Supplement To Application To Approve Settlement And Distribution Of Wrongful Death And Survival Claims
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Supplement To Application To Approve Settlement And Distribution Of Wrongful Death And Survival Claims Form. This is a Ohio form and can be use in Stark County (Court Of Common Pleas).
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Tags: Supplement To Application To Approve Settlement And Distribution Of Wrongful Death And Survival Claims, 14.0C, Ohio County (Court Of Common Pleas), Stark
PROBATE COURT OF STARK COUNTY, OHIO
DIXIE PARK, JUDGE
, DECEASED
ESTATE OF
CASE NO.
SUPPLEMENT TO APPLICATION TO APPROVE SETTLEMENT
AND DISTRIBUTION OF WRONGFUL DEATH AND SURVIVOR CLAIMS
Attorney's Name (Plaintiff)
Attorney's Name (Defendant)
Age of Decedent
Attached hereto as an Exhibit is a narrative statement of facts in accordance with Sup. R. 70(A)
regarding the details of the claim.
Gross settlement or jury verdict
Recapitulation of expenses:
Funeral & burial
Last illness
Litigation expenses
Fiduciary fees
Attorney fees
Net remaining
$
$
$
$
$
$
$
The offer of settlement includes a structured settlement and the details of the structure
are attached hereto as an Exhibit.
Specific details of structured settlement: (attach written verification)
Present value of structure
Lifetime value of structure
Guaranteed value of structure
Immediate cash payment
$
$
$
$
Name of annuity underwriter
Best rating of annuity underwriter
The proposed settlement includes a wrongful death trust. Details of the wrongful death
trust, including a proposed Judgment Entry is attached hereto as an Exhibit.
Date
Attorney for Fiduciary
SCPC FORM 14.0C - SUPPLEMENT TO APPLICATION TO APPROVE SETTLEMENT
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