Report Of Distribution And Entry Minors Claim {MST22.4}

<document>COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PROBATE COURT OF LUCAS COUNTY, OHIO JACK R. PUFFENBERGER, JUDGE:::::::Index No.Calendar No.IN THE MATTER OF THE MINOR SETTLEMENT OF CASE NO. JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)REPORT OF DISTRIBUTION AND ENTRY MINOR'S CLAIMPursuant to Entry Filed , , the proceeds have been paid as shown below and on the accompanying vouchers. Gross Proceeds$ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Less:Medical expenses$ Reimbursement of suit expenses toTHE PEOPLE OF THE STATE OF NEW YORK TO$ Attorney Fees to$ Loss of service to$ Other:$ Total$ GREETINGS:Net Proceeds . Deposited pursuant to R.C. 2109.13 Form 22.3 attachedWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County of$ . Delivered to legal guardian of the estateo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in room$ . Delivered to parent(s) and natural guardian(s)$ . Delivered to the person by whom the minor is maintainedYour 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 $50 and all damages sustained as a result of your failure to comply.$ . Structured see documents previously filed$ , one of the Justices of theCourt in Witness, Honorableday of, 20 County,. Balance$-0-(Attorney must sign above and type name below)Attorney for ApplicantApplicant Attorney Registration No.Attorney(s) forENTRYThe above report of distribution is hereby approved and the applicant is discharged from further responsibility.Office and P.O. AddressDateJudge Jack R. PuffenbergerTelephone No.: Facsimile No.: E-Mail Address:«NTU33/5i-Mobile Tel. No.:4/97FORM 22.4 REPORT OF DISTRUIBUTION AND ENTRY MINOR'S CLAIMAmerican LegalNet, Inc. www.USCourtForms.com</document>