PROBATE COURT OF __________________ COUNTY, OHIO IN THE MATTER OF ___________________________________________________ CASE NO. ___________________ ENTRY APPROVING SETTLEMENT OF A MINOR'S 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 minor attains the age of majority or upon further order of this Court with Form 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 ____________________________________________ Probate Judge Print Form FORM 22.2 - ENTRY APPROVING SETTLEMENT OF A MINOR'S CLAIM 10/1/98 American LegalNet, Inc. www.FormsWorkFlow.com