TO: _________________________________
(Name of Beneficiary)

DATE: __________________________________

YOU ARE HEREBY NOTIFIED THAT, _____________________________, Administrator/Executor of the Estate of ________________________, Deceased has filed (or will file) on _____________________________, A Petition to Approve a Settlement of a Wrongful Death and Survival Action. A copy of that Petition is enclosed.

If you object to the proposed settlement and/or proposed distribution, you must submit your written objections or Response to the Petition on or before* _____________________, 19____, to the following address:

I hereby certify that the within Notice has been mailed to the above named individual(s) on the date set forth above.

_________________________ Name of Attorney Attorney for Petitioner

*Unless waived by all beneficiaries or interested parties, the response period shall be thirty (30) days.