HomeMy WebLinkAbout07-15031N THE MATTER OF : IN THE COURT OF COMMON PLEAS
JOSEPH CLARK : OF CUMBERLAND COUNTY, PENNSYLVANIA
NO. 0 7`' ~ ~ a3 CIVIL
PETITION FOR APPROVAL OF TRANSFER OF STRUCTURED SETTLEMENT
PAYMENTS PURSUANT TO THE STRUCTURED SETTLEMENT PROTECTION ACT
AND NOW, comes Joseph Clark by and through his attorney Michael D.
Rentschler, Esquire, who files the within Petition, as follows:
1. The Petitioner is Joseph Clark, an adult individual who is currently residing at
95 Wagner Street, Carlisle, Cumberland County, Pennsylvania 17013 (hereinafter
referred to as "Petitioner/Payee"). Petitioner is married and has one child.
2. This Petition is being filed pursuant to the Structured Settlement Protection
Act, 40 P.S. 4000, et se . (The "Act"). The Act requires Court approval of transactions
such as the one contemplated herein.
3. Following a wrongful death action relating to the death of his natural father
asserted against the tortfeaser, the matter was settled by Petitioner's mother through
her attorney. The settlement amount to Petitioner was placed in an annuity. The
current owner of the annuity is Fireman's Fund Insurance Company. The issuer of the
annuity is First Colony Life Insurance Company n/k/a Genworth Life and Annuity
Insurance Company.
4. Petitioner/Payee now desires to transfer one (1) payment of $100,000.00
payable on March 11, 2021 and one (1) payment of $75,000.00 payable on March 11,
2031. The aggregate amount of the purchased payments is $175,000.00. The
discounted present value of the aggregate payments at 5.60% is $66,757.22. 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 due to the Seller is $21,750.00, which represents 32.60% of the present
value of the transferred payments. There is no compliance or administrative fee.
Consequently, the net payment to the Seller is $21,750.00. Petitioner/Payee intends to
use the proceeds of this transaction to pay bills.
5. Prior to the enactment of the Act, Court approval was not necessary in order
to effect a transaction sale such as the one contemplated herein.
6. On February 27, 2007, Petitioner/Payee executed a Purchase Agreement with
321 Henderson Receivables Origination, LLC, whereby 321 Henderson Receivables
Origination, LLC agrees to purchase those structured settlement payments and give
Petitioner/Payee a lump sum payment. A true and correct copy of the Purchase
Agreement is incorporated herein, made a part hereof, and attached as Exhibit "A".
7. Schedule 1, entitled "Disclosure Statement", advises Petitioner/Payee of
certain disclosures and statements concerning the transaction. Said Disclosure
Statement is incorporated herein, made a part hereof, and attached as Exhibit "B".
B. According to Exhibit "B", the Petitioner/Payee will be entitled to a lump sum
payment of $21,750.00 which amount is the lump sum payment from 321 Henderson
Receivables as described in Exhibit "B".
9. After the transfer of the aforementioned payments, Petitioner/Payee will still
be scheduled to receive $175,000.00 payable on March 11, 2031, since he is only
transferring $75,000.00 of his scheduled $250,000.00 payment.
10. This transfer is in Petitioner/Payee's best interest and represents the
settlement as a beneficiary of the wrongful death claim concerning his father's death
that arose out of a traffic accident. First Colony Life Insurance Company n/k/a
Genworth Life and Annuity Insurance Company, the issuer owner of the annuity, and
Fireman's Fund insurance Company, the owner of the annuity, will receive a copy of
this Petition.
11. Both the owner and the issuer of the annuity may file comments indicating
its respective agreement or disagreement with this Petition by filing said comments in
the Prothonotary's Office in the Cumberland County Courthouse, Carlisle, Pennsylvania
17013.
WHEREFORE, it is respectfully requested that this Honorable Court
grant the within Petition and, therefore, approve the lump sum payment from the
Petitioner/Payee's structured settlement, pursuant to the Act, consistent with the
statements contained herein.
Respectfully submitted,
MICHAEL D. RENTSCHLER, ESQUIRE
28 North 32"d Street
Camp Hill, PA 17011
(717) 975-9129
Attorney for Petitioner/Payee
VERIFICATION
I, Michael D. Rentschler, attorney for Joseph Clazk, do hereby sweaz and/or affum that the
information contained in the forgoing Petition was information provided to me by Petitioner and
that the information in the Petition is true and correct to the best of my information and belief. I
further state that I am authorized to sign this verification. I understand that any false statements
may be punishable pursuant to 18 PaCS Section 4904, relating to unsworn falsification to
authorities.
~`
Michael D. Rentschler, Esquire
FEB-28-2007 10:40 PM
AeO~Dttnt 1D: 756001
'This is a Prttclrase Agreement. The date ofthat Agraernerk is .200 . Jaepie GLrk is the
tiellat'. 321 Hatdet'apo It~eivablae ~ 4LC, a Newda Wmitied Liablllty Cotnpipsy, in wooessars
and/or asetgas it dre '. la 6rls Agreement, Jotepb Clark h roferred to at "You" or "YonC' aed 321
Handerwtr RaCelvablee Ot~lglrii~On LLC or itt notnlttee, is roib~d to at "We", °Ua° or "out".
ti; , ~aU ~ Y,1 - ,L Y_
1. Your ar eoaseono an your behalf signed a Settlement Agreeracnt (the "lease" ar ffie
` ~Retttemant Agreement"}. in oonoactiofl with the resolution of a per~onel injury alaim.
2. The lnsm+er landed the Paymentts by buying an amruity carii'ACt (the "Ari1tNi(jr")1tau0d by First
/C7ol~ony,~L~iPo Insurance Company n/k!a t,anwatlr Lifb and Annuity Inautatroo Com~gty (the "Amtuity
~^.'..F.w7 "~.
3. A llst ottee Paymarrts being Sold under dtb ARreanrrnt ie attached to this Agr+eemeru as
SxhibB "A".
4. You desim to cell anQ amigo to Us ati of'Your rlghte to receive all er a pardon O~CtI~ Payments
wider tlur Ralease, es described cn rsklrlbit "A", ail of @re othar dgbis You have Under the Release and dto
other rigtrts as described in seetlor+ 1{a) bebW. We desire to p~aoireee all of Your rights sad benaHts, on
the forma acrd under iho condklotw datcrlbed in Orin AgreetgMt.
You aqd We agree es i+tilkrws:
1. Per+ehase
a. Yon now Ali. transfbr and a~i8n to Us all of Your rlghCs ht the "Assigned Attdtt" as
listed in Bxtdblt "A'°. ay ~Ip' signing mY A,~eemottt, We are hetrby ~ and
rrocepting she sale and assignmoat of all of the Amignod Aetets dasCrtbed above.
b. The t3t+oss Ftsohase Price ' . Twenty"Onc Thoaa~d Ssvar- Hundi+ed Fifty Doll#rs end
00/IUO Casts (SZ1,730.01>~'l'he Net Pm~chatb Frloe payablo to Ymt Is g21,~50.00 (the
"Pur+elrase Ftlte"}. The Nat Pmchew Frioe wlri be psbd to Yeu when bo8r Xou and We
alga tlds Agroe god R-e have corrrpleted Orrr Isdernal process.
2, ~S~~lll~1l~
s. You will agree after Your signirrg of this Agreement to dulivor to Ue, addressed ee We
may roquire, other not[oes, inetrrwtiarrs or doarments, and copies of Qrenn, ae We tlrlnlt
are neeesdrry or propot ba Berry out this Agncemettt_
b. ~Nhen You end ~We sign this Agreement, You will also dollvrr ~ Us: (1) a ktfer
atklretised to the Annuity C.ornparry direaing.that all paym~ of the Aaslgtted Assets
ate Yaur degQ- tltall be sent dir+eatly m Ua, srsd (2) a Chaagp of Be~&!roy Farm
Changing the baretic~ty of the Assigned Assets, ai~er your deatlr, to "321 Nlrtdasaar
lteoeivsbles won LLC", ee sob berr~eAdarY Ill) ~ (7} above aro relbrred b m
the Change of Benelkiary Form]. The Chaag~e of BareBctery Fond will slate dart the
iestruatioae may Trevor be rsvatted and that no chensa may be made is the lttsitneeiont or
1
Jrinaio ~ ~10D7 9Z (Eid~daeoN Reeeivlbbs Liroaod PerGieMrip
P_20
FE8-29^20QT 10:41 PM
Aopaurtt IU: Z3~i001
is the paymonb (ineludi'~ as to
paymerw) without utw prior wrlttetn
by You and [ls, deliver too Us,
iaetruotioas ~ ate. and copies
early out this Agreement.
the payee ar the » ~ ldaca ~ "taking auah
coatsestt. Y~ M-il! oleo, alien attelt otbna-
g~pated ~+ we may tbquire.
of thetp, as We think aro ttecewry or l~~' to
a. Begnre Yost and We sigh tble Agt+oemant, You will M1.ivbr to i!a an aalotowladgmint ai
Befits of Joseph Clark as gaitnafrY bet-efla~ty- of the Assigned Aeeees, of the forme of Ihia
Agreement; Mate of Joseph Cleric will agree that they are not entitled do eaY ~
any vt'the AselgRted Aerets.
d. You age to t~ ell otlter documearte which We may ' ~~ Us as t8e
onl ~' of the Asalgned Aseatl, i4chtdiag but ~ l)mrted to at- agreement to
proYvWo in Yo~~ieac W111 end Tes~ment ~ ell of Year r to the Aasipted Aseeb
oyere Bald to Ue (s "TesbttineaatarY p-Bmem+N-~•
e. You acknowledge that We advised Yea tv obtain hrdepeadaat Ploroel tax ~
determine whether thie tr'snaactiott wilt rerult In u-y advarss if~sl andlor state tsx
t~tC06.
f. Yon mcknowla~e that we advlsacl You must abtsin irtcb~at ~~
prior to exearting this Agreement end that We Dave edvieed yvu
You do any apediflo atlott~y for tmoh
~ You now reprorent and warrant 13o Ue that:
s. Ynu oven (ra'1tl are eellif!8 and assl~gaing tv U6 ua~er tlsti Agreeme~) etl of the
Aselgtdad Aeeete, &ee and clear of ell claiate. liens, ehsrges~, intet+elts.
envwnbranees, sad gents atF any netnre (ail~t' tbaa tbhr ,+~gibetllettt)s and
whoa Yvv and We elfin this Agreetneat; no Dora othm then Ua ehail have say
present or >liture right io the Aifigsed Aseele-
. b. 'Ihirr Agroemet-t and elf ~ 4f the other dvopmettb in eo~t{sal wim 1h4
A htrve been properly aigtted by You, attd tlral' ropresetrt Your legal,
valid and bindhrg obltgetlon, etr6oz~lbls against Yvu ut aooootdtume wilt their
a. 'r'im siptting +~ p~a'~ra of ~~ Agtoetrant by You and tare traeaaotlone
deaoeibed hs thle Agt+eotnorrt:
ii.
i1i.
iv.
da not coaflict with arty ottrer obiigatloua of Youes;
qdl! twt a violetbn nrtdet (or create any right of ~
cat~cellatlon or aoeatett~on or eimihrr rfgbt uttdw) anp- pcartraet or
agreernettt by which You ar Your meets, 3aclading fire il~oleaN, sre
baand or may be aisaseoed;
will trot create, er ~ arty Itat'tY (~-' ~ Us) the right ~ ereaoe, anY
lien, cltargL+- interest ~ e>tatmtrrenee in, t4 or an any of ffia
Asafgrted Ae arnd
will iwt a proeant mr lltbrrxe slBht in at~r odta party ~ tttttira arty
claim a$aittst You or Your aeeNa. or any of rite Aaignad Asarh.
lntttsl: ~ ~taQ7 32 t t~iseduson AeaehrnblM Um1Md Pai~tp
P. 21
FE8-26-2007 10:x1 PM
AeeoutrtlD: ssa~1
d. You uaddatat~d the tdxne and prorblOtts of this A~eaeent seal Yau have been
nepraeettted by ttpt and acca~ting advleore Imd a Lawyer In the sip~i~ of tlsie
e. Neither You nor anyone eiso bare to da anytl+b~ eke for (1) the proper aistting
and pet~fornneocs by You of ~k A~nement and aagr tranraotbne ialendod be be
dare ht thi, Agreott~es-t, or (~) tl-e oarrying oot by Ve of say oP Our tests and
raenedias under this Aaraeanart. Na other peuraan hn made a olaim in mtY rlghb
to or to tt~e AssiBaed Assets.
f. You have valid seesous for Melling Your iata~est in the Aes~aed Asaeb rather
than obtaining a loan with the Assigned Assets as oolbrtaal, sad You agree that
the #ransactlon ~ tbrdi in this A~reemtsat , k not a loan or odter ~aoing
trptsaotion.
g, This ABreeanant is a valid salq transfie and aselgameat bo Us of the Assigned
Assets,
h. Your residence and legal address is es deecctbed In ParaArapb L i of thk
Agroetnont. Uuriag the lase yenta, Yop have Bred at such tlddreaa.
i. No tepre4a~tatioet or wanunty of Yours In this Agreement or hn any oP the
daaunenfs d~ivere4 ht oonmecdott wilt dtie Agreetent ar la w1- went
nequh+ed by this Agroenuent, fs hunsau~ or oaatfune .any u~ue or mtrleading
J. The signing by You of this Agreement wilt not vlolda any_ oti-er promise or
egreetrwut you have made with Ana a1ae. You ttndersbntd t1Md mi' end all
reetrictlotu an the aaslgusblli4y of thb Sahtdukd Payn~ts water deluded in the
Reltrase dltdlor Attttulty at Your r8gae8t. tsar Your beoeAt and ttat for the btl~tit
of any other person, Tbese ~, if soy, tt~ ineinded by Yw a a
procai~tionaty meaeare to malm sure You wens sllavred 6v~osebk tart tterfnisa+t
ands' rho Internal Rereaw t",oda Yau wtderatettd that by it-to this
Agt+eetnent, you may be givMg ~ thb fltverable tax treetmant. You underetmd
that my in~roatia earned by You on smy inveettnent ~' use of the [ha+ehase 1
may be taxable to You. You way bare to pay dote is taxis as a r+estllt of tld.
Arreewant: For Our beaeAt ared the bet~eflt of Our assigns m st>oedNOr4, You
agree m WA1VB AND RBT,BA~B ail of Yonr rlglrts in, M, or ntuiar, suo6
~eetriotions on aadgaabllily, if any. .
k, Yau have net bedare the date of th# Agreement, said or assigned Your rigs tv the
Assigned AMa#s ar any part ofdta Aeatgned Aesats. Yau do not sate arty nor
tD Your present ar tornser speuse Bar tHtppott nudnbaateaes ar shnlLr obllgetieanti
nar do Yau Mve any woney t0 say of Ye~u dtildren or guendiaM et Your
cbll~h+0it. 'ibe Assigned AaaeM ere not sab;{eet to say oomatuaity prapsrty or
similar merWal rights of any person.
3
tnltlrt: t~ ~ t ti~oda~on tlee.tvmt.. i.ladt~d P~rtlnen6ip
P. 22
FEH-29-2087 10:42 PM
Aoca~wtt ID; 25tIQOl
i. Vow tigtrt to dte Aaigned Aeeeb ie not td by anY mott~0~ l• ~
al+at~ tecurttY ltttere~ ettaunbt+atce, r+at[lotion a adverse oWtn of etry
natta+e. You gedalthrd thpt'tyr vlalatlott pf wy of Yorr repretet-tattottt !n
Wit prtettlN-t gill rrralt b an ttt of hand by Yar Mhleb aoold rwdlt b
You buts t+eltl rMpontible mr daraaget in bvor of Ur, with mottty to be
pall by You to Ut,
tn. You ere not ~ violetiOn of ~+ obN~pKiant vottcerning ~l>'~otre, aiitlwt-y ar
aappott.
n. Ypu turw give up #orcver Alt Yow right in atq- a~eemert that tayt titer You
eeonot ettiga or roll Ycntr rigblt- in dta Aetigtred Awota tb Us. Yptt have not
requatted and Yon do not oapeat to receive ifioe+ Us, a Fprm 1099 or aq- ptirsr
dowirretttatton which ooaid raai~e tits tratep~atiau desorlbed by hilt Agreement
taxable do Ypu in any way. Ypu lfs~her m-dat~Attd that We have riot given to
Yptt asy advice about any a~ Your tetra in ~ tttnrstt~icrt. You hate relied on
Ypur own profetalvt-el advltcrt eonceming taxd~
o. A` ot'the date of that Agreement, You are of ie$pl epe 6n die sgee hated rt Yota
addrers In t3ectlan 1l of dtit A~+aeme~at~ ' tens, aed pf a Bound mind.
Yon have itetiar been conviotod of a ~la~+ or any ptleear aline lmrolving
dithareety.
p. Ypu are very fhtttiliAr wilt Your ftnanciel at~lrt fwd oatdideu. W!$r that lhl)
utrderetandMg, You certify that (i) on the dt~ We pay You the Pumhtie Frioe .
mid You Ceti to Ua the Attfgned Assets drt brit vAine of YDUt' Aerate are and
will be gnerter Wta e11 of Your 4etyor (2) Vat pc+eta>ety inOttrd to pry At) of
Yonr arodibart when twch payrnmts era dine; and (3} You have tint htte>tdpnaliy-
hidden the tliot Rom soy creditor pf Yaws that You have entered i~o t6ats
A.groerr~ttt and the pthar dwcutttetta relined to m ehk Ahrasntani.
q. Ypu da not intend to fTli a for brnlrtuptay and them era no ~wauita pr othx
etfaa'tt by any of Yow croditors to put You into banlQU~cy pr to tltlce the
Auigmed Aatete.
r, The purrtu~te Pehae ~ not Yonr only air matt tntportant eputvte of iucorxe and
Yau do not havo twy mmrtei er phyaicAl ptable~ that would peevettt Yoa 1l+att
having s pt}yiap,,lob.
s` You pnontite W w that no btwker, Snder~ or oltmr petyott other dtesr dwte
perept>: named M the hr~olaa ~Aloesetrt signed by you bt cptmaatlosl twith tide
Agreement wAt imrolved In or Mrportatrt in atrutgtog the purohase tnmeaotioa in
this Agteetn~etrt. No olbar petseat het a rl~tt to any flee, eotnmisslon,
ar ethers' eoaspentation beeause o#Wte Agnetyrant
t. You agfee drat We have not f6rred You eo give to Ut copier of +my cont'!d'ardal
docttmenb. You a`tm Hutt WQ W!d Yet that We only needed to see drove
dpeut~rtb which deaotibnf die AMigaed Aatett ee we crouki teuy Anm You the
Arelgned Mete. Yon agt~ee that Wo do nat httend ~ fed arq- pdrer gsety abous
vWat is included in tttow doWertents. You tprderrhnd that K We do tai k wits
only be lbr the aoie purppro of the Assigttad Aateot.
a
tniti~ ~ X2007 921 FtMirerren ie+aaotv.bien ttetlad Pw6eetel~
P. 23
F~$'-~e--2007 18 L43 PM
AOOOUI~t IL): X36001
A. Yoa ander~tand ~ it usueliy dams six to oi~at waela to coatplete this proaas,
tna< thset it oodd take toner, You undatatattd ~ we hnv~e to ab~dan aautt
apptnt-al of this ttatu~. XOU' UNDERSTAND THAT, DUE
Ta accASYaNAL DELA''YS~ wE WILL ESCROW
TSE AMOUNT EQUAL Tt~ THE NEXT TWO
MaNTHLY PAYl1+IENT$ DUE 'I`4 YOU FRO~VI
THE ANNUITY COMP,A-NY TO IN:~U'RE THAT
EVE RECEIVE ALI. oTr THE PAYMENTi9 'THAT
WE PUIICHASE. YbU UN11E1il~TAND THAT WE
MAY EITHER PAY OR ESCR[)W FUNDS Tt")
SATYSFY ANY dUiIGMEAT'TS, TAK LIEriTS oR
CHILD ~UFPORT AGAII~S'I' YOU OR THE
ASSIGNED A$8ET8 AND DEDU4'"T THCISE
AMauNTS FROG THL~ PURC~IA~4E PRICE. You
UNDERSTAND THAT WE WILL 11EDUCT FRb1VI
THE pURGHASE PRICE A1~Y AMOY7NT8 OF
PAXMENTS RECEIVED BY YOU P~VR '~
FrJNIaiNG, IF SUCH AMOUNTS ARE NOT
COVERED BY THE ESCROWF~D FUNDS,
~4, You promise Us ttu~t:
s. You wit! not, and will sot aitaw auy other F~4Y (except Us or Our aesigiaee,
if epptlGabb} to talcs ilarads away ~rotn the Asst6taed Assets. Yeu will not
do anytiaiag nhie be agbcc the Asst~eed Assds. Yo1t Wlii not self Yoia still
own the A~i~aa8 Assets. You wW a~ do or aibw esd-aae ebe
to do ~ tiaet could is any wq' lMsrtbt+e ~ cr lessen Our tip itt
the Assisted Assets.
b. You w{li tact do anything thet wW, or could in the i~ Yblals the
Rskue, oY s»y o! the ep+aaneeds required to be wcocated ley this
AgKeatlaetlt. You atw ague to cooperate whh Us b ~ Us ~ obbin all of
the rlghtt that Wa aro buying flan You in thb Agroatn®t and in, Sae
Release.
c. Yoa will give to Ue at least thirty (30} d'Ws wcltbeta notice of Youe lnbntlan
to. move Yoaar nsldeoce oC dasega Your legal ~t !loan the addtea in
Ptuagrttph 11 oi`th4 Agreaetettt,
d. You will sot iMlaro auy in Yatr lae~nrxlons to dae Aasadiy
Coaapmy re~diag ps~yuaents to be nude b4 Yeas.
tj ~
L~kYi: X00'! 311 Nredsrioc-ttseelvibl~ t.ta~ Pates
P. 24
FEB-2B-2007 10:4',.' PM
AooouM lB: X5001
You uadenewttd ~ the ~lnnutty atd the R,eiesee tnry ~Y tMit Yaa ~
nat to sell Your rights to the Aaigaed Aet~eb.
You egrve tq 4orditnte b ooopet~ato whh Us. Thy Your obliSation
to immadiatelj- dollver to Us tM1Y ode or o0tar them of Pstytdent
t+eoeived after the setts of this Agt+ootnettt by Yea a myaate Myer stall IJs. If
any Fgnoent ~ ever denied, dol~yeA, a whhbeld Rramn Us, ae dehtmiaod by
Us in our rauoneble ~ dheaty- or indb+ecdy on accauat et'nt~y net
or atniedon by You or any peteon ettin$ ibt Yau, tlsa- Yau shall be in
default under this Ag~rtetnettt (add sn Svmt of baiiuth under ¢S sbdt be
deemed b ltava occurred). imnaedlately upatt each defhult, sad without any
fuctiur notice to You, You wit! pay to Us tbo folbwb~g atnouttte:
(n the tlttl, dollar value of all reining Aaeigned . as they
becaetle sae niter the date ofthe datlwlt;
Alt of the remedies spesifibd under this aeotion eltsil be aamulatiw with afl
of the romedies for de0eutepursuaat to ge.
g. If You learn before or sitar the sigoiop of this Agreen~eat of the tlu~eat or
ectwel beginning of any >eweutt or prooeadletg that !w anythint b do with
Our rights under this 1-greemedt or tt-e Aedgtied Assets, then Yotit will
immediately notlt~+ Us of that alts You viii glue Ua capiea of all natlasa and
athm' writiagi rehting to h pranptiy alter You reeetve them.
h. [f You diva any oodce relating to aeq+ enpposedty uttpatd oiaim eifectiag
the Ant-uity or the Aeeigtted Aeseta et to aey elder claim aenlnet the
Annuity er tim Amigned Assets, then You whl pratnptty dott4r Us aQd Will
promptly glue UA oop~ aE all notiaea ems oti~er wrifi>1gs relating to it,
reoelved by You prmnpt(y+ alter You reoeire them.
3. tt~H't' TQ._CArtCit TION. YOU MAY CANCBI. THIS COTITRAC['
WTTNOUT P'gNAL'iY OR FI1R'TH13R 0l3irtQATION WITHIN TWBNTY-bN8 DAYS FRrOM TIi~
DATE YOiT R®CStVB PAYMt3N'T FROM 321 FiB~OH,R34N. Ia elder ~ the cenoetlstlan b be
atfbotive, Yet must meal a notice of eeocellatbn by ragisteeed ar certified U.S. mail, poattmni<ed whit
tveenty-anus (~l) days of rec0~t of ibs Pure6ate Prk:e oo [la, o/o Vice Pneaident of Opentiona at 3993
Rowels Hughes Paticwuy, bolts 250, Lps Yegee, NV i9t69-6734. Furihermw~e, in a~tder Bee Y~r motke
of cnaoetistion bo be ei'6lotive, Yattr or certified U.g. anvil pecid~s b u. must itWwde a bank er
aerti8ed cbecik for the 8r1! Purchaas Price that We paid Yost utukt this I+urduiee Amt. Airy falluro b
ootttp$r with d-e t-bove pMOCed~u+o shalt be a waii-er of Your right m osnoe! tdie traaaation.
6. Yarr FartLer Pronslsea. You ngroe that, fE+otn time to time, at Your etcpane, Yau wUl
~rptnptty+ sign and gee to Us nay and all dateuttoats b Aet{- Us radize our rlgl~ tool bafeflts at~er this
Ag~reetnent. 'This prnmise includes aignbg, filit>g ar allowing Us ea file tflntmcing ar eontltsstdon
statarne~s, or. atnendmatts ar aasigmnents of those doomtmte. You permit Ua ar estate aotmg fior tb m
sign our nano et~lor yotu nenie and Ste without Yaur eiWtagtre ettah iLuateing ~, if then is
permitted !n Yonr state of raldance. VYUea You alga this Agroanent, You will else sipt and deliver b Us
a "9pacht! Irravoaabla Power o4 Atbotnay" You tnwt rotaitt tits servioea of an attat7tay and dslivm~ en
opinion of Your attorney about the sate of Asalgned Aasass b Us, is d norm aocoptable to Ud.
6
Initist: ~Z00? S21 Heoia~aa ~eadvablet Limitel PMMN~
P.25
FEB-~8-2087 20:44 PM
Accawtt m: a~aafat
~~ Sal°`~~"S '~' 4'~'!~tl i. Wier ~d c5owr.wtn- All vY YoA~
rep<+meatd~tlom, wamlattipa and pneanieea midis >a thir Amt wilt oontiatte to be trdtod oat by Ut stbr
this AEreeattept is aiguod.
_, $TiSitgi4 Your ~yihn~e to oa~sly whh a>ty farm oP this A~reeaneatt or Your
ba+eevh oPaaty of Your t+eptrer~tians 3n this Agrtemem will amatt that Yon wW be in delhtfit. We relisr to
d~ir ee an "Event of Inuit." If there is an 13vent otDeiltuk, We have the rift t0 eue You i» oow't to nine
You paibnn Yaw promises or to get ataaey tt»tn You. Your igtlare do oaaagly with airy mlal forma of
~ Agreorndnt wall be a da&ult.
1» Paragraph ~ {e) Y'ou agree to give U9 at irast thirty (30) dayr wrkten notkrD ~ Your tnov~e to
a yaw t+esidenuoe or of.YoulC legal address 8~am the addnsar h- Farms 11 of this A6reaan~t. If we
are gurehaeing $oni You eottain hnuP sum payamntt~ life will oontaCt ynu at least 3 months betbro tiro
achddulad pgrtween b duo to doternalna if dta addreer We have effected wl~ the ooanpani~ b
in phue and to dettirmhae if Your legal eddraer has remained the soma. ItE Wa ao~ oastact you becaure
Yon have dwnged Yoar hpi aaddreae or ioered Yaar nddaytes artd ilriNd b nMMir Uf+, We w-iS
eoweMkr saes fsYMr+e eo a-ettq~ Us to fie an lIVEJ~I'1' OF DBp'AULT sad We will eur~s aE of onr
~ rigRta rndor fhb Agresraeut OUR RIGHT TO PROCEED AGfAII~J7' YOU UNDBI! TIiiIB
AGRe.Fbi[FNT 9HALiG Hli< SOLELY L1iMt'I'ED TQ WH1P~1 Yp1l HAVi! CdMM1T'!'ZD AN
EYENT OF DEBAULT. VVE SHALL NOT NAV$ THE RIGHT TO SUE YOU Ili OR CAUSE
TI18 AA1NU[TY COMPM~IY ~ IfbT AHLis TO MAKE PAYMEN'j73 BILCAUgE IT ffi NOT
1~ANCIALLY ABLfI TO DO ~.
g,[`.nnfreta'nn dw. Thta Agreement shalt be gQVOr»ed, ooruarlted and eht6roed M
accadtntoe w#it the iabernal laws of fhe StAta of your domicile without ragerd for the oandiwts of law Hulas
thereof or dseuaitaia. (Far t~tat t,~ctera ar Nodes TlrattM6era obtained in the following ~ua3adi~ionr: AK,
Alt. AI.., A~, CA, C(?, CP, DII, I+I,, f3A, Hi, IA, IU, it,, AV, K8, bCY, LA. AdA. bm, M$, MI. MN, MO,
~. MT, NC, NE, NJ, NM, NV, OH OK„ OR, RI, 8C, SD, TN, 7'X, IIT, YA, WA, WV sand WY the krve
of those jurisdis~ion.4 shsl! be applied io the dv~ of st dispata reg~ndittg dye traMS9lbr.) Your domicile is the
proper plaroe of venue to brlag saq- salon arising wt of a bresoh of this A~emartt.
10. Tbia Agraentant will hold reapanaible Yoar heir,
exeaatoua, euoverrors and msfgha and wilt bs®e9t ~ repaeaaamtfvea, suooeaera, be»efbi~iee and
penaritbrd arrlgnr. Notbieg is tl~ Agroemeatt b intended ibo give atq-~e ether than You or Ue or e~ of
Our stitoaemoaa ar agigna airy betreAh.
ii. . All wotiaeo sod other e0mmunl~CatlOtts na~der that m will ba in wrtd+~
sad wilt be r~da by delivery by iueane by ahlda ttye aeatider o6tahye a receipt 04 deliveay fiota Rhe rmrrler
(includiatg wkho~rt limitation, certified mail r+elvrn t'eo+ript tequea~ed or overnight oouriar earvicaa~
addressed to doe prrty to wham a ragaeu or danaand it :o he made. demtamd or uotloe m slwil
be daeanad given on the debe whiff b ooze business des!' alter the data swat by avaeMgi~ mail ar three days
offer the date a~at by oeatiflpd ttrslL
The addttieeas of fire patttsr era 4r fbllowr:
lfto You:
loaeph CIaRc
93 Wad Surest
Carliea, PA 1'9013
~ ~
tai X2007321 taaadinor nao~h-.Mw Liiatled t~rrb~mrhtp
P. Z6
FES-2B-2007 30:43 PM
P. 27
AOOOtayt lD: ~S' 6001
Ifto Ua:
321 Hee~son Reoeivabdes Origination I.LC
3993 He»etend Hteghea Pericway .
8ttlb 2S0
I.as Veers, NV 84169.6734
' Attetrtion: Yke PraWatu -~ Operatioas
lZ. ~ Anythheg either You or We did or said before ihld Agteetteent wAa agreed
will pet at~ot Your or Our rtgioe tinder d-is Agreement in any way.
13. ~ 8att~pt sa otherwiss ati9retalwly set inrth is this ~. Yae turd We
clot we will each ppr our e+ospeCtixo cwts mtd etti+seeses in eattteeotz+etr w~ the aarryptg ant of thu
Agreetnant.
i 4. ~p~. The •eotlon and subseCdoa headiagc ~etah3ed ht thin Agraeeneet are lbr
tefbreace purgoaey only and wID :eot atyOCt in any way the meaning or lttt~rebnt3ast of this Agatt
15, . Qne a mnro orfglnala of this Amt enay bo signed arch Ycmr ar Oqr
slgt-elure. When put together O+ey wilt Make a~ac egreeateat and the Agrearreent wip he ca®eklered signed
by all patti0a that twed to sign. A 9rosimile slgtiettme will be non`i~daeed an original.
16. We end anyone to whom We assigp this Agteen-gtt raay arellga Our right,
title aced interest in acrd ~ thh Agreaaeont, the Mnulty and tiye Assigned Assets without Your approval.
Yoa end We agree that if there is an aasigtn~at br Us no- some ~ 1Ye shall not be rdpopdble b
Ybu. Yore must look only b the person or catryeagy flees Wo assign t6la Agreemmed 1o Bor any payptant (gOr
e~carnple, of the Pareltaae Price) std perfoe of this AgreeneeM. When aslaed by Us or ta<y assignee,
You wits alga end deliver arty suclt doaatttents es We may t~ogttiro to po~rm this transaction, ss ase~igne<l.
~~
~oe7 321 ilOndenon lteainbtes t.l+nierd Hr~hlp
' FEa-x6--2007 10 : av PM
Acoouet tA: '?~St100!
17. Y,..= ^ ~. You d-d Y'our Bowe era fl~!!y swim ai Yaar rl~lme in qa Awi~!
Aseetr. You and Your spouse IWtY dive up thoea rl~u. You and Your sponge ~ by eallln~
the Aaal~oed Aeeoie to Us, You and Your erv not receivitt~ dao seeta amount a~ eaotuy r Yau
would ii You vwl~ed i~ ali olP the aoi~duted Psyntaets of tine Asdgsed Aamis but, rad-er, ~ro ncoiv~ s
dt~otuitad value 1n reborn $ot ieaeipt of the Purdura Prlee igtmediahely. You atul Your have valid
reesams fiat aoltiog tAe Aaigped Aasets. You and Your Telly d the terms of dre Putobdte
Agreemattt and underanmd drat dte Bale otthr Assigned Aesats is flt~al. You aieo uedaretaed drat Your
spouse uP aqy protletty right he or sha may havo in the Assigned Assets dud Your spouse ooold chdm
because of Yaw tnsrrlsge.
tg. iirc ~ppdat. This A~ree~e+u and ~e Bxbibits and otter d Yau sued
make ~ the entire uaderstaeding and agreametrt betaean Ymt and Us about this Agr+Aemenl. 't'his
Agtaetueu replsoes sit prime n~ orhether wriltan er argil, about Chia Agree. TMs Agreemeot
testy got be alined uele:s M n aYridng slg~d by You said Us.
19, Yoa uadbestAnd that Our liability to Yw tuxler this
Agroomeot is aRrictly titnieod m tha eaquirateeat b psy the Pgr+dNiae Prioa and tinder no ~tawetenoes will
We be rospanslbk for acnsegttamttal darnagaa.
20. ~"dilulAp You vnderafartd. diet oemrt approval ~ retptlrod For this enmsGer.
Yaa agree to oooperabe v-h1t us m abbsln such court spptaveJ.
21. Atteohed to this PurcZuso Agxoatan-t are the }bllowing 13ahibite;
13athffiit "A° List of Wbaet Ftlyrnenta Ws are Baying.
Ieeendittg to be ledaally botnu#, You and We have signed this ~ as of tha daee at the top of
dta ftret page oPtbis Agreement.
321 HBNDFRSON RB~IYABL.ES QRKitNATION I.I.C
H
P. 26
y~ .~......~..,._...
a
1.
~° 8It3i+T
ring
t3woee to geld s
bes~re tM.lhis gay of sa1~'
otaty
it~wii«i tt~
taeu~r Awe
pMt-NU.ogorvN, aura cauMnr
nor Qatatrwon wee dw ~, >roov~
~~ ~~~ ~
FE;H-,'28-200? S 0 S46 PM
We ars hereby par~uin8 Snm Yeu ut~ the Annuity:
A) 2 pRymetft ai ~ It~,t100.00 on March l 1,2021 Ha a peS-aua~t of ~"IS,OW.00 oti Mturob 11~ 2031
P. 29
Acceunt 11): ~StS001
~~
OAUNTY pB ~'GNk~&'~AK~-
!>M this ,~, deh+ o! ~ad~_,,,,,~ 200, bKf-n ule, tAe IlboWe ~Md Fe~~ xPP~rad balbre Mtg perroeslly Imorra to
me M be the persox whose cause h exhaerlibed to #ae xtithin hraErumext and xxknervled~t to n~ thtlt he rxaeal`d It.
Notary
i
~`•~AMMl~01~01t„p,001M1r
` ~-' ~ 1MpUgJUI ~ ~
FE8-2A-2007 10137 PM
P. 35
m: ~s6ao~
PLEAST BE Ari'VIBED TEAT THE PROPOSED TRANSACTION IS A
SALE, NOT A LOAN, AND THAT YCIU WILL HE SELLING ALL RIGHTS
AND TITLE TO THE ASSIGNED A55ET8 ONCE THIN TRANSACTIOI~T
ffi CONS'Ia'MMATED. PLEASE BE ADVXSED THAT YOU MAY BE
SUS.YEC'I' TO ,AiDVERSE FEDERAL A,ND STATE XNCOME TAX
CONSEQUENCES AS ,A, RESULT OF THE PROPOSED TRANSACTION.
YOU SHOULD COATSULT YOUR ClWN COUNSEL, ACCOUNTAA~T~ pR
FINANCIAL ADVxSOR REGARDING ANY FEDERAL OR STATE
INCClMI~ TAX CONSEQUENCES ARISING FROM THE PROPOSED
TRA1~1'~iFER
YOUR PURCHASE PRICE WAi9 DERIVED ASSUMING A DISCOUNT
RATE 91GNIFICANTLY HIGHER'CHAI~ THE PRIME ~1TEREST RATES
CI~IARGED BY COMMERCIAL BANKS, THERE~`ORE, WE URGE YOU
TO ExF.~ORE ALL ~ANC;AL oPTIOr~S.
WE WILL ~PURCH'ASE FRO1Vi YOU A) i p®yment of 5100,~0,~ on ll+~rch .
11, 2021 B) I p~ymant of S7S,000.00 on MArch 11, 2031
['I`HE REMAINDER OF THIS WAGE LEFT BLAND INTENTIONALLY]
FEE-26--2007 10:38 PM
l~0001Nlt ~ ~~l
TIIE AGGREGATE AMOUNT OF THE PURCHASED I'AYMENTIS IS
5175,000,04.
THE DISCOUNTED PRESENT VALUE OF THE AGGREGATE
PAYMENTS AT 5:64°/6 IS X66,75?.3~. THE DIUNT~D P'~BF~NT
yALUE IS TAE CALCULATION OF THE t;URRENT VALUE OF THE
'I~NgO'EItRED STRUCTURED SETTLE1VrENT PAYMENTS UNDER
FEDERAL STANDARDS FOR vALVnvG ANNUITIES. TILE GROSS
AMtJ~TNT PAYABLE TO SELLER ?S 5Z1,7S0.04.
THE FOLLOWING EXPENSES ARE INCURRED BY THE SELLER
(YOU) AND WILL BE DEDUCTED FROM THE p'IJRCHASE PRICE:
COMPLIANCE AND ADMINIS'I'RATIVE FEE: 50.00
-FII.-ING AND RELATED EXPENSES FEE: $0.00
THE NET AMOUNT PAY'A$LE TO THE SELLER(YOU~ IS 531,730.00.
NO OTHER EXPENSES ARE INCURRED BY 'YOU.
THE DISCOUNTED PRESENT VALUE OF PAYMENTS SHALL B&
CALCULATED AS FOLLOWS: THE APPLiCADLE FEDERAL RATE
UiSED IN CALCULATING THE DISCOUNTED PRF.fSENT VALUE IB
5.60°!v.
'r'HE EFFECTIVE ANNUAL DISC~'IUNT RATE FOIL THL9
TRANSACTION ~S 13.06°/.. THE CAfiH PAYMENT YOU RECEIVE 1N.
TFIIS TRANSACTION FROYVI US WAS DETERMINED BY APPLYING
THE SPECIFIED EFFECTIVE ANNUAL DISCOUNT RATE, .
COMPOUNDED MONTHLY, TO THE TQTAL AMOUNT C1F FUTURE
PAYMENTS TO BE RECEIVED BY US, LESS THE TOTS AMOUNT OF
COMMISSIOriS, FEES, COSTS, EXPENSES AND CHARGES PAYABLE
BY YOU.
THE NET A1bI0[INT THAT YOU WILL RECEIVE FROM US IN
EXCHANGE FOR YOUR FY.rTURE $TRUCTUREII SETTLEMENT -
FAYMENTS REPRESENTS 32.60°/6 OF THE ESTIMATED CUIIRENT
VALUE OF THE PAYMENTS BASED UPON
P. 1S
FEB-29-200T 10:38 PM
AOOOt111t ID; ~S6liG1
THI6 DISCOUNTED VALUE USING THE APPLICABLE Ii'EDERAL
RATE.
T~iE QUOTIENT OBTAINED HY DIVIDING THE NET PAYMENT BY
THE DISCOUNTED PRESENT YALUIF IS 32.60~i6.
BA9FD ON TTIIE NET AIVIQUNT THAT YOU WILL RECEIVE FROM YTS
AND THE AMOUNTS AND TIMYNG dF THE ~T1~UCTURED-
SETTLEMENT PAYMENTS THAT YOIJ ARE TURNING DYER TO US,
YOU WILL, IN EFFECT, BE PAYING INTEREST TO US AT A RATE OF
I3.06°/~i PER YEA1L TIIE NET AMOUNT PAID TO YdU (THE PAYEE)
BY ~IJS (THE TRANSI~,REE) REPRE5ENT8 AN ESTIMATE OF THE
FAIR MARKET rV'ALUE OF THE FUTURE PERIODIC PAYMENTS
'TRANSFER~D UNDE1~ THE STRUCTiJRED SETTLEMENT
AGREEMENT.
NOTICE OF CANCELLATION RIGSTS:
YOU MAY CANCEL THIS TRANSAC'T'ION AT ANY TIIVIE PRIOR TO
5:00 P.M, dF THE TWEI~TY~FIR9T DAY FOLLOWING THE LATER OF
THE EXECCUTICIN OF TITS PURCHASE AGR'~EMENT, dR THE DATE
THE PAYEE BECOMES OBLIGrATED UNDER THE PURCHASE
AGREEMENT WiTHdUT PENALTY OR FURTHER taBLI+~ATI4N.
THIS CANCELLATION RIGHT CAN1~iOT $E WAIVED IN ANY
MAN1~R.
TO CANCEL, YOU MUST PROVIDE WRITTEN N01'ICE TO THE
1~ANSFEREE. WRITTEN NOTICE SHOULD BE MAILED OR
DELIVERED TO THE ADDRESS BELOW BY 5:00 P.1VI.OF
(`rHE TWENTY-FIRST DAY FOLLCIWING'1`HE TRAI+tSAC~'ION}. IT I5
BEST TO 1VIAIL IT BY CERTIFIED MAIL, RETURN ItEi~RIP'I'
P. 17
~P'EB-26-2007 1 Q ; 39 PM
A,oCptmtlD: ZS6O01
REQUESTED, AND TO DEEP A PH4'i'OCUPY bF TaE SIGNED FORM
AND YQUR P(~iT OFFICE RECEIPT. ADI1RFjSS Ta WHICH
CANCELLATION IS Ta BE ItETUR1~iEDs
~Zi ~rtDoN R~EIVABLE~ aRiGINATXON LLC
3~3 ~awARD HUGHES PARKWAY
suITE ~.so
LAS VEGAS, NV' 89169-6154
ATTENTION: VICE p1tESIDENT - OPERA'T'IONS
IMI'oRTANT NOTICE: YOU ARE STRONGLY URGED TO COATSULT
WITH AN ATTORNEY wH0 CAN ADYI4E YOU OF THE POTBN'Y'IAL
TAIL Ct~NSEQUENCES QF TICS TRANSACTION.
PLEASE BE ADVISED THERE ARE NO PENALTIES OR LIQUIDATED
YfAMAGEB PAYABLE BY YOU IN THE EVENT QF ANY BREACkI OF
THE TRANSFER AGREEMENT BY YOU. THERE ARE NO BROKERS
COMMISSIONS, iSERVICE Ct'I!-RbF,S, APPLICATION FEES,
PROCESSING FEES, CLQSING C08'I`S, FILING FEED,
ADMINISTRATIVE FEES, LEGAL FEES, NOTA1tY FEES AND O~'HER
COIVIMISSIONS, FEES, COSTS, EKPENSES AHD CHARGES PAYABLE
BY 1YOU aR DEDUCTED FRGM GROSS AMOUNT dTHLR~MISE
PAYABLE TO YOU dTHER'X'HAN THE Ct)-MPLIANCE AND
ADMYNIl5TRATIi~E FEE AND THE FILING AND RELATED EXPENSF•S-,
FEE.
IF YOU BELIEVE YaU WERE TREATED UNFAIRLY OR WERE
Mi6LED AS TO'I'13E AtATU1tE OF TIIE OBLIGATIONS YOU ASSUMED
UPaAT ENTERING INTO TTlIB AGREEMENT, YaiT SHHQULD REPC'1ITT
THOSE CIRCUMSTANCES TO YOUR Lt)CAL Dil~'I~CT ATTaRri~Y
OR~THE OFFICE OF THE ATTQRNEY GENERAL.
TBE Ek'FECTIVE DATE OF THE TRANSFER AGREEMENT SHAI.,L BE
DEEMED T4 BE TBE DATE THAT THE AGREEMENT WAS SIGNED
Bit' THE YUU (PAYEE).
P. LB
PLEASE BE ADVISED THAT PAYMENT Tp YOII P'IJRSUAI~IT TO THE
TRANsF~R AGREEMENT IS Car~TnvGENT vPQN covRT APPROVAL
OF TH$ TRANSFER AGREEMENT.
FED-2B-2067 10:46 PM
Aaoamt ID; 2!6001
PLEASE EE ADVISED THAN PAYMENT TO YOU WILL BE DELAYED
UP TO 30 T#AYS OR MORE IN' QRDER FOR THE COt1RT TO REVIEW
AND APPROVE THE TRANSFER AGREEMENT.
BY SIGNING AELOW YOU ARE CONFIRMING RECEIPT QF TSIS
DYSCL08URE AT LEAST 10 RAYS PRIOR TO RECEIPT QF THIS
CON~'RACT.
a H s~
P. 19
CERTIFICATE OF SERVICE
I, Michael D. Rentschler, Esquire, do hereby certify that, on the date stated below, I
served a copy of the foregoing Petition and the attachments as required thereto upon the
following by Certified Mail, return receipt requested and addressed to:
First Colony Life Insurance Company n/k/a Genworth Life and Annuity Insurance
Company
700 Main Street
Lynchburg, VA 24505-1280
Attn: Legal Dept/Structured Settlements
Fireman's Fund Insurance Company
777 San Mann Drive
Novato, CA 94998
Attn: Legal Dept/Structured Settlements
Date:
Michael D. Rentschler, Esquire
28 N. 32nd Street
Camp Hill, PA 1701 I
(717) 975-9129
PA Supreme Court ID # 45836
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MAR 1 S 20QT
IN THE MATTER OF
JOSEPH CLARK
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
O
AND NOW, this _ Zo ~ day of ~ .~, ~ ~ , 2007,
upon consideration of the Petition for Approval of Transfer of Structured Settlement Payments
Pursuant to the Structured Settlement Protection Act, a hearing is hereby scheduled to occur on
~~ d the x`36_ ~ day of C C~~.c~, , 2007, at
-`D D , m., Courtroom Number _~ _ of the Cumberland County Courthouse,
One Courthouse Square, Carlisle, Pennsylvania, the Honorable Judge ~ ~.
presiding.
Distribution:
~ofichael D. Rentschler, Esquire
~f"reman's Fund Insurance Company
~rst Colony Life Insurance Company n/k/a Genworth Life and Annuity Insurance Company
J
J.
BY THE COURT:
EJ`~ I'~ fir; `, ~~~.~~~ l~~
8 S =z ad 1 Z ~~N t~Dl
~~~~~~~~~a~ ~~. ~o
~~~~~
s
IN THE MATTER OF : IN THE COURT OF COMMON PLEAS
JOSEPH CLARK : OF CUMBERLAND COUNTY, PENNSYLVANIA
NO. 07-1503 CIVIL
ORDER OF COURT
AND NOW, to-wit this ~ day of 2007, upon
consideration of the Petition for Transfer of Structured Settlement Payments by Joseph
Clark to 321 Henderson Receivables Origination, LLC and its nominees, successors and
assigns pursuant to 40 P.S. 4001 et se ., and any response thereto, the Court hereby
makes the following findings:
1. The transfer satisfies all statutory requirements of the Structured Settlement
Protection Act, 40 P.S. 4001 et sew., and will not contravene any other
applicable Federal or State statutes or regulations or order of any court or
responsible administrative authority; AND;
2. Not less than ten days prior to the date on which the payee first incurred any
obligation with respect to the transfer, the Transferee has provided to the Payee
a disclosure statement as required by 40 P.S. 4003(a)(2); AND
3. The transfer is in the best interests of the Payee, taking into account the welfare
and support of the Payee's dependents; AND
4. The Payee was advised in writing of his right to receive or waive consultation
and to receive independent counsel pertaining to this transaction. The payee
has elected to employ independent counsel in the name of Michael D.
Rentschler, Esquire, and Payee has received independent legal advice
regarding the implications of the transfer, including considering the tax
ramifications of the transfer, AND
5. Timely written notice of the Transferee's name, address and taxpayer
ident~cation number has been provided to the Annuity Issuer and Structured
Settlement Obligor as required by 40 P.S. 4003(a)(6), neither of whom have
objected to the transfer.
6. The Transferee shall be liable to the Structured Settlement Obligor and to the
Annuity Issuer:
a. If the transfer contravenes the terms of the structured settlement, for any
taxes incurred by the Structured Settlement Obligor or the Annuity Issuer as a
consequence of the transfer, and
b. For any liabilities or costs, including reasonable costs and attorney's fees,
arising from compliance by such parties with this order of the Court or arising as
a consequence of the Transferee's failure to comply with the Act.
The Structured Settlement Obligor and Annuity Issuer shall irrevocably change
the beneficiary for the Transferred payments to the transferee, and no other
individual or entity other than the transferee shall have the authority to change
beneficiary for the Transferred Payments.
Based on the foregoing findings, and being satisfied that the proposed transfer
satisfies all applicable statutory requirements as set forth in 40 P.S. 4001 et se ., and is in
the best interests of the Payee, and that upon review and consideration of the pleadings on
file and the argument of counsel, if any, and all evidence presented to the Court in this
matter, the Court is of the opinion that approval should be granted of the transfer by
Petitioner, Joseph Clark to 321 Henderson of the right of Annuitant to receive two (2)
payments comprising the aggregate amount of $175,000.00; as follows: one (1) payment
of $100,000.00 on March 11, 2021 and one (1) payment of $75,000.00 on March 11, 2031,
from structured settlement obligor as the party obligated by way of a Uniform Qualified
Assignment to make such payment under a settlement agreement, and which obligation
has been funded by its purchase of an annuity from Annuity Issuer bearing annuity contract
number 0303344.
IT IS THEREFORE ORDERED AND ADJUDGED that the assignment, per the
terms of the transfer agreement denominated "Purchase Agreement" attached hereto as
Exhibit A, by Joseph Clark to 321 Henderson of all his right, title and in#erest in and to the
two (2) payments comprising the aggregate amount of $175,000.00; as follows: one (1)
payment of $100,000.00 on March 11, 2021 and one (1) payment of $75,000.00 on March
11, 2031 (the "Assigned Payments"),from Structured Settlement Obligor bearing annuity
contract number 0303344 is hereby approved.
IT IS FURTHER ORDERED AND ADJUDGED that Structured Settlement Obligor
and Annuity Issuer be and are hereby directed to deliver the assigned payment, payable to
Joseph Clark, at the following address: 321 Henderson Receivables Origination, LLC at
P.O. Box 7780-4244, Philadelphia, PA 19182-4244.
IT IS THEREFORE ORDERED AND ADJUDGED that 321 Henderson Receivables
Origination, LLC, its successors or affiliated companies, shall hold harmless, indemnify and
defend Structured Settlement Obligor and Annuity Company and Annuity Issuer and their
successors and assigns, parents, affiliates, subsidiaries, and the underlying parties to the
Settlement Agreement or to the Uniform Qualified Assignment, including without limitation,
First Colony Life Insurance Company n/k/a Genworth Life and Annuity Insurance Company
and Fireman's Fund Insurance Company ("Indemnitees") from any against any and all
liability, claims, losses, damages, awards, penalties and judgments, including but not
limited to claims which may be brought by Joseph Clark (including his heirs, beneficiaries,
contingent beneficiaries, or personal representative), by any individual or entity to which
321 Henderson subsequently attempts to assign or transfer the payment or any portion
thereof, or by any other individual or entity.
IT IS THEREFORE ORDERED AND ADJUDGED tha# 321 Henderson will provide
written notice of this Order to Structured Settlement Obligor within 30 days of the date of
this Order. The Structured Settlement Obligor shall, within 30 days of receiving said notice
from 321 Henderson of this Order, instruct the Annuity Issuer to redirect the transferred
payment in accordance with the notice provided by 321 Henderson.
IT IS THEREFORE ORDERED AND ADJUDGED that the Annuity Issuer, within 30
days of receiving said notice from Structured Settlement Obligor shall process the request
and implement the change.
IT IS THEREFORE ORDERED AND ADJUDGED, in conformation with 321
Henderson's acknowledgement and agreement that the resolution of this matter is
premised upon the specific annuity file in issue, the specific language of the applicable
underlying annuity documents and the governing law, and further that the resolution of this
matter is case specific, that this Order and the resolution of this matter does not constitute
waiver of any defenses or claims of the Annuity Issuer and/or Structured Settlement
Obligor in other annuity transactions nor is it, nor shall it be used or cited to as, precedent
or authority persuasive in any other proceeding regarding any other annuity contract,
transaction, attempted transfer of structured settlement payments, or otherwise.
IT IS FURTHER ORDERED AND ADJUDGED that Petitioner, Joseph Clark for
himself and his assigns, heirs and administrators, or individuals or entities that may claim
through his (the "Releason;"), hereby remise, release, and forever discharge the Annuity
Issuer and the Structured Settlement Obligor and its directors, shareholders, officers,
agents, employees, servants, reinsurers, successors, and assigns, and any parent,
subsidiary, or affiliate thereof, and their directors, shareholders, officers, agents,
employees, attorneys, servants, successors, and assigns, past and present {the
"Releasees"), of and from any and all manner of actions and causes of actions, suits,
debts, dues, accounts, bonds, covenants, contracts, agreements, judgments, settlements,
damages, claims, and demands whatsoever, in law or in equity, arising out of, related to, or
in connection with the Assigned Payment identified herein, or the Annuity Issuer and the
Structured Settlement Obligor's compliance with this Order.
IT IS FURTHER ORDERED AND ADJUDGED that, upon payment by the Annuity
Issuer of the Assigned Payment identified herein and inconformity with this Order, Annuity
Issuer and Structured Settlement Obligor's obligations with regard to the structured
settlement payment will be forever and finally extinguished.
IT IS FURTHER ORDERED AND ADJUDGED that Petitioner, Joseph Clark shall no
longer have the power or authority to request changes of address or beneficiary
designs#ion relating to the Assigned Payments, and no person or entity other than 321
Henderson or affiliated companies shall have the power or authority to change the address
for payment of the Assigned Payments.
IT IS FURTHER ORDERED AND ADJUDGED that neither Structured Settlement
Obligor nor Annuity Issuer shall change the payment address for the Assigned Payments
except upon receipt of written notice from 321 Henderson or its affiliated companies to do
so.
IT IS FURTHER ORDERED AND ADJUDGED that any further attempted
assignments, in whole or in part, by Joseph Clark, of any other structured settlement
payments, must be submitted to this Court for approval, and neither Annuity Issuer nor
Structured Settlement Obligor have waived or prejudiced their right to object to any such
further assignments.
IT IS FURTHER ORDERED AND ADJUDGED, as agreed to and understood by
Petitioners, that in the event that 321 Henderson attempts to further assign the Assigned
Payment to another person or entity, neither Structured Settlement Obligor nor Annuity
Issuer ever will be obligated to re-direct or make payable the Assigned Payment to any
such person or entity. If 321 Henderson is granted by Court Order approval to further
assign the Assigned Payments, Annuity Issuer and Structured Settlement Obligor will
remain obligated only to forward such Assigned Payments without change to 321
Henderson as per this Court Order, then 321 Henderson shall make payments pursuantto
its approved further assignment and 321 Henderson shall continue to service the further
Assigned Payments.
IT lS FURTHER ORDERED AND ADJUDGED that any Structured Settlement or
Assigned Payments that are distributed before the expiration of the Annuity Issuer's thirty-
day notice of this Order as provided herein, extinguishes the Obligor and Annuity Issuer's
obligations and liabilities with respect to the payment and it is solely 321 Henderson's
responsibility to collect the funds.
IT IS FURTHER ORDERED AND ADJUDGED that this Order shall in no way
modify nor negate the ownership of the underlying annuity contract number 0303344
issued by First Colony Life Insurance Company n/k!a Genworth Life and Annuity Insurance
Company and owned by Fireman's Fund Insurance Company.
IT IS THEREFORE ORDERED AND ADJUDGED that the Transferee shall be liable
to the Structured Settlement Obligor and to the Annuity Issuer:
a. If the transfer contravenes the terms of the structured settlement, for any taxes
incurred by the Structured Settlement Obligor or the Annuity Issuer as a
consequence of the transfer; and
b. For any liabilities or costs, including reasonable costs and attorney's fees, arising
from compliance by such parties with this order of the Court or arising as a
consequence of the Transferee's failure to comply with Act.
The Structured Settlement Obligor and Annuity Issuer shall irrevocably change the
beneficiary for the Transferred payments to the Transferee, and no other individual or
entity other than the Transferee shall have the authority to change beneficiary for the
Transferred Payments.
DISTRIBUTION:
321 Henderson Receivables Origination, LLG
First Colony Life Insurance Company n/kla Genworth Life and Annuity Insurance Company
Fireman's Fund Insurance Company
Michael D. Rentschler, Esquire - C'a~,y ~m.saw,~CtY q, ~~
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BY THE COURT,
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