PROBATE COURT OF STARK COUNTY, OHIO IN THE MATTER OF CASE NO. ENTRY APPROVING SETTLEMENT OF A MINORS CLAIM Upon hearing the application to approve and distribute the settlement of the claim of the minor, the Court: [check whichever of the following are applicable] Approves the proffered settlement of $ Orders payment of $ for medical and other expenses, as follows: Orders payment of $ to the attorney for reimbursement of suit expenses and $ for attorney fees for service rendered with respect to this matter; Orders payment of $ to the parent for damages on account of loss of service of this minor; Authorizes the applicant to execute a release which, shall be effective upon payment of the settlement; Orders that the net amount of $ , for the benefit of the minor be: Deposited in the name of the minor and not to be released until the mino r attains the age of majority or upon further order of this Court with For m 22.3 Verification of Receipt and Deposit filed with the Court; Delivered to the legal guardian of the estate of this minor; Delivered to , parent and natural guardian Delivered to , the person by whom the minor is maintained; Structured as set forth in the documents attached to the application; Orders the applicant and the attorney to report on their distribution of the proceeds within thirty days of the date of this entry; Further orders Date Dixie Park, Probate Judge American LegalNet, Inc. www.USCourtForms.com FORM 22.2 - ENTRY APPROVING SETTLEMENT OF A MINORS CLAIM 10/1/98