Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Order Approving Settlement Of Minors Claim With Minors Funds To Be Deposited With Restricted Withdrawal Form. This is a Illinois form and can be use in Dupage Local County.
Loading PDF...
Tags: Order Approving Settlement Of Minors Claim With Minors Funds To Be Deposited With Restricted Withdrawal, Illinois Local County, Dupage
STATE OF ILLINOIS
)
) SS.
COUNTY OF DU PAGE)
IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT
DU PAGE COUNTY, ILLINOIS
)
)
)
)
)
vs.
No.
ORDER APPROVING SETTLEMENT OF MINOR’S CLAIM
WITH MINOR’S FUNDS TO BE DEPOSITED WITH RESTRICTED WITHDRAWAL
This cause coming on for hearing for approval of settlement of minor’s claim, the Court
does find:
1.
The minor plaintiff is: (name) _____________________________________________
and the minor’s birth date is ______________________________.
2.
The minor plaintiff makes claim for personal injuries against ______________________
arising out of ________________________ on ________________________________.
3.
At the time of the occurrence, a policy or policies of liability insurance were in effect
providing coverage of _________ per person or __________ per occurrence. The
insurer is ______________________________.
4.
As a result of the occurrence, the minor plaintiff received injuries of: _______________
_____________________________________________________________________.
5.
Medical and hospital expenses incurred on behalf of the minor plaintiff amount to
___________.
6.
A current statement of a medical doctor evaluating the condition of the minor plaintiff is
attached to this order.
7.
An offer of settlement of the claim for damages for personal injuries to the minor plaintiff
has been made in the sum of _________________ in exchange for a properly executed
release.
8.
_______________________________, ______________________________ of the
(name)
(relationship)
minor plaintiff has requested approval be granted to accept the offer.
9.
_______________________________, attorneys for minor plaintiff, have rendered
10.
_______ hours of professional services valued at __________________.
Costs and expenses of minor’s claim have been incurred in the amount of __________.
(name)
Appendix of Civil Forms
G
American LegalNet, Inc.
www.FormsWorkflow.com
IT IS THEREFORE ORDERED that the following is approved:
1.
Settlement in the amount of _________________ in exchange for a properly executed
release of any and all claims.
2.
Payment from settlement proceeds to: _______________________________________
Attorneys fees: ________________________________________________________
Reimbursement of costs and expenses: _____________________________________
3.
Payment of net settlement proceeds to a guardian of the estate of the minor plaintiff in
the amount of ______________________.
IT IS FURTHER ORDERED that:
1.
______________________________, __________________________________ is
(name)
(relationship)
appointed guardian of the Estate of __________________________, the minor plaintiff.
2.
Net settlement proceeds to the minor plaintiff in the amount of ____________ shall be
deposited in _______________________________, ____________________________
(name of depository)
(address)
______________________________________________________________________
for the benefit of the Estate of _______________________, the minor plaintiff, and no
part of said amount shall be withdrawn without approval by court order or until the minor
attains majority on ___________________.
(date)
3.
The guardian shall file a surety bond in the amount of $___________ pending deposit of
the minor’s funds as ordered.
OR (Strike non-applicable paragraph)
4.
The Court finds it is in the best interests of the minor to waive surety. The appointed
guardian shall file a personal bond in the amount of $_________ and
__________________________ has personal responsibility for depositing the minor’s
(name of attorney, not firm)
funds as ordered.
5.
Voucher from the depository acknowledging receipt of the minor’s funds, the restriction
on withdrawal without approval by court order, and the date of the minor’s majority shall
be presented on ___________________ at __________ o’clock, at which time bond of
the guardian may be canceled.
ENTER: ___________________________
Judge
Appendix of Civil Forms
H
American LegalNet, Inc.
www.FormsWorkflow.com
