5/23/2017 Document Essentials for Settling Minor s Cases Jacquelyn D. Melius PROCESS OVERVIEW Settlement Agreement in Minor s Case Probate Estate Petition the Court for Approval Order mirrors Petition Detail Insurance, Treatment, and Expenses CH. 3C Page 1
5/23/2017 PETITION Background Information Your petitioner is the parent and next friend of SALLY DOE, a minor, who was born on June 12, 2002. The minor Plaintiff suffered personal injuries as a result of an automobile collision that occurred on July 29, 2009. A claim was made against JOHN SMITH of 123 ABC St., Racine, WI 53406. Insurance Policy Information At the time of the aforesaid occurrence, a policy of liability insurance was in effect providing coverage as follows: GEICO Insurance $100,000.00 per person/$300,000.00 per occurrence. CH. 3C Page 2
5/23/2017 INJURIES General Injury Information As a result of the aforesaid occurrence, the minor Plaintiff suffered injuries as follows: Headache; glass in her scalp; abrasions; and left ankle pain with a possible occult fracture. The minor Plaintiff came under the care of physicians at Vista Medical Center East, Kenosha Community Health Center, Wheaton Franciscan Healthcare and All Saints. The medical records are attached hereto as Exhibit A. Medical Expenses Expenses were incurred on behalf of the minor Plaintiff for her medical care and treatment. See the Specials Summary attached hereto as Exhibit B for the itemization of medical expenses. MEDICAL REPORT/INFO The Plaintiff was last seen by Dr. Kaz, an orthopedic surgeon, on July 31, 2009. As described in Paragraph 4, those records are attached hereto. The Plaintiff last saw Dr. Waltenberger, a surgeon, on December 16, 2009. His records are attached, as well. CH. 3C Page 3
5/23/2017 Necessary Language Your Petitioner retained the legal services of Dudley & Lake, LLC to represent the minor Plaintiff in the aforesaid claim for personal injuries. The attorney retained believes the settlement offer as described above is a fair and reasonable settlement of the personal injury claim of the minor Plaintiff; it is in the best interest of the minor Plaintiff that the settlement offer be accepted; and that the person against whom the claim for damages has been made be released from any and all further liability. 25% Fee Your Petitioner has agreed to pay attorney s fees to Dudley & Lake, LLC in the amount of 25% of any settlement, plus costs incurred for investigation purposes. CH. 3C Page 4
5/23/2017 COSTS Investigation costs have been incurred in the amount of $851.34. See itemization of costs attached hereto as Exhibit C. WHEREFORE clause Permitting your Petitioner to accept the settlement offer in the amount of $27,000.00 in consideration of your Petitioner executing and delivering a release of any and all claims; Directing the retained attorney to be paid the sum of $6,750.00 for attorney s fees, and further, the sum of $982.34 for the reimbursement of the amount paid out for investigation and litigation costs; That appointment of a Guardian Ad Litem be waived; and Directing the Petitioner to open an Estate in the Probate Division for the Circuit Court of Lake County, Illinois to oversee the net settlement funds distributed to the minor Plaintiff. CH. 3C Page 5
5/23/2017 ORDER The Petitioner is authorized to accept the settlement offer of $27,000.00, and is authorized to execute a release of any and all claims. The retained attorney shall be paid the sum of $6,750.00 for attorney s fees, and shall be paid the sum of $982.34 for reimbursement of investigation and litigation costs. Appointment of a Guardian ad Litem is waived. The Petitioner shall open an Estate in the Probate Division for the Circuit Court of Lake County, Illinois to oversee the net settlement funds distributable to the minor Plaintiff, NECESSARY PROBATE DOCUMENTS Petition for Appointment of Guardian Acceptance and Oath of Office Nomination of Guardian for Minor (if minor over 14 Appearance and Consent to Appointment Order Appointing Certificate of Depository http://www.lakecountycircuitclerk.org/court forms CH. 3C Page 6
5/23/2017 ADDITIONAL PROBATE DOCUMENTS (IF NO LAWSUIT Petition for Leave to Settle Order Authorizing Settlement CH. 3C Page 7
STATE OF ILLINOIS SS. COUNTY OF LAKE IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS JANE DOE, as mother and next friend of SALLY DOE a minor, and JANE DOES, Individually, Plaintiffs, No. vs. JOHN SMITH, Defendant. PETITION TO APPROVE SETTLEMENT NOW COMES, the Plaintiff, JANE DOE, as mother and next friend of SALLY DOE, a minor, by and through her attorneys, DUDLEY & LAKE, L.L.C., and for her Petition to Approve Settlement, states as follows: 1. Your petitioner is the parent and next friend of SALLY DOE, a minor, who was born on June 12, 1999. 2. The minor Plaintiff suffered personal injuries as a result of an automobile collision that occurred on July 29, 2009. A claim was made against JOHN SMITH of 123 ABC St., Racine, WI 53406. 3. At the time of the aforesaid occurrence, a policy of liability insurance was in effect providing coverage as follows: a. Geico Insurance - $100,000.00 per person/$300,000.00 per occurrence. CH. 3C Page 8
4. As a result of the aforesaid occurrence, the minor Plaintiff received injuries as follows: a. Headache; glass in her scalp; abrasions; and left ankle pain with a possible occult fracture. The minor Plaintiff came under the care of physicians at Vista Medical Center East, Kenosha Community Health Center, Wheaton Franciscan Healthcare and All Saints. The medical records are attached hereto as Exhibit A. b. Expenses were incurred on behalf of the minor Plaintiff for her medical care and treatment. See the Specials Summary attached hereto as Exhibit B for the itemization of medical expenses. 5. The Plaintiff was last seen by Dr. Kaz, an orthopedic surgeon, on July 31, 2009. As described in Paragraph 4, those records are attached hereto. 6. The Plaintiff last saw Dr. Waltenberger, a surgeon, on December 16, 2009. His records are attached, as well. 7. At a pre-trial settlement conference, this Honorable Court recommended a settlement figure of $27,000.00 and the parties agreed to same. 8. Your Petitioner retained the legal services of Dudley & Lake, LLC to represent the minor Plaintiff in the aforesaid claim for personal injuries. The attorney retained believes the settlement offer as described above is a fair and reasonable settlement of the personal injury claim of the minor Plaintiff; it is in the best interest of the minor Plaintiff that the settlement offer be accepted; and that the person against whom the claim for damages has been made be released from any and all further liability. CH. 3C Page 9
9. Your Petitioner has agreed to pay attorney s fees to Dudley & Lake, LLC in the amount of 25% of any settlement, plus costs incurred for investigation purposes. 10. Investigation costs have been incurred in the amount of $851.34. See itemization of costs attached hereto as Exhibit C. WHEREFORE, your Petitioner prays that an Order be entered: a. Permitting your Petitioner to accept the settlement offer in the amount of $27,000.00 in consideration of your Petitioner executing and delivering a release of any and all claims; b. Directing the retained attorney to be paid the sum of $6,750.00 for attorney s fees, and further, the sum of $982.34 for the reimbursement of the amount paid out for investigation and litigation costs; c. That appointment of a Guardian Ad Litem be waived; and e. Directing the Petitioner to open an Estate in the Probate Division for the Circuit Court of Lake County, Illinois to oversee the net settlement funds distributed to the minor Plaintiff. Respectfully submitted, Jacquelyn D. Melius Dudley & Lake, LLC 325 Milwaukee Ave., Ste. 202 Libertyville, IL 60048 847-362-5385 By: CH. 3C Page 10
STATE OF ILLINOIS SS. COUNTY OF LAKE IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS JANE DOE, as mother and next friend of SALLY DOE a minor, and JANE DOES, Individually, Plaintiffs, No. vs. JOHN SMITH, Defendant. ORDER This matter coming to be heard on Petition to Approve Settlement, the Court being fully advised in the premises, due notice having been given; IT IS HEREBY ORDERED: 1. The Petitioner is authorized to accept the settlement offer of $27,000.00, and is authorized to execute a release of any and all claims. 2. The retained attorney shall be paid the sum of $6,750.00 for attorney s fees, and shall be paid the sum of $982.34 for reimbursement of investigation and litigation costs. 3. Appointment of a Guardian ad Litem is waived. 4. The Petitioner shall open an Estate in the Probate Division for the Circuit Court of Lake County, Illinois to oversee the net settlement funds distributable to the minor Plaintiff, ORDERED BY: Order Prepared By: JUDGE CH. 3C Page 11
Jacquelyn D. Melius Dudley & Lake, LLC 325 Milwaukee Ave., Ste. 202 Libertyville, IL 60048 (847 362-5385 CH. 3C Page 12
IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS ESTATE OF Gen No.: a minor 1. Petitioner resides at: PETITION FOR APPOINTMENT OF GUARDIAN FOR A MINOR (Petitioner (Address, a reputable citizen of Illinois, hereby certifies: (City/State/Zip 2. Petitioner is a(n to the minor. (Relationship to Minor 3. The following minor child is in need of a guardian. (birth certificate required to be presented to the Judge (Name of Minor (Date of birth - mm/dd/yyyy (Current Address, City, State, Zip (Current County of Residence 4. The names and post-office address of the biological parents of the minor are: Mother (Name of Mother (Address, City, State, Zip Father (Name of Father (Address, City State, Zip 5. If one or both of the biological parents are no longer living (attach death certificate and list the minor s next closest relatives: (Name (Relationship to Minor (Address, City State, Zip (Name (Relationship to Minor (Address, City State, Zip (Name (Relationship to Minor (Address, City State, Zip (Name (Relationship to Minor (Address, City State, Zip 6. The minor currently resides with at and has so resided since. 7. Does Petitioner know of any orders of any court affecting the parentage, custody or guardianship rights of the minor? Yes No If yes, describe the order and state the name and current address of any person who has an interest in the minor as a result of such order(s: 8. Petitioner is years of age; employed as, has never been convicted of a felony, (Occupation is qualified and willing to act as guardian of the Person, Estate, Person and Estate of the minor. 9. The approximate value of the minor s personal estate is $. 10. The amount of current / anticipated gross annual income, financial assistance and other receipts is $. Page 1 of 2 CH. 3C 171P-31 Page (R 04/10 13
11. It is necessary or convenient that a guardian of the Person, Estate, Person and Estate be appointed because: 12. It is necessary that a temporary guardian be appointed in order to enroll the minor child in school and or obtain emergency medical treatment. (Delete if not requested WHEREFORE, Petitioner requests appointment as Guardian of Person, Estate, Person and Estate of: (Minor. CERTIFICATION Under penalties of perjury as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct. Date:, 20 Signature of Petitioner * - Any person who makes a false statement, material to the issue or point in questions, which he does not believe to be true, in any document certified by such person in accordance with 735 ILCS 5/1-109 shall be guilty of a Class 3 felony punishable by two (2 to five (5 years imprisonment and/or a $25,000.00 fine. Page 2 of 2 CH. 3C Page 14 171P-31 (R 04/10
IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS ESTATE OF Case No. a minor ACCEPTANCE AND OATH OF OFFICE I,, under penalties of perjury as provided by law (Name of Court-appointed Guardian hereby state that I accept the office of guardian of the person estate for (Name of Minor the above named minor; and further state that I will discharge faithfully the duties of said office. CERTIFICATION Under penalties of perjury as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct. Date:, 20. Signature of Court-appointed Guardian Printed Name of Court-appointed Guardian Prepared by: Name: Attorney s Name: Address: City: State: Phone: Zip Code: Fax: ARDC #: 2017 Civil Trial 171P-28 Seminar (Rev. & 12/11 Golf Outing CH. 3C Page 15
IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS ESTATE OF Case No.: a minor NOMINATION OF GUARDIAN FOR MINOR I,, am a minor over 14 years of age, and I do hereby nominate (Name of Minor as guardian of my person. (Name of Nominated Guardian Signature of Minor Printed name of Minor SUBSCRIBED and SWORN to before me this day of, 20. Notary Public (Seal Prepared by: Name: Attorney's Name: Address: City: State: Phone: Zip Code: Fax: ARDC #: CH. 3C Page 16 171P-256 (Rev. 12/11
IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS ESTATE OF Case No. a minor APPEARANCE AND CONSENT PETITION FOR APPOINTMENT/DISCHARGE OF GUARDIANSHIP FOR MINOR I,, relationship: mother, father or current guardian (Name of consenting party of the minor child, state that I am under no legal disability. (Name of minor child I do hereby appear, waive notice, and consent to the immediate appointment discharge of, as guardian of the person of the minor child. (Name of petitioner Signature of Consenting Party Printed Name of Consenting Party Address of Consenting Party City/State/Zip SUBSCRIBED and SWORN to before me this day of, 20. Notary Public (Seal CH. 3C Page 17 171P-386 (12/11
IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS ESTATE OF Gen No.: a minor ORDER APPOINTING GUARDIAN FOR A MINOR On the verified petition of, a reputable citizen of the state of Illinois (Name of Petitioner for the appointment of a guardian of, a minor, whose (Name of Minor date of birth is, and whose current residence is, (Minor s Address the Court finds that Petitioner is qualified and willing to act as guardian and has herewith presented to the Court his/her acceptance and oath of office. Additional findings of court: A. B. C. The Court has reviewed the minor s birth certificate and confirmed the minor s date of birth is ; (Minor s Birth Date the minor s mother s name is ; and the minor s father s name is. The Court has reviewed and accepted the Affidavit of Petitioning Guardian of the Person for a Minor Child and the related reports on the criminal background check and Department of Children and Family Services Register for the Petitioner. IT IS HEREBY ORDERED THAT is appointed. (Name of Petitioner Temporary Guardianship: Temporary guardian of the person of the minor; temporary guardian of the estate of the minor; and that Letters of Office as Temporary Guardian [ Co-Guardians] of the Person [ and Estate] shall issue, subject to termination on, 20 and this cause is continued to said date at 9:00 a.m. in courtroom C- for presentation of: proof of publication notice of proof of service by mail return of background check consent of parent or guardian birth certificate death certificate nomination by minor, and entry of plenary guardianship order. Plenary Guardianship: Plenary guardian of the person of the minor; plenary guardian of the estate of the minor; and that Letters of Office as Plenary Guardian [ Co-Guardians] of the Person [ and Estate] shall issue, subject to termination on the Minor s 18th birth date on, 20. CH. 171P-32 3C (R Page 01/11 18
Other: Dated at Waukegan, Illinois this day Enter: of, 20. Judge Prepared by: Name: Attorney for: Address: City/State/Zip: Telephone: ARDC: CH. 171P-32 3C (R Page 01/11 19
IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS ESTATE OF Case No. CERTIFICATE OF DEPOSITORY - RECEIPT To the Probate Court of Lake County, Illinois: The undersigned hereby acknowledges that Guardian or Personnel Representative of the Estate of Name of Ward or Decedent has deposited in the Name of Institution the sum of titled in the name of Guardian/Representative for the Estate of Ward/Decedent in Account Number. It is being understood that the same is to be held on deposit, in trust, with no withdrawals or distributions until further order of the Probate Court of Lake County, Illinois. Date:, 20 Name of Institution By: Its: Authorized Representative Print Name Signed and sworn to before me this day of, 20, Notary Public 2017 Civil Trial 171P-209 Seminar (Rev. & 12/11 Golf Outing CH. 3C Page 20