IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY
FIRST JUDICIAL DISTRICT
: CIVIL TRIAL DIVISION
:
: TERM, 19
:
: NO:

ORDER APPROVING SETTLEMENT
AND
ORDER FOR DISTRIBUTION

AND NOW, thisday of, 19 , upon consideration of the Petition For Leave to Compromise A Minor's Action, filed ____________________ it is hereby ORDERED and DECREED that Petitioner is authorized to enter into a settlement with
Defendant(s) ______________________________________________________________ in the
gross sum of ____________________________ ($ ) Dollars. Defendant(s) shall forward all settlement drafts or checks to Petitioners' counsel for proper distribution.

IT IS FURTHER ORDERED and DECREED that the settlement proceeds be allocated as follows:

NAMEDATE OF BIRTH SOC. SEC. #
________________________________________________$_____________
________________________________________________$_____________

BY THE COURT:
_________________________________
J.
ORPHANS' COURT DIVISION


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