Petition To Settle Cause Of Action - Minors Estate {CC53}

STATE OF ILLINOIS UNITED STATES OF AMERICA IN THE CIRCUIT COURT OF THE TWENTY-THIRD JUDICIAL CIRCUIT COUNTY OF KENDALL IN RE THE ESTATE OF __________________ CASE NUMBER _____________________ MINOR PETITION TO SETTLE CAUSE OF ACTION ­ MINOR'S ESTATE I, of 1. The minor has a cause of action against For injury to him on File Stamp Here , guardian of the estate ______ , a minor, on oath states: , 20 by a reason of (briefly describe the accident) 2. The injuries were: 3. The minor was treated at Dr. 4. Suit has has not been filed as Case Number (Court) hospital, and attended by whose certificate is attached. in 5. A settlement of $ 6. The only charges against the proceeds are: has been offered, and the petitioner recommends that it be accepted. for hospitalization for medical treatment for medical treatment for medical treatment for court costs for bond premium for for for legal services: ( % of settlement) $ $ $ $ $ $ $ $ $ $ 11/13 CC53-1 American LegalNet, Inc. www.FormsWorkFlow.com STATE OF ILLINOIS UNITED STATES OF AMERICA IN THE CIRCUIT COURT OF THE TWENTY-THIRD JUDICIAL CIRCUIT COUNTY OF KENDALL For attorney's disbursements (itemize): for for for for TOTAL $ $ $ $ $ 7. A reasonable amount to be paid to for the benefit of the minor is $ 8. for $ until he reaches majority on (Name of Guardian, Parent of Relative, stating relationship) is a qualified depository , the balance of the settlement proceeds, to be held for the account of the minor , 20 , or until further order of the court. Petitioner asks leave to settle the cause of action for the sum offered, to distribute the proceeds and to be discharged as guardian. Signature Signed and Sworn before me this , 20 Notary Public CERTIFICATE OF ATTORNEY I certify that I have examined the facts of this case and the applicable laws and in my opinion the proposed Settlement is just and proper and that my disbursements were necessary and reasonable. Attorney Name: Kendall Attorney Number: Attorney for : Address: City/State/Zip: Telephone: 11/13 Pro Se CC53-2 American LegalNet, Inc. www.FormsWorkFlow.com