COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. : Calendar No. IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY : Plaintiff(s) JUDICIAL SUBPOENA FIRST JUDICIAL DISTRICT -against- : : : : : : CIVIL TRIAL DIVISION : TERM, 20____ : No. Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ORDER .APPROVING SETTLEMENT ...... .......... AND ORDER FOR DISTRIBUTION AND NOW, this OF NEW of __________________, 20____, upon consideration of the Petition For Leave to THE PEOPLE OF THE STATE ______ dayYORK TO Compromise A Minor’s Action, filed _____________________________________ it is hereby ORDERED and DECREED that Petitioner is authorized to enter into a settlement with Defendant(s) _____________________________ in the gross sum of ____________________________________ ($___________) Dollars. Defendant(s) shall forward all settlement drafts or checks to Petitioners’ counsel for proper distribution. IT IS FURTHER ORDERED and DECREED that the settlement proceeds be allocated as follows: GREETINGS: 1. To: Minor Plaintiff(s) WE COMMAND YOU, that all business and excuses BIRTH laid aside, you SECURITY # you attend before NAME DATE OF being SOCIAL and each of the Honorable __________________________ at the Court __________________ _____________________ $ _____________ , located at County of __________________________ _____________________ __________________ $ _____________ in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify To: Adult Plaintiff(s)as a witness in this action on the part of the 2. and give evidence _______________________________________ $____________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to _______________________________________ $____________________ the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a IT IS FURTHER result of your failure to comply. ORDERED and DECREED that the settlement proceeds be distributed as follows: 1. Court in Minor Plaintiff* Witness, Honorable NAME County, day of __________________________ __________________________ , one of the Justices of the SOCIAL SECURITY # , 20 _____________________ __________________ $ _____________ DATE OF BIRTH _____________________ __________________ $ _____________ a. (Attorney must sign above and type name below) To: ________________________________ , Esquire $____________________ Reimbursement of Costs b. To: _______________________________________ $____________________ Attorney(s) for Costs c. To: ________________________________ , Esquire Counsel Fees d. The balance, the sum of $___________, payable to ________________________, a minor, Office and P.O. Address shall be distributed as follows+: $____________________ * The share of each minor Plaintiff shall be separately distributed. + Telephone annuity, In the event a portion of the settlement is payable through the purchase of an No.: set forth the credit rating of the entity which assumes responsibility for future payments, the present cost ofFacsimile No.: as the periodic and lump sum payments. the annuity, as well E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. : -against- Calendar No. : Plaintiff(s) OPTION 1 : JUDICIAL SUBPOENA To: _______________________________________ , Guardian of the Estate of _______________________, : a minor; provided, however, that no payment shall be made to the guardian until the guardian has posted additional security as required by the Orphans’ Court Division of ____________________County pursuant to 20 Pa.C.S. §5121, et seq. An appropriate Petition shall be filed with the Orphans’ Court within thirty (30) days. : Defendant(s) OPTION: 2 ...................................................... Counsel is hereby authorized to execute all documentation necessary to purchase saving certificate(s), from federally insured banks or savings institutions having an office in Philadelphia County, in the sum of $___________, each not to exceed the insured amount, with the funds payable to the minor upon majority. The certificate shall be titled and restricted as follows: THE PEOPLE OF THE STATE OF NEW YORK TO ___________________________, a minor, not to be redeemed except for renewal in its entirety, not to be withdrawn, assigned, negotiated, or, otherwise alienated before the minor attains majority, except upon prior Order of Court. Counsel shall open a savings account in the sum of $___________ in the name of the minor. The savings account shall be titled and restricted as follows: GREETINGS: ___________________________, a minor, not to be withdrawn before the minor attains majority, except for the payment of city, state, and that all business and the interest earned by the savings certificate and savings account, or WE COMMAND YOU,federal income taxes on excuses being laid aside, you and each of you attend before upon , the Honorable prior Order of Court. at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed 2. Adult Plaintiff* or adjourned date, to testify and give evidence as a witness in this action on the part of the The portion of the settlement payable to ________________________, an Adult Plaintiff named in the Complaint, shall be distributed as follows: To: ________________________________, Esquire $____________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to ReimbursementwasCosts for a maximum penalty of $50 and all damages sustained as a for issued the party on whose behalf this subpoena result of your failure to comply. To: _______________________________________ Costs Witness, Honorable Court in County, day of , 20 To: ________________________________, Esquire $____________________ , one of the Justices of the $____________________ Counsel Fees To: _______________________________________ $____________________ (Attorney must sign above and type name below) Plaintiff Pursuant to Phila. Civ. R. #2039.1(I), counsel shall file with the office of Civil Administration within sixty (60) days from the date of this final Order, proof of the establishment of the accounts as required herein, by Affidavit from counsel certifying compliance with this Order. Counsel shallAttorney(s) for attach to the Affidavit a copy of the Certificate of Deposit and/or bank account containing the required restrictions. BY THE COURT: _______________________________________ Office and P.O. Address J. ORPHANS’ COURT DIVISION *The share of each adult plaintiff shall be separately distributed. Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com