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HomeMy WebLinkAbout07-0798 RE: MIGUEL GARCIA :IN THE COURT OF COMMON PLEAS :CUMBERLAND COUNTY, PENNSYLVANIA : NO. C'Y - '79P CI"u~LJ~ PETITION FOR PARTIAL TRANSFER OF STRUCTURED SETTLEMENT PURSUANT TO STRUCTURED SETTLEMENT PROTECTION ACT 40 P.S. 4000 ET. SEQ. TO THE HONORABLE JUDGES OF SAID COURT: AND NOW comes Petitioner, Miguel Garcia, by and through counsel, Lawrence J. Rosen, Esquire, and respectfully represents as follows: 1. Petitioner is and adult individual residing at 2250 Dusty Lane, Enola, P A 17025. 2. Petitioner is the beneficiary of an annuity contract issued by Allstate Life Insurance Company located at 544 Lakeview Parkway, L3F, Vernon Hills, IL 60061. The structured settlement provides payments to the Petitioner as follows: A. Lump sum payment of$32,000.00 due on.................................................10/27/2000 B. Lump sum payment of $50,000.00 due on................................................. 10/27 /2005 C. Lump sum payment of $75,000.00 due on................................................. 1 0/27/2010 3. The structured settlement payment schedule is more fully set forth in the Policy Certificate. (Attached hereto as Exhibit "A") 4. Petitioner proposes to enter into a purchase agreement with 321 Henderson Receivables Origination LLC ("Buyer" or "Transferee"), its nominees, successors, or assigns, whose address is 40 Morris avenue, Bryn Mawr, PA 19010 who will purchase one payment of seventy five thousand dollars ($75,000.00) due on October 27, 2010 owned by Erie Insurance Exchange and issued by Allstate Life Insurance Company for a one time payment of forty seven thousand five hundred dollars ($47,500.00). A copy of the Purchase Agreement is attached hereto, made a part hereof, and designated as "Exhibit B". 5. The Buyer/Purchaser has furnished Petitioner with a Disclosure Statement pursuant to 40 P.c. Section 4003 (See Exhibit C) at least 10 days prior to the date on which Petitioner first incurred any obligation to the Buyer. The Statute also requires a Petition and court Order, authorizing the sale and a finding the sale is in the best interest of the Petitioner or the Petitioner's dependents. 6. The buyer/purchaser has served written notice, including its name, address and tax identification number, to the structured settlement obligor and has served written notice as required by Pennsylvania Statute 40 P.S. Section 4004 upon all interested parties, none of whom have objected to the transfer. True and correct copies of said notices are attached hereto made a part hereof and designated as "Exhibit D". 7. Petitioner's best interest would be served by granting the relief requested herein so that Petitioner can obtain appropriate housing for his family. WHEREFORE, Petitioner respectfully requests this Honorable Court to enter a rule upon Allstate Life Insurance Company and Erie Insurance Exchange to show cause why the sale of the structured settlement payment between Erie Insurance Exchange (issued by Allstate Life Insurance Company) and Miguel Garcia to be sold and transferred to 321 Henderson Receivables Origination LLC, its nominees, successors or assigns should not be approved. Date: ,13./fJ.... I Respectfully submitted: KREVSKY & ROSEN, P.C. By: bi2- a enc J. Rosen, Esquire 1101 North Front Street Harrisburg, PAl 71 02 ID# 10625 (717) 234-4583 Sent 717 728 3257; .Jan-2-07 THE UPS STORE; -~..:':>:::::'~ Page 1/1 ~~~~~~~,~~~".o,'(.'h.or~~.6W:':'~:*""__"""'''''''~r'' ..-,.....-. r~....-.T.;,~'~r"..-"'."'-". . ........~'-'~4~;.t.,?~.......,,~~~w;!J.~t~.~;ii. ~'., ...~"'"'...\U,.~;;~~.1~1t.I:I.l i'~'~~ / ..:.. - SC~ OF p~ . .nM'fI: ~t;. 27, 2000' . '~.:. 27, 20'.05 ~.~:.,:n" ,2010 HDJN'l' $32,500.00 50,000.00 75,000.00 4'.:'; .:...w~;,;.~. t~..-_.. . '.;'.~~..:.a:.._....:...:...:..;..........;:..:. . a+l~f/;t 1m: -ro ;rt~k ".'.'", ;...,:.,~ 8alt .~'~:~,... OCt. 27, 1975 ... '_":':~-:',"""".:;'..U"f.~40""_"""~,_",,,,,,_,,_IU~ .'~.., ._...,t~.A;i.;".~,.;.r.... ~.M1gQ.el ~iAl Mal.e :1 . ','~~.' ;;.:;:':;...:~~~,'n'~...'~~~;~~..~:~:77' ",-~"22' 0001"00 ...." J~::.~~~!:~':'~';", ~ . ., i~' VM'" v.... 'WIll. ~_ 115 .:1 .~.~: '.0;';$00:.;.2'54 ." :';SSUl!Um!l'I!l~~. li. ~98r .}i. ~f E:rie :tm'lami.t:y. c:b. ',;{" '. ':j " X. :::k:..' ..:....,;.:.:::1: ".".~~I\".ll\o.=.~'_'" ;;............,'"'..Mo'...':-..~ Exhibit "B" AccountlD: 308194 PURCHASE AGREEMENT This is a Purchase Agreement. The date of this Agreement is ,200_, Miguel Garcia is the Seller. 321 Henderson Receivables Origination LLC, a Nevada Limited Liability Company, its successors and/or assigns is the Buyer. In this Agreement, Miguel Garcia is ref~ed to as "You" or "Your" and 321 Henderson Receivables Origination LLC or its nominee, is referred to as "We", "Us" or "Our". BACKGROUND OF THIS AGREEMENT 1. Your or someone on your behalf signed a Settlement Agreement (the "Release" or the "Settlement Agreement"). in connection with the resolution ofa personal injury claim. 2. The insurer funded the Payments by buying an annuity contract (the" Annuity") issued by Allstate Life Insurance Company (tbe "Annuity Company"). 3. A . list of the Payments being sold under this Agreement is attached to this Agreement as Exhibit "A", 4. Vou desire to sell and assign to Us all of Your rights to receive all or a portion of the Payments under the Release, as described on Exhibit "A", all of the other rights You have under the Release and the other rights as described in Section l(a) below. We desire to purchase all of Your rights and benefits, on the terms and under the conditions described in this Agreement. You and We agree as follows: 1. Purchase and Sale. a. You now sell, transfer and assign to Us all of Your rights in the "Assigned Assets" as listed in Exhibit "A". By Our signing this Agreement, We are hereby purchasing and accepting thesalc and assignment of all of the Assigned Assets described above. b, The Gross Purchase Price is Forty-Eight Thousand Dollars and 00/100 Cents ($48,000.00). The Net Purchase Price payable to You is $47,500.00 (the "Purchase Price"). The Net Purchase Price will be paid to You when both You and We sign this Agreement and We have completed Our internal process. 2. Aeknowledlunent. a. You will agree after Your signing of this Agreement to deliver to Us, addressed as We may require, other notices, instructions or documents, and copies of them, as We think are necessary or proper to carry out this Agreement. b. When You and We sign this Agreement, You will also deliver to Us: (I) a letter addressed to the Annuity Company directing that all payments of the Assigned Assets after Vour death shall be sent directly to Us, and (2) a Change of Beneficiary Form changing the beneficiary of the Assigned Assets, after Your death, to "321 Henderson Receivables Origination LLC", as sole beneficiary [(1) and (2) above are referred to as the Change of Beneficiary Fonn]. The Change of Beneficiary Form will state that the instructions may never be revoked and that no change may be made in the instructions or Initial: fV\ G .. @2006321 Henderson Receivables Limited Partnership Account 10: 308194 in the payments (including as to the payee or the manner or place of making such payments) without Our prior written consent. You will also, when this Agreement is signed by You and Us, deliver to Us, addressed as We may require, such other notices, instructions or documents, and copies of them, as We think are necessary or proper to carry out this Agreement. C. Before You and We sign this Agree~ent, You will deliver to Us an acknowledgment of the Estate of Miguel Garcia, as primary beneficiary of the AlIsigned Assets, of the terms of this Agreement. the Estate of Miguel Garcia will agree that they are not entitled to any rights to any ofthe Assigned Assets. d. Vou agree to sign all other documents which We may request forever naming Us as the only beneficiary of the Assigned Assets, including but not limited to an agreement to provide in Your Last Will and Testament that all of Your rights to the Assigned Assets were sold to Us (a "Testamentary Agreement"). e. You acknowledge that We advised You to obtain independent professional tax advice to detelmine whether this transaction will result in any adverse federal and/or state tax consequences. f. You acknowledge that We advised You must obtain independent legal representation prior to executing this Agreement and that We have advised you that We may not refer You to any specific attorney for such purpose. 3 . Your Reoresentations and Warranties. You now represent and warrant to Us that: a. You own (and are selling and assigning to Us under this Agreement) all of the Assigned Assets, free and clear of all claims, liens, charges, security interests, encumbrances, and agreements of any nature (other than this Agreement), and when You and We sign this Agreement, no one other than Us shall have any present or future right to the Assigned Assets. b. This Agreement and all of the other documents signed in connection with this Agreement have been properly signed by You, and they represent Your legal, valid and binding obligation, enforceable against You in accordance with their terms. c. The signing and performance of this Agreement by You and the transactions described in this Agreement: i. do not conflict with any other obligations of Yours; ii. will not cause a violation under (or create any right of tennination, cancellation or acceleration or similar right under) any contract or agreement by which You or Your assets, including the Release, are ,bound or may be affected; Hi. will not create, or give any party (other than Us) the right to create, any lien, charge, security interest or encumbrance in, to or on any of the Assigned Assets; and iv. will not create a present or future right in any other party to make any claim against You or Your assets, or any of the Assigned Assets. Initiol: J1I\ b .. 2 @2006 321 Henderson Receivables Limited Partnership Account 10: 308194 d. You understand the terms and provisions ofthis Agreement and You have been represented by tax and accounting advisors and a lawyer in the signing of this Agreement. e. Neither You nor anyone else have to do anything else for (I) the proper signing and performance by You of this Agreement and any transactions intended to be done in this Agreement, or (2) the carrying out by Us of any of Our rights and remedies under this Agreement. No other person has made a claim in any rights in or to the Assigned Assets. f. You have valid reasons for selling Your interest in the Assigned Assets rather than obtaining a loan with the Assigned Assets as collateral, and You agree that the transaction set forth in this Agreement is not a loan or other financing transaction. g. This Agreement is a valid sale, transfer and assignment to Us of the Assigned Assets. h. Your residence and legal ad.wess is as described in Paragraph 11 of this Agreement. During the last 0( years, You have lived at such address. i. No representation or warranty of Yours in this Agreement or in any of the documents delivered in connection with this Agreement or in any agreement required by this Agreement, is inaccurate or contains any untrue or misleading statement. J. The signing by You of this Agreement will not violate any other promise or agreement you have made with anyone else. You understand that any and all restrictions on the assignability of the Scheduled Payments were included in the Release and/or Annuity at Your request, for Your benefit and not for the benefit of any other person. These restrictions, if any, were included by You as a precautionary measure to make sure You were allowed favorable tax treatment under the Internal Revenue Code. You understand that by entering into this Agreement, you may be giving up this favorable tax treatment. You understand that any income earned by You on any investment or use of the Purchase Price may be taxable to You. You may have to pay more in taxes as a result of this Agreement. For Our benefit and the benefit of Our assigns or successors, You agree to WAIVE AND RELEASE all of Your rights in, to, or under, such restrictions on assignability, if any. k. You have not before the date ofthis Agreement, sold or assigned Your right to the Assigned Assets or any part of the Assigned Assets. You do not owe any money to Your present or former spouse for support maintenance or similar obligations, nor do You owe any money to any or Your children or guardians of Your children. The Assigned Assets are not subject to any community property or similar marital rights of any person. 1"..1, M-- .. 3 @2006 321 Henderson Receivables Limited Partnership mitial: fV\ (J, AccountID: 308194 l. Your right to the Assigned Assets is not affected by any mortgage, pledge, lien, charge, security interest, encumbrance, restriction or adverse claim of any nature, You understand that any violation of any of Your representations in this agreement will result in an act of fraud by You which could result in You being held responsible for damages la favor of Us, with money to be paid by You to Us. m. You are not in violation of any obligations concerning child-care, alimony or support. n. You now give up forever all Your rights in any agreement that says that You cannot assign or sell Your rights in the Assigned Assets to Us. You have not requested and You do not expect to receive from Us, a FOlm ]099 or any other documentation which could make the transaction described by this Agreement taxable to You in any way. You further understand that We have not given to You any advice about any of Your taxes in this transaction. You have relied on Your own professional advisors concerning taxes. o. As of the date of this Agreement, You are oflega] age in the state noted as Your address in Section II of this Agreement, mentally sane, and of a sound mind. You have never been convicted of a felony or any other crime involving dishonesty. p. You are very familiar with Your financial affairs and condition. With that full understanding, You certify that (1) on the date We pay You the Purchase Price and You sell to Us the Assigned Assets, the fair value of Your assets are and will be greater than all of Your debts; (2) You presently intend to pay all of Your creditors when such payments tire due; and (3) Vou have not intentionally hidden the fact from any creditor of Yours that You have entered into this Agreement and the other documents referred to in this Agreement. q. You do not intend to file for bankruptcy and there are no lawsuits or other efforts by any of Your creditors to put You into bankruptcy or to take the Assigned Assets. r. The Purchase Price is not Your only or most important source of income and You do not have any mental or physical problems that would prevent You from having a payingjob. s. You promise to us that no broker, finder, or other person other than those persons named in the broker statement signed by you in connection with this Agreement was involved in or important in arranging the purchase transaction in this Agreement. No other person has a right to any fee, payment, commission, or other compensation because of this Agreement. t. You agree that We have not forced You to give to Us copies of any confidential documents. You agree that We told You that We only needed to see those documents which described the Assigned Assets so we could buy from You the Assigned Assets. You agree that We do not intend to tell any other party about what is included in those documents. You understand that if We do so, it will only be for the sole purpose of buying the Assigned Assets. .. 4 @2006 32\ Henderson Receivables Limited Partnership Account 10: 308194 U. You understand that it usually takes six to eight weeks to complete this process, but that it could take longer. You understand that we have to obtain court approval of this transfer. YOU UNDERSTAND mAT, DUE TO OCCASIONAL DELAYS, WE WILL ESCROW THE AMOUNT EQUAL TO mE NEXT TWO MONTHLY PAYMENTS DUE TO YOU FROM THE ANNUITY COMPANY TO INSURE THAT WE RECEIVE ALL OF THE PAYMENTS THAT WE PURCHASE. YOU UNDERSTAND THAT WE MAY EITHER PAY OR ESCROW FUNDS TO SATISFY ANY JUDGMENTS, TAX LIENS OR CHILD SUPPORT AGAINST YOU OR THE ASSIGNED ASSETS AND DEDUCT THOSE AMOUNTS FROM THE PURCHASE PRICE. YOU UNDERSTAND THAT WE WILL DEDUCT FROM THE PURCHASE PRICE ANY AMOUNTS OF PAYMENTS RECEIVED BY YOU PRIOR TO FUNDING, IF SUCH AMOUNTS ARE NOT COVERED BY THE ESCROWED FUNDS. 4. You promise Us that: a. You will not, and will not allow any other party (except Us or Our assignee, if applicable) to take funds away from the Assigned Assets. You will not do anything else to affect the Assigned Assets. You will not say You still own the Assigned Assets. You will not do anything or allow anyone else to do anything that could in any way interfere with or lessen Our rights in the Assigned Assets. b. You will not do anything that will, or could in the future, violate the Release, or any of the agreements required to be executed by this Agreement Vou also agree to cooperate with Us to help Us to obtain all of the rights that We are buying from You in this Agreement and in the Release. C. You will give to Us at least thirty (30) days written notice of Your intention to move Your residence or change Your legal address from the address in Paragraph 11 of this Agreement. d. You will not make any change in Your instructions to the Annuity Company regarding payments to be made to You. ".."l!1.L_ 5 @2006 321 Henderson Rc:ccivlIbles Limited Partnership Account ID: 308194 e. You understand that the Annuity and the Release may say that You agree not to sell Your rights to the Assigned Assets. f. You agree to continue to cooperate with Us. This includes Your obligation to immediately deliver to Us any checks, funds or other form of Payment received after the date of this Agreement by You or anyone other than Us. If any Payment is ever denied, delayed, or withheld from Us, as determined by Us in our reasonable discretion, directly or indirectly on account of any act or omission by You or any person acting for You, then You shall be in default under this Agreement (and an Event of Default under ~8 shall be deemed to have occurred). Immediately upon such default, and without any further notice to You, You will pay to Us the following amounts: (i) the full, dollar value of all remaining Assigned Assets as they become due after the date oftbe default; All of the remedies specified under this section shall be cumulative with all of the remedies for default pursuant to ~8. g. If You learn before or after the signing of tbis Agreement of the threat or actual beginning of any lawsuit or proceeding that has anything to do with Our rights under this Agreement or the Assigned Assets, then You will immediately notifY Us ofthat and You will give Us copies ofall notices and other writings relating to it promptly after You receive them. h. If You receive any notice relating to any supposedly unpaid claim affecting the Annuity or the Assigned Assets or to any other claim against the Annuity or the Assigned Assets, then You will promptly notifY Us and will promptly give Us copies of all notices and other writings relating to it received by You promptly after You receive them. 5. RIGHT TO CANCELLATION. YOU MAY CANCEL THIS CONTRACT WITHOUT PENALTY OR FURTHER OBLIGATION WITHIN TWENTY.ONE DAYS FROM THE DATE YOU RECEIVE PAYMENT FROM 321 HENDERSON. In order for the cancellation to be effective, You must mail a notice of cancellation by registered or certified U.S. mail, postmarked within twenty-one (21) days of receipt of the Purchase Price to Us, c/o Vice President of Operations at 3993 Howard Hughes Parkway, Suite 250, Las Vegas, NV 89119-6754. Furthermore, in order for Your notice of cancellation to be effective, Your registered or certified U.S. mail package to us must include a bank or certified check for the full Purchase Price that We paid You under this Purchase Agreement. Any failure to comply with the above procedure shall be a waiver of Your right to cancel this transaction. 6. Your Further Promises. You agree that, from time to time, at Your expense, You will promptly sign and give to Us any and all documents to help Us realize our rights and benefits under this Agreement. This promise includes signing, filing or allowing Us to file financing or continuation statements, or amendments or assignments of those documents. You permit Us or others acting for Us to sign our name andlor your name and file without Your signature such financing statements, if that is pennitted in Your state of residence. When You sign this Agreement, You will also sign and deliver to Us a "Special Irrevocable Power of Attorney" You must retain the serv ices of an attorney and deliver an opinion of Your attorney about the sale of Assigned Assets to Us) in a fonn acceptable to Us. Initial: ~ 6 .. 6 @2006 321 Henderson Receivables Limited Partnership Account ID: 308194 7. Continuation of ReDresentations. Warranties and Covenants. All of Your representations, warranties and promises made in this Agreement will c~mtinue to be relied on by Us after this Agreement is signed. 8. Event of Default. Your failure to comply with any term of this Agreement or Your breach of any of Your representations in this Agreement will mean that You will be in default. We refer to this as an "Event of Default." If there is an Event of Default, We have the right to sue You in court to make You perform Your promises or to get money from You. Your failure to comply with any material terms of this Agreement will be a default. In Paragraph 4 (c) You agree to give US at least thirty (30) days written notice after Your move to a new residence or change of Your legal address from the address in Paragraph 11 of this Agreement. If we are purchasing from You certain lump sum payments, We will contact you at least 3 months before the scheduled payment is due to determine if the address change We have effected with the annuity company is in place and to determine if Your legal address has remained the same. If We cannot contact you because You have changed Your legal address or moved Your residence and failed to notify Us, We will consider such failure to notify Us to be an EVENT OF DEFAULT and We will exercise all of our legal rights under this Agreement. OUR RIGHT TO PROCEED AGAINST YOU UNDER THIS AGREEMENT SHALL BE SOLELY LIMITED TO WHEN YOU HAVE COMMITTED AN EVENT OF DEFAULT. WE SHALL NOT HAVE THE RIGHT TO SUE YOU IF OR BECAUSE THE ANNUITY COMPANY IS NOT ABLE TO MAKE PAYMENTS BECAUSE IT IS NOT FINANCIALLY ABLE TO DO SO. 9. Controlling Law. This Agreement shall be governed, construed and enforced in accordance with the internallaw9 of the State of your domicile without regard for the conflicts of law rules thereof or elsewhere. (For Court Orders or Notice Transfers obtained in the following jurisdictions: AK, AR, AL, AZ, CA, CO, CT, DE, FL, GA, HI, lA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, ~~~~~~~oo~~~~~m~~~~~~~b~ of those jurisdictions shall be applied in the event of 11 dispute regarding the transfer.) Your domicile is the proper place of venue to bring any action arising out of a breach of this Agreement. 10. Responsibility for this Agreement. This Agreement will hold responsible Your heirs, executors, successors and assigns and will benefit Our representatives, successors, beneficiaries and permitted assigns. Nothing in this Agreement is intended to give anyone other than You or Us or each of Our successors or assigns any benefits. 11. ~. All notices and other communications under this Agreement will be in writing and will be made by delivery by means by which the sender obtains a receipt of delivery from the carrier (including without limitation, certified mail return receipt requested or overnight courier services), addressed to the party to whom a request or demand is to be made. Such demand or notice or request shall be deemed given on the date which is one business day after the date sent by overnight mail or three days after the date sent by certified mail. The addresses of the parties are as follows: If to You: Miguel Garcia 2250 Dusty Lane Enola, PA 17025 Initial: _W\ G .. 7 @2006 321 Henderson Receivables Limited Partnership Account In: 308194 lfto Us: 321 Henderson Receivables Origination LLC 3993 Howard Hughes Parkway Suite 250 Las Vegas, NV 89169-6754 Attention: Vice President - Operations 12. Past Actions. Anything either You or We did or said before this Agreement was signed will not affect Your or Our rights under this Agreement in any way. 13. EXDenlies. Except as otherwise affirmatively set forth in this Agreement, You and We agree that we will each pay our respective costs and expenses in connection with the carrying out of this Agreement. 14. HeadinllS. The section and subsection headings contained in this Agreement are for reference purposes only and will not affect in any way the meaning or interpretation of this Agreement. 15. Counter.,arts. One or more originals of this Agreement may be signed with Your or Our signature. When put together they will make one agreement and the Agreement will be considered signed by all parties that need to sign. A facsimile signature will be considered an original. 16. Assismment. We and anyone to whom We assign this Agreement may assign Our right, title and interest in and to this Agreement, the Annuity and the Assigned Assets without Your approval. Vou and We agree that if there is an assignment by Us to someone else, We shall not be responsible to You. You must look only to the person or company that We assign this Agreement to for any payment (for example, of the Purchase Price) and performance of this Agreement. When asked by Us or any assignee, You will sign and deliver any such documents as We may require to perform this transaction, as assigned. Initial: ~'V\G .. 8 @2006 32] Henderson Receivables Limited Partnership Account 10: 308194 17. Your SDouse, You and Your spouse are fully aware of Your rights in the Assigned Assets. You and Your spouse fully give up those rights. You and Your spouse understand that by selling the Assigned Assets to Us, You and Your spouse are not receiving the same amount of money as You would if You waited for all of the scheduled Payments of the Assigned Assets but, rather, are receiving a discounted value in return for receipt of the Purchase Price immediately. You and Your spouse have valid reasons for selling the Assigned Assets. You and Your spouse fuUy understand the terms of the Purchase Agreement and understand that the sale of the Assigned Assets is final. You also understand that Your spouse gives up any property right he or she may have in the Assigned Assets that Your spouse could claim because of Your marriage. 18. Entire A2reemeot. This Agreement and the Exhibits and other documents You signed make up the entire understanding and agreement between You and Us about this Agreement. This Agreement replaces all prior agreements, whether written or oral, about this Agreement. This Agreement may not be changed unless in a writing signed by You and Us. 19. Limitation of Liability of Buver. You understand that Our liability to You under this Agreement is strictly limited to the requirement to pay the Purchase Price and under no circumstances will We be responsible for consequential damages. 20. Court ADDroval. You understand that court approval is required for this transfer. You agree to cooperate with us to obtain such court approval. 21. Exhibits. Attached to this Purchase Agreement are the following Exhibits: Exhibit "A" List of What Payments We are Buying. Intending to be legally bound, You and We have signed this Agreement as ofthe date at the top of the first page of this Agreement. 321 HENDERSONRECElVABLES ORIGINATION LLC <3ION HERE I Spouse ~ Sworn to and subscribed () J before me this l day, of ~ 20047 .....~~.C0"~A~ , ....y. \.. I "- .' " I." ar,y,. I . " '. . ,":~,':~~.~~ . w____~~ ( i l ' N()TARIA~SEAL MARY C. SIGNOR, NOTARY PUBLIC MiboLETOW~1 Bbnol,lo:~; COUNTY OF DAUPHIN . .'~~!i[~~~IES~~~:"'~!~~:"2.".:2!~~~ 9 @200S 321 Henderson Reeeivables Limited Partnership Account ID: 308194 Exhibit A We are hereby purchasing from You under the Annuity: A) ] payment of$75,000.00 on October 27,2010 !llJ~,~414~; MiguKGarcia <3IGN HERE I STATE OF COUNTY OF On this ::-2..- day of f1 ~ - , 20~, before me, the above signed personally appeared before me, personally known to me to be the person w~ subscribed to the within instrument and acknowledged to me that he executed it. (t~tJJ-?fh~<--' ,,1' , ,I, J ". , .,( i,~ "~7'~~N01ARi~L SEAL ..' MARY C. BI~NOR;:~OTARY PUBLIC , ' J.,,()n "J 1(3" \ COUNTY OF DAUPHIN MlDOI.ETQW,' \~ nl.r, "'.. 7 '. MY COMly';r,:",?~~>lPIR~~~~200 :l'U;.'''I~,..'.;l..+J"''l-~ I), EXHIBIT "C" Account 10: 308194 SCHEDULE 1 DISCLOSURE STATEMENT PLEASE BE ADVISED THAT THE PROPOSED TRANSACTION IS A SALE, NOT A LOAN, AND THAT YOU WILL BE SELLING ALL RIGHTS AND TITLE TO THE ASSIGNED ASSETS ONCE THIS TRANSACTION IS CONSUMMATED. PLEASE BE ADVISED THAT YOU MAY IDE SUBJECT TO ADVERSE FEDERAL AND STATE INCOME TAX CONSEQUENCES AS A RESULT OF THE PROPOSED TRANSACTION. YOU SHOULD CONSULT YOUR OWN COUNSEL, ACCOUNTANT, OR FINANCIAL ADVISOR REGARDING ANY FEDERAL OR STATE INCOME TAX CONSEQUENCES ARISING FROM THE PROPOSED TRANSFER. YOUR PURCHASE PRICE WAS DERIVED ASSUMING A DISCOUNT RATE SIGNIFICANTLY HIGHER THAN THE PRIME INTEREST RATES CHARGED BY COMMERCIAL BANKS, THEREFORE, WE URGE YOU TO EXPLORE ALL FINANCIAL OPTIONS. WE WILL PURCHASE FROM YOU A) 1 payment of $75,000.00 on October 27,2010 [THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY] Account ID: 308194 SCHEDULE 1. PAGE 2 THE AGGREGATE AMOUNT OF THE PURCHASED PAYMENTS IS $75,000.00. THE DISCOUNTED PRESENT VALUE OF THE AGGREGATE PAYMENTS AT 5.60% IS $60,911.61. THE DISCOUNTED PRESENT VALUE IS THE CALCULATION OF THE CURRENT VALUE OF THE TRANSFERRED STRUCTURED SETTLEMENT PAYMENTS UNDER FEDERAL STANDARDS FOR VALUING ANNUITIES. THE GROSS AMOUNT PAYABLE TO SELLER IS $48,000.00. THE FOLLOWING EXPENSES ARE INCURRED BY THE SELLER (YOU) AND WILL BE DEDUCTED FROM THE PURCHASE PRICE: COMPLIANCE AND ADMINISTRATIVE FEE: $500.00 FILING AND RELATED EXPENSES FEE: $0.00 THE NET AMOUNT PAYABLE TO THE SELLER(YOU) IS $47,500.00. NO OTHER EXPENSES ARE INCURRED BY YOU. THE DISCOUNTED PRESENT VALUE OF PAYMENTS SHALL BE CALCULATED AS FOLLOWS: THE APPLICABLE FEDERAL RATE USED IN CALCULATING THE DISCOUNTED PRESENT VALUE IS 5.600;0. THE EFFECTIVE ANNUAL DISCOUNT RATE FOR THIS TRANSACTION IS 12.71 %. THE CASH PAYMENT YOU RECEIVE IN THIS TRANSACTION FROM US WAS DETERMINED BY APPLYING THE SPECIFIED EFFECTIVE ANNUAL DISCOUNT RATE, COMPOUNDED MONTHLY, TO THE TOTAL AMOUNT OF FUTURE PAYMENTS TO BE RECEIVED BY US, LESS THE TOTAL AMOUNT OF COMMISSIONS, FEES, COSTS, EXPENSES AND CHARGES PAYABLE BY YOU. THE NET AMOUNT THAT YOU WILL RECEIVE FROM US IN EXCHANGE FOR YOUR FUTURE STRUCTURED SETTLEMENT PAYMENTS REPRESENTS 78.00010 OF THE ESTIMATED CURRENT VALUE OF THE PAYMENTS BASED UPON Account 10: 308194 SCHEDULE i,PAGE3 THE DISCOUNTED VALUE USING THE APPLICABLE FEDERAL RATE. THE QUOTIENT OBTAINED BY DIVIDING THE NET PAYMENT BY THE DISCOUNTED PRESENT VALUE IS 78.00%. BASED ON THE NET AMOUNT THAT YOU WILL RECEIVE FROM US AND THE AMOUNTS AND TIMING OF THE STRUCTURED. SETTLEMENT PAYMENTS THAT YOU ARE TURNING OVER TO US, YOU WILL, IN EFFECT, BE PAYING INTEREST TO US AT A RATE OF 12.710A>> PER YEAR. THE NET AMOUNT PAID TO YOU (THE PAYEE) BY US (THE TRANSFEREE) REPRESENTS AN ESTIMATE OF THE FAIR MARKET VALUE OF THE FUTURE PERIODIC PAYMENTS TRANSFERRED UNDER THE STRUCTURED SETTLEMENT AGREEMENT. NOTICE OF CANCELLATION RIGHTS: YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO 5:00 P.M. OF THE TWENTY-FIRST DAY FOLLOWING THE LATER OF THE EXECUTION OF THE PURCHASE AGREEMENT, OR THE DATE THE PAYEE BECOMES OBLIGATED UNDER THE PURCHASE AGREEMENT WITHOUT PENALTY OR FURTHER OBLIGATION. THIS CANCELLATION RIGHT CANNOT BE WAIVED IN ANY MANNER. TO CANCEL, YOU MUST PROVIDE WRITTEN NOTICE TO THE TRANSFEREE. WRITTEN NOTICE SHOULD BE MAILED OR DELIVERED TO THE ADDRESS BELOW BY 5:00 P.M. OF (THE TWENTY-FIRST DAY FOLLOWING THE TRANSACTION). IT IS BEST TO MAIL IT BY CERTIFIED MAIL, RETURN RECEIPT Account 10: 308194 SCHEDULE 1. PAGE 4 REQUESTED, AND TO KEEP A PHOTOCOPY OF THE SIGNED FORM AND YOUR POST OFFICE RECEIPT. ADDRESS TO WHICH CANCELLATION IS TO BE RETURNED: 321 HENDERSON RECEIVABLES ORIGINATION LLC 3993 HOWARD HUGHES PARKWAY SUITE 250 LAS VEGAS, NV 89169-6754 ATTENTION: VICE PRESIDENT - OPERATIONS IMPORTANT NOTICE: YOU ARE STRONGLY URGED TO CONSULT WITH AN ATTORNEY WHO CAN ADVISE YOU OF THE POTENTIAL TAX CONSEQUENCES OF THIS TRANSACTION. PLEASE BE ADVISED THERE ARE NO PENALTIES OR LIQUIDATED DAMAGES PAYABLE BY YOU IN THE EVENT OF ANY BREACH OF THE TRANSFER AGREEMENT BY YOU. THERE ARE NO BROKERS COMMISSIONS, SERVICE CHARGES, APPLICATION FEES, PROCESSING FEES, CLOSING COSTS, FILING FEES, ADMINISTRATIVE FEES, LEGAL FEES, NOTARY FEES AND OTHER COMMISSIONS, FEES, COSTS, EXPENSES AND CHARGES PAYABLE BY YOU OR DEDUCTED FROM GROSS AMOUNT OTHERWISE PAYABLE TO YOU OTHER THAN THE COMPLIANCE AND ADMINISTRATIVE FEE AND THE FILING AND RELATED EXPENSES FEE. IF YOU BELIEVE YOU WERE TREATED UNFAIRLY OR WERE MISLED AS TO THE NATURE OF THE OBLIGATIONS YOU ASSUMED UPON ENTERING INTO THIS AGREEMENT, YOU SHOULD REPORT THOSE CIRCUMSTANCES TO YOUR LOCAL DISTRICT ATTORNEY OR THE OFFICE OF THE ATTORNEY GENERAL. THE EFFECTIVE DATE OF THE TRANSFER AGREEMENT SHALL BE DEEMED TO BE THE DATE THAT THE AGREEMENT WAS SIGNED BY THE YOU (PAYEE). PLEASE BE ADVISED THAT PAYMENT TO YOU PURSUANT TO THE TRANSFER AGREEMENT IS CONTINGENT UPON COURT APPROVAL OF THE TRANSFER AGREEMENT. Account 10: 308194 SCHEDULE 1.. PAGE 5 PLEASE BE ADVISED mAT PAYMENT TO YOU WILL BE DELAYED UP TO 30 DAYS OR MORE IN ORDER FOR THE COURT TO REVIEW AND APPROVE THE TRANSFER AGREEMENT. BY SIGNING BELOW YOU ARE CONFIRMING RECEIPT OF THIS DISCLOSURE AT LEAST 10 DAYS PRIOR TO RECEIPT OF THIS CONTRACT. ((J./!I~ I~E GARCIA <}IGNHEREI EXHIBIT "D" 321 HENDERSON RECEIVABLES ORIGINATION LLC January 25,2007 Allstate Life Insmance Company 544 Lakeview Parkway, L3F Vernon Hills, IL 60061 Attn: Legal Department/Structured Settlements Erie Insurance Exchange Erie Insurance Exchange ) 00 Erie Insurance Place Eric, P A 16530 Attn: Legal Department/Structured Settlements RE: Notice of Sale/Assignment of Payment Rights Y 0\.11' Contract #: 90800254 Payee: Miguel Gal'cia SS #: 186-56.8444 Dear Insurer: Please be advised that 321 Henderson Receivables Origination LLC and/or its successors and assigns, have entered into a transaction with the above-referenced annuitant who is seeking to transfer ce11ain of his/her rights to the payments scheduled to be received under the above- referenced annuity policy. We are currently seeking court approval pursuant to the applicable structured settlement transfer statute. Pursuant to the statute, please note the following information about the Purchaser: 321 Henderson Receivables Origination LLC 40 Morris Ave Bryn Mawr PA 19010 Tax 10 # 20-4728885 PLEASE NOTE: No payments under this mmuity should be held until the courts have entered a final order and we have forwarded this order to you. Very truly yours, By: President 3993 Howard Hughes parkway' suite 250. LAS VEGAS, NV 89169-6754 PHONE: 800-454-9368. FAX: (215) 567-7525. E-MAIL: JGW@TGWFUNDING.COM WEB SITE: WWW.JGWFUNDING.COM IN RE: MIGUEL GARCIA :IN THE COURT OF COMMON PLEAS :CUMBERLAND COUNTY, PENNSYLVANIA :NO: VERIFICATION I, LAWRENCE 1. ROSEN, ESQUIRE on behalf of Miguel Garcia, hereby verify that the information contained in the foregoing Petition is true and correct to the best of my knowledge, information and belief. I also understand that false statements made herein are subject to the penalties of 18 Pa. C.S. ~ 4904, relating to unsworn falsification to authorities. DATE: !/do/(J IN RE: MIGUEL GARCIA :IN THE COURT OF COMMON PLEAS :CUMBERLAND, COUNTY, PENNSYLVANIA :NO: CERTIFICATE OF SERVICE AND NOW, this ~ day of January, 2007, I, Lawrence J. Rosen, Esquire, counsel for Petitioner, Miguel Garcia, hereby certify that I have this day served a copy of this Petition in the above-captioned matter, by First Class U.S. Mail, on the following: Allstate Life Insurance Company 544 Lakeview Parkway, L3F Vernon Hills, IL 60061 Attention: Lisa Sterner Erie Insurance Exchange 100 Erie Insurance Place Erie, P A 16530 321 Henderson Receivables Origination LLC 40 Morris Avenue Bryn Mawr, PA 19010 b:f.tn 1101 North Front Street Harrisburg, P A 17102 (717) 234-4583 J:J (::) ~ 1l i ~ ....... '" & ~ ~ ~ C' r--~ . . c:'~:'l 0 (~- \) -n ~ ~ -r'! .--1 ,-- ,- ~ . . nl ;TI '- C-J '-l::: I ~ll \D ':~J eLl $ --. ,.., .~-~ - : :..;h: , - ) c.,) l:~) i'l" ,--{ r:1 )> :D w -< IN RE: MIGUEL GARCIA 7 RBlI~ :IN THE COURT OF COMMON PLEAS :CUMBERLAND COUNTY, PENNSYLVANIA "* r :NO: 0'1- 191 (!;uLY~ RULE AND NOW, this 1(, ~ day of J~ , 200( , upon consideration of the within Petition for Partial Transfer of Structured Settlement Pursuant to Structured Settlement Protection Act, 40 P.S. 4000, Et. Sec., a Rule is hereby issued upon Allstate Life Insurance Company, Erie Insurance Exchange and 321 Henderson Receivables Origination LLC to show cause why said Petition should not be granted. ~ RULE RETURNABLE FOR HEARING the ~ day of Ifl~ 2007 at ~ :00 PM. in Courtroom No. 3 in the Cumberland County Court House, Carlisle, Pennsylvania. J. Distribution: LawrenceJ.Rosen,Esquire, 1101 North Front Street, Hbg, PA 17102 - ~ ~ .J.j/"jI7 9..- Miguel Garcia, 2250 Dusty Lane, Enola, P A 17025 Allstate Life Insurance Company, 544 Lakeview Parkway, L3F, Vernon Hills, IL 60061; Attention: Lisa Sterner Erie Insurance Exchange, 100 Erie Insurance Place, Erie, PA 16530 321 Henderson Receivables Origination LLC, 40 Morris Avenue, Bryn Mawr, PA 19010 V1N\1/nASNN3d ) ! N.ne,'-! (l1\\/l~-r:;RIA1n'" u.. 'I H' '.- '.,' - .._c' ~4V If. V 95 :01 WV 91 S3J tOOl AtN10NCrLLOod 3H1 ;K) 381::HQ-Cl311:! IN RE: MIGUEL GARCIA : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : No. 07-798 : Civil Term ~ ORDER AND NOW, this )fo day of March, 2007, upon consideration ofthe unopposed petition of Miguel Garcia a1k/a Miguel Juan Garcia ("Mr. Garcia"), and upon consideration of the court order approving the underlying structured settlement, the Court hereby finds as follows: 1. The Court has jurisdiction over this matter pursuant to the Pennsylvania Structured Settlement Protection Act, 40 P.S. ~~ 4001 et seq. 2. The transfer of the structured settlement proceeds, specifically one lump sum payment of $75,000.00 due on October 27, 2010 (the "Assigned Payment"), by Mr. Garcia to 321 Henderson Receivables Origination LLC ("321 Henderson") as described in the purchase agreement between Mr. Garcia and 321 Henderson (the "Purchase Agreement") and in the petition in this matter (the "Proposed Transfer") (i) does not contravene any applicable federal or state statute or the order of any court or responsible administrative or governmental authority or any applicable law limiting the transfer of workers' compensation claims, and (ii) is in the best interest ofMr. Garcia, taking into account the welfare and support of Mr. Garcia's dependents, if any. 3. The Proposed Transfer complies with the requirements of the Structured Settlement Protection Act, 40 P.S. ~~ 4001 et seq. and 215 ILCS 153/1 et seq., and does not contravene other applicable law. BE\360525\2 4. Not less than lO days prior to the date on which Mr. Garcia first incurred any obligation with respect to the Proposed Transfer, 321 Henderson provided Mr. Garcia a disclosure statement in full compliance with 40 P.S. ~ 4003(a)(2). 5. Mr. Garcia has received or expressly waived, in a separate written acknowledgment signed by Mr. Garcia, independent legal advice regarding the implications of the Proposed Transfer, including consideration of the tax ramifications of the Proposed Transfer. 6. Mr. Garcia has given written notice of321 Henderson's name, address and taxpayer identification number to Erie Insurance Exchange ("Erie") and Allstate Life Insurance Company ("Allstate Life"), and has filed a copy of such notice with the Court. 7. Mr. Garcia has timely filed and served on all interested parties, including Allstate Life and Erie, a notice of the Proposed Transfer and the application for its authorization in compliance with the requirements of 40 P.S. ~ 4004. 8. Mr. Garcia has consented, in writing, to the Proposed Transfer. Based upon the foregoing findings, IT IS HEREBY ORDERED that: 1. Pursuant to 40 P.S. ~ 4003, the Proposed Transfer is approved. Until the due date ofthe Assigned Payment, the designated beneficiary under annuity contract no. 90800254 shall be the Estate of Mr. Garcia. However, 321 Henderson's right to receive the Assigned Payment shall not be affected by Mr. Garcia's death. 2. Allstate Life shall forward the Assigned Payment, within 7 days of the date due, by check made payable to "321 Henderson Receivables Origination LLC," at P.O. Box 7780- 4244, Philadelphia, PA 19182-4244, as follows: one lump sum payment of $75,000.00 due on October 27,2010. BE\360525\2 - 2 - 3. In the event 321 Henderson further assigns or otherwise transfers the Assigned Payment (or any portion thereof or interest therein) to another person or entity (a "Reassignment"), Allstate Life will not itself be obligated to redirect the Assigned Payment (or any portion thereof) to any person or entity other than 321 Henderson or to any payment address other than that specified herein, and 321 Henderson shall remain obligated to comply with all terms and conditions herein. 4. 321 Henderson shall defend, indemnify, and hold harmless Allstate Life and Erie and their respective directors, shareholders, officers, agents, employees, servants, successors, and assigns, and any parent, subsidiary, or affiliate thereof, and their directors, shareholders, officers, agents, employees, servants, successors, and assigns, past and present, from and against any and all liability, including but not limited to costs and reasonable attorney's fees, for any and all claims made in connection with, related to, or arising out of the Purchase Agreement, the Proposed Transfer, the Assigned Payment, any Reassignment, or Allstate Life's compliance with the parties' Stipulation or Allstate Life's and Erie's compliance with this Order, except with respect to claims by 321 Henderson against Allstate Life to enforce Allstate Life's obligations to 321 Henderson under the parties' Stipulation. To the extent that 321 Henderson fails to honor this indemnification and defense obligation, Allstate Life and Erie may, in addition to all other remedies afforded by law, satisfy the same by withholding to their own credit the Assigned Payment. 5. Allstate Life's lack of opposition to this matter, or its or 321 Henderson's stipulation hereto or compliance herewith, shall not constitute evidence in this or any matter, and is not intended to constitute evidence in this or any matter, that: BE\360525\2 - 3 - (a) payments under a structured settlement contract or annuity or related contracts can be assigned or that "anti-assignment" or "anti-encumbrance" provisions in structured settlement contracts or annuities or related contracts are not valid and enforceable; or (b) other transactions entered into by 321 Henderson and its customers constitute valid sales and/or secured transactions; or (c) Allstate Life has waived any right in connection with any other litigation or claims; or (d) 321 Henderson has waived any right other than as expressly set forth in the parties' Stipulation and/or this Order. 6. 321 Henderson and Mr. Garcia, for themselves and for their respective directors, shareholders, officers, agents, employees, servants, successors, heirs, beneficiaries, contingent beneficiaries, executors, administrators, and assigns, and any parent, subsidiary, or affiliate thereof, and their directors, shareholders, officers, agents, employees, servants, successors, and assigns, past and present (the "Releasors"), hereby remise, release and forever discharge each other and Allstate Life and Erie and their respective directors, shareholders, officers, agents, employees, servants, successors, and assigns, and any parent, subsidiary, or affiliate thereof, and their directors, shareholders, officers, agents, employees, servants, successors, and assigns, past and present (the "Releasees"), of and from any and all manner of actions and causes of action, suits, debts, dues, accounts, bonds, covenants, contracts, agreements, judgments, settlements, damages, claims, and demands whatsoever, in law or in equity, in connection with, related to, or arising out of any claim or allegation that was or could have been asserted in connection with, related to, or arising out of the Purchase Agreement, the Assigned Payment, the Proposed BE\360525\2 - 4 - Transfer, or the parties' Stipulation, which against each other or the Releasees, the Releasors have or had from the beginning of the world through the date of this Order, except for claims of Releasors against the Releasees to enforce the Releasees' obligations to Releasors, if any, under the parties' Stipulation or this Order. 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