Proposal For Minor Settlement

<document>COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.PROBATE COURT OF STARK COUNTY, OHIOCalendar No.IN RE: GUARDIANSHIP OFCASE NO.JUDICIAL SUBPOENACASE NO.IN THE MATTER OFPlaintiff(s) -against-Defendant(s)PROPOSAL FOR MINOR SETTLEMENTDATE OF BIRTHAGE OF MINORNAME OF FATHERNAME OF MOTHERADDRESS OF CUSTODIAN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NAME OF ATTORNEY (PLAINTIFF)NAME OF ATTORNEY (DEFENDANT)THE PEOPLE OF THE STATE OF NEW YORK TOBRIEF DESCRIPTION OF INJURYNATURE OF ACCIDENTSUIT FILEDYESNOPOLICY LIMITS $GREETINGS:OFFER OF SETTLEMENT $VERDICT $WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,DID THE PARENTS RECEIVE MONEY IN THIS OR A RELATED CASE?YESNOlocated at County ofIF YES, HOW MUCH $MINOR'S S.S. #o'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomEXPENSESMEDICAL EXPENSE$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 $50 and all damages sustained as a result of your failure to comply.HOSPITAL EXPENSETO PARENTS, one of the Justices of theATTORNEY FEE(%)Court in Witness, Honorableday of, 20 County,NET TO MINORSTRUCTUREDYESNOBEST RATING OF ANNUITY UNDERWRITER(Attorney must sign above and type name below)PRESENT VALUE OF STRUCTURE$WILL MINOR BE PRESENT?NOYESAttorney(s) forWILL BOTH PARENTSBEPRESENT?NOYESWILL DOCTOR'S DISCHARGE LETTER BE PRESENTED?NOYESOffice and P.O. AddressWILL TORTFEASOR'S ATTORNEY BE PRESENT?NOYESWILL FUNDS BE IMPOUNDED?NOYESTelephone No.: Facsimile No.: E-Mail Address:DATEATTORNEY FOR CLAIMANTMobile Tel. No.:DETAILS OF STRUCTURE ATTACHEDAmerican LegalNet, Inc. www.USCourtForms.com</document>