PETITION TO COMPROMISE DOUBTFUL CLAIM OF MINOR/ADULT WARD INSTRUCTIONS I. Specific Instructions 1. This form is to be used when petitioning the Probate Court for authorization to compromise a doubtful personal injury claim of a minor pursuant to O.C.G.A. § 29-3-3. 2. The term "gross settlement" is defined in O.C.G.A. § 29-3-3. 3. This form can also be used to compromise a doubtful personal injury claim of an adult ward pursuant to O.C.G.A. § 29-5-23 (c) (5); however, some modifications may be necessary. 4. This form must be modified when a covenant not to sue, as opposed to a release from liability, will be executed by the natural guardian or conservator. 5. This form may also be used when compromising claims other than personal injury claims pursuant to O.C.G.A. § 29-3-3, provided appropriate changes are made in the form. 6. If there is a legally qualified Conservator, it may not be necessary to file a separate Petition to Encroach on Corpus concerning the expenses listed in Paragraph 17 of this form. However, the Court may direct that a separate encroachment petition be filed, in which case the prayers listed on Page 8 and the provisions of the Order should be modified. 7. The full particulars as to the facts that give rise to the cause of action should be listed in the Petition. 8. The amount of assets the Minor/Adult Ward has prior to the settlement or action addressed in this Petition must be listed. 9. If an annuity or structured settlement is being purchased for the Minor/Adult Ward, the terms of the annuity must be specified on the form titled "Disclosure of Structured Settlement" and signed by the parties and the insurance company that is funding the annuity. 10. When a structured settlement is to be purchased for the Minor/Adult Ward, the terms of who is responsible for funding the annuity, including terms and time limits for the purchase and/or funding, should be included in the Final Order. 11. O.C.G.A. § 53-11-2 provides that a party to a probate proceeding who is not sui juris must be represented by a guardian provided that the Court may appoint a guardian ad litem or determine that the natural guardian, guardian, conservator or testamentary GPCSF 19 [1] Eff. July 2015 American LegalNet, Inc. www.FormsWorkFlow.com guardian has no conflict and may serve. Should a guardian ad litem be necessary because a party is not sui juris, use Supplement 1. [Also see O.C.G.A. § 29-3-22 (c) (5).] 12. Use Supplement 2 if the Court determines it is appropriate to appoint a special process server. 13. Use Supplement 3 when an additional certificate of service is necessary. 14. Exhibits should be labeled at the bottom of each exhibit as Exhibit "A," Exhibit "B," etc. in consecutive order. The corresponding letter of each exhibit should be inserted into the appropriate place in the form. II. General Instructions General instructions applicable to all Georgia Probate Court Standard Forms are available in each Probate Court, labeled GPCSF 1. GPCSF 19 [2] Eff. July 2015 American LegalNet, Inc. www.FormsWorkFlow.com IN THE PROBATE COURT COUNTY OF _______________________ STATE OF GEORGIA IN RE: ESTATE OF ) ) ESTATE NO. _________________ ____________________________________, ) MINOR/ADULT WARD ) PETITION TO COMPROMISE DOUBTFUL CLAIM OF MINOR OR ADULT WARD The Petition of [Full name of Petitioner(s)] First Middle Last , , whose physical address(es) is/are Street City County State Zip Code and mailing address(es) is/are Street City County State Zip Code , shows the Court the following: 1. The Minor/Adult Ward: [list full name and address of Minor/Adult Ward] ______________________________________________________________________________ [Full name and address of Minor/Adult Ward]First Middle Last ______________________________________________________________________________ [Full physical address] Street City County State Zip Code whose birth date is _________________________ and is ____________ years old, received personal injuries as a result of the following occurrence: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 2. The Minor/Adult Ward currently has cash and/or personal property in the amount of $ ___________________________ and will receive funds of $ ________________________ as a result of this settlement. Petitioner(s) currently has/have a bond on file, to cover the cash/personal property of this Minor/Adult Ward in the amount of $ ______________________. Petitioner(s) is/are prepared to file a bond or rider for a total of $ ____________________ to secure the amount of the personal property currently in the Minor's/Adult Ward's estate plus the proceeds of this compromised claim. GPCSF 19 [1] Eff. July 2015 American LegalNet, Inc. www.FormsWorkFlow.com [Complete either Paragraph 3 or Paragraph 4] 3. There is no conservator for the Minor/Adult Ward, and: [Initial one] _____ The Petitioner(s) herein has/have filed a Petition to be appointed conservator(s) along with the filing of this Petition. _____ The Petitioner(s) do(es) not seek to be appointed as conservator(s), but another person, __________________________________, will file a Petition for appointment as conservator at the same time or shortly after this Petition is filed. _____ The Petitioner(s) allege(s) that the establishment of a conservatorship is not necessary because: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 4. [Initial if applicable] _____ The Petitioner(s) is/are the Conservator for the Minor/Adult Ward. Copies of the Order of Appointment and Letters of Conservatorship are attached hereto as Exhibit "____." _____ ____________________________ is/are the Conservator(s) for the Minor/Adult Ward. Copies of the Order of Appointment and Letters of Conservatorship are attached hereto as Exhibit "____." 5. The claim being settled by this Petition is against ________________________________ by virtue of an incident occurring on or about