__[Attorney name]__ __[Address]__ __[Telephone number]__ Attorney for Plaintiff, __[name]__ _ _ _ _ _ _ Court, County of _ _ _ _ _ _ __[_ _ _ _ _ _ District]__ _ _ _ _ _ _ _ _ _ _ _ _ _ ) No. _ _ _ _ _ _ Plaintiff) By __[name]__, ) ORDER APPROVING COMPROMISE OF __[his/her]__ guardian ) __[MINOR/INCOMPETENT]__'S ad litem )CLAIM vs. ) ) _ _ _ _ _ _ _ _ _ _ _ _ _ ) Defendant(s)) _________________________ ) The petition of __[name]__, as guardian ad litem for plaintiff, __[name]__, __[a minor/an incompetent person]__, for an order approving the proposed compromise of plaintiff's claim against defendant, __[name]__, was heard at the above date and time. Appearing as attorneys were: __[List names of attorneys and parties represented by each]__. Satisfactory proof having been made, and good cause appearing, IT IS ORDERED that: 1. The compromise be approved. 2. On payment of $_ _ _ _ _ _ in the manner provided below, defendant be fully released and discharged from all claims of plaintiff arising from the facts set forth in the petition. 3. The proceeds of the settlement be disbursed as follows: a.__[Itemize payments authorized to be made from settlement proceeds, e.g., to Allen & Black, Attorneys-at-Law, for legal services rendered, $_ _ _ _ _ _, and for costs advanced, $_ _ _ _ _ _; to Dr. John Smith, for medical services rendered, $_ _ _ _ _ _]__. b.The balance of $_ _ _ _ _ _ is to be __[state disposition, e.g., deposited in the Union Central Bank, Main Street Branch, in the name of petitioner as trustee for plaintiff, together with a certified copy of this order, and is not to be withdrawn without first obtaining a court order. Bond is hereby waived]__. 4. On receipt of the full amount of the settlement, petitioner be authorized and directed to execute and deliver to defendant: a.A complete final release and discharge of all claims of plaintiff arising from the facts set forth in the petition. b.A properly executed dismissal of this action with prejudice. 5. __[State any additional orders]__. Date: _ _ _ _ _ _ ___________________________ Judge
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Legal Forms : Set Two