Name, Address and Telephone No. of Attorney(s) Space Below for Use of Court Only Attorney(s) for (SUPERIOR or JUSTICE) COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO (Name of Justice Court District or branch court, if any) Plaintiff(s): CASE NUMBER Defendant(s): Order Approving Compromise of Minor's Claim (Abbreviated Title) (Under Section 372 C.C.P.) The Petition of ad litem, hereinafter called "petitioner," minor against hereinafter called "payor", came on regularly for hearing on , as guardian for approval of the proposed compromise of the claim of the above-named 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 said sum of $ (being the total amount of the settlement sum herein approved) in the manner herein provided, the payor shall be fully 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 settlement: 13-2141-356 8/88 ORDER APPROVING COMPROMISE OF MINOR'S CLAIM 2002 © American LegalNet, Inc. SB-27 (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 (Name of depositary) 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 Branch, and shall deliver to said depositary 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. Recept of Depository of Order to Deposit Money shall be filed with the Court within ten (10) days. Attorney fees shall not be paid until such time as the balance of the funds have been deposited pursuant to this order. (3) The Court finds said minor was born . When said minor attains the age of eighteen (18) years, said depository without further order of this Court, is authorized and directed to pay, upon proper demand, the monies, hereby ordered to be deposited, directly to said minor. 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 any and all claims and demands of said minor by reason of the accident described in said petition and resultant injuries and damages to said minor, and a properly executed dismissal of this action with prejudice. Dated: Judge 2002 © American LegalNet, Inc.