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Entry Approving Settlement And Distribution Of Wrongful Death And Survival Claims Form. This is a Ohio form and can be use in Lorain County (Court Of Common Pleas).
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Tags: Entry Approving Settlement And Distribution Of Wrongful Death And Survival Claims, 14.2, Ohio County (Court Of Common Pleas), Lorain
Lorain County Probate Court
Judge James T. Walther
ESTATE OF _______________________________________________________, DECEASED
CASE NO. _______________________
ENTRY APPROVING SETTLEMENT AND DISTRIBUTION OF
WRONGFUL DEATH AND SURVIVAL CLAIMS
Upon hearing the application to approve settlement and distribution of the wrongful death and survival claims, the
Court:
Approves the proffered settlement of $ _______________________________.
Orders payment of $ _____________________________ to be applied to decedent's funeral and burial
expenses.
Orders payment of $ ____________________________ to the fiduciary for services rendered with respect to
the wrongful death and survival claims.
Orders payment of $ ____________________________ to the attorney for reimbursement of case expenses
and $ ______________________________ for attorney fees for services rendered with respect to the wrongful
death and survival claims.
Orders that the net proceeds of $ _____________________________ be allocated $ ____________________
to the wrongful death claim and $ ______________________________ to the survival claim. The amount
allocated to the survival claim shall be considered an asset of the estate and shall be reflected in the fiduciary's
account of the administration of the estate.
Finds all of the beneficiaries of the wrongful death claim are on an equal degree of consanguinity, are adults,
and have agreed how the net proceeds allocated to the wrongful death claim are to be distributed.
Orders distribution of the net proceeds allocated to the wrongful death claim to the surviving spouse, children,
parents and other next of kin, in the equitable shares shown below, fixed by the Court having due regard for the
injury and loss to each beneficiary resulting from the death and for the age and condition of the beneficiaries.
___________________________________________________________________________________________
Name
Residence
Relationship
Birthdate
Amount
Address
to Decedent
of Minor
___
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
FORM 14.2 - ENTRY APPROVING SETTLEMENT AND DISTRIBUTION OF
WRONGFUL DEATH AND SURVIVAL CLAIMS
4/1/97
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(Reverse of Form 14.2)
Orders that the share of:
______________________________________________________________________a minor(s) be
deposited in lieu of bond pursuant to R.C. 2111.05.
______________________________________________________________________a minor(s) be paid to
the guardian of the estate of such minor.
_______________________________________________________________________a child(ren) be
deposited in a trust for the benefit of the child(ren) until twenty-five years of age.
Authorizes the fiduciary to execute a release which, upon payment, shall be a discharge of the claim.
Orders the fiduciary and the attorney to report the distribution of the proceeds within thirty days of the date of this
Entry.
Further orders ______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Approved:
____________________________________________
Attorney for Fiduciary
______________________________________
JUDGE
Attorney Registration No. ____________________
______________________________________
Date
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