PROBATE COURT OF SUMMIT COUNTY, OHIO GUARDIANSHIP OF: CASE NO. , A MINOR JUDGMENT ENTRY - MINOR SETTLEMENT This matter came on to be heard this day upon the Application to Settle a Minor's Claim pursuant to R.C. 2111.18. This Court finds upon the pleadings, the testimony and other evidence presented in open Court that the Application is well-taken. IT IS SO ORDERED, ADJUDGED, AND DECREED that the Applicant is authorized to settle the minor's claim upon the terms as set forth in the Application, and to execute all necessary releases. IT IS FURTHER ORDERED that: Attorney fees in the sum of $ beneficial to the minor. are approved in that the fees were reasonable and The net estate to the minor exceeds $25,000.00 and shall be delivered to the appointed guardian of the minor's estate, to be accounted for in his trust. The net estate to the minor does not exceed $25,000.00, and the appointment of a guardian is dispensed with. The sum of $ minor's benefit. shall be delivered to the custodian of the minor to be expended for the The amount of the structured settlement as attached to the Application is approved. The sum of $ shall be deposited in a local banking institution, to wit, , in the name of the minor, impounding both the principal and interest and releasing said funds to the minor at the age of majority (18) or upon further Order of the Court. Counsel shall file a verification of deposit with the Court within seven (7) days of this Order. IT IS SO ORDERED. JUDGE ELINORE MARSH STORMER APPROVED: Attorney Form 22.2 American LegalNet, Inc. www.FormsWorkFlow.com