from all claims, charges and demands of said minor arising from the accident mentioned in said petition; B. Payor shall disburse the proceeds of the settlement hereby approved in the following manner: (1) By one or more checks or drafts drawn payable to the order of petitioner and/or the respective parties entitled to receive payment of the following items of expense or damage which the petitioner is hereby authorized and directed to pay out of the proceeds of the settlement: ORDER APPROVING COMPROMISE OF MINOR'S CLAIM ACIS Code 37306(02) 13-1813-360 Rev. 10/94 SB-26 2002 © American LegalNet, Inc. (a) Attorneys' fees hereby fixed and allowed to . . . . . . . . . . . . . . . . . . (b) Reimbursement to petitioner for medical and other expenses paid by petitioner . . . . . (c) Medical, hospital, ambulance, nursing, and other like expenses . . . . . . . . . . . (d) Other (Specify) $ $ $ $ $ $ Total of allowances for fees and expenses . . . . . . . . . . . . . . . . . . $ (2) By check or draft drawn payable to the order of petitioner as trustee for said minor, and bearing an endorsement on the face or reverse side of such check or draft to the effect that same is for deposit to the account of said petitioner as trustee for said minor, in the amount of $ . Within 48 hours after receiving the check or draft mentioned in this Paragraph B (2), petitioner shall deposit same in petitioner's name as trustee for said minor in Branch, and shall deliver to said bank two (2) copies of the Order to Deposit Money, which order is being signed contemporaneously herewith. Petitioner shall make no withdrawal from said account without first obtaining an order of this court authorizing same. Bond is hereby waived. C. Upon receipt of the full amount of the settlement sum herein approved, petitioner is hereby authorized and directed to execute and deliver to said payor a full, complete, and final release and discharge of and from any and all claims and demands of said minor by reason of the accident described in said petition and the resultant injuries and damage to said minor. Dated by , Judge 2002 © American LegalNet, Inc.