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HomeMy WebLinkAbout03-5551IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION IN RE: PETITION OF JAMES HOCKER TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS PETITION TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS Petitioner, JAMES HOCKER, brings forth the following Petition to Transfer Structured Settlement Payment Rights pursuant to, and in compliance with, the Structured Settlement Protection Act, 40 P.S. §§ 4001-4009, and in support states as follows: 1. The Petitioner is JAMES HOCKER, an adult individual whose date of birth is June 14, 1947, and who resides at 60 Mountain View Terrace, Newville, Cumberland County, Pennsylvania, 17241. 2. This Court has venue pursuant to the Structured Settlement Protection Act, because the Petitioner is domiciled in Cumberland County, Pennsylvania. 3. On or about September 27, 1988, the Petitioner sustained bodily injuries as a result of an accident. Thereafter, on or about September 1, 2000, Petitioner entered into a Settlement Agreement and Release (the "Agreement") with West American Insurance Company. The Agreement provided for 142 monthly payments of $1,524.48 to Petitioner commencing September 1, 2000, though and including June 10, 2012. A true and correct copy of the Agreement is attached as Exhibit "A." The Agreement further provides that "[a]ll sums paid to Plaintiff pursuant to this Settlement Agreement constitute damages on account of personal injuries or sickness, in a case involving physical injury or physical sickness arising from the Occurrence and are intended to fall within the meaning of Section 104(a)(2) of the Internal Revenue Code of 1986, as amended." 4. By virtue of a Uniform Qualified Assignment, West American Insurance Company assigned its obligation to make the monthly periodic payments to American Home Assurance Company, the Structured "Settlement Obligor" as defined by 40 P.S. § 4002. American Home Assurance Company is located at 70 Pine Street, New York, NY 10270. 5. American Home Assurance Company funded the obligation by purchasing an annuity (Annuity Contract Number T00005140I) from AIG Life Insurance Company, the "Annuity Issuer." Id~. AIG Life Insurance Company is located at Annuity Administration, P.O. Box 1277, Wilmington, DE 19899-1277. True and correct copies of the Uniform Qualified Assignment, the Application for Annuity and the Annuity issued by AIG, including confirmation of the payments terms, are attached collectively as Exhibit "B." 6. On October 9, 2003, Petitioner executed an Absolute Assignment and UCC Article 9 Security Agreement (the "Transfer Agreement"), a true and correct copy is attached and incorporated herein as Exhibit "C." The Transfer Agreement provides for the assignment of Petitioner's right and interest in receiving 97 monthly payments each in the amount of $1,524.48 commencing on June 10, 2004, through and including June 10, 2012 (the "Assigned Payments"), to Settlement Funding, LLC (the "Transferee"). Settlement Funding, LLC d/b/a Peachtree Settlement Funding ("Settlement Funding") is a Georgia Limited Liability Company with its 2 principal place of business at 6501 Park of Commerce Blvd., Suite 140B, Boca Raton, Florida, 33487. 7. The Transfer Agreement was executed by the Transferee on October 10, 2003. 8. Additionally, as set forth in further detail in his Affidavit dated October 9, 2003, attached and incorporated herein as Exhibit "D," Petitioner avers that: a. He is 56 years old and has supported himself for the last 30 years. He is not married and has no dependents. b. He desires to sell the Assigned Payments to Settlement Funding, LLC. c. The transaction contemplated by the Transfer Agreement is in his best interest, it will improve the quality of his life, and he has thoroughly considered all of the ramifications of the transaction. d. He is in need of the money to purchase a home in North Carolina so that he can move closer to his daughter and grandchildren, his closest living relatives. He also plans to use some of the money toward the purchase ora new vehicle. He intends to pay cash for both, so as to not incur any financing obligations or interest charges. e. He will not be using any of the proceeds for day-to-day expenses, and he is not required to pay any child support. f. He has acknowledged that he has been advised to obtain independent professional advice, and that he has in fact obtained such advice as set forth in the Independent Professional Advice ("IPA") Statement attached as Exhibit "E." 9. Petitioner has been provided, and has acknowledged receipt at least 10 days prior to receipt of the Transfer Agreement, of the "Transfer Disclosure" required by 40 P.S. § 4003 (a)(2) attached and incorporated as Exhibit "F?' As set forth in greater detail in the Transfer Disclosure, the following terms have been disclosed to the Petitioner: a. The amounts and due dates of the structured settlement payments to be transferred are: 97 monthly payments each in the amount of $1,524.48 commencing on June 10, 2004, through and including June 10, 2012. 3 b. The aggregate amount of the structured settlement payments to be transferred is $147,874.56. c. The discounted present value of the payments transferred using the most recently published applicable federal rate for determining the value of an annuity is $122,453.42. d. The federal discount rate used to determine the discounted present value is the effective annual rate of 4.2% as of 9/29/03. e. The gross amount payable to Petitioner in exchange of the transferred payments is $74,205.95. f. The good faith itemized listing of all broker's commissions, service charges, legal fees, notary fees, costs etc. deductible from the gross amotmt otherwise payable to the Petitioner is: Legal Fees of $2,000.00 and processing fee of $200.00. g. The net amount payable to Petitioner after deduction of the above commissions, legal fees, etc., is $72,005.95 minus any advances made to Petitioner against the amount payable to Petitioner. h. The quotient is 58.80%. i. The amount of penalty and aggregate amount of any liquidated damages inclusive of penalties payable by the Petitioner in the event of any breach of the transfer agreement by the Petitioner is: NONE. 10. Petitioner has been provided, and has acknowledged receipt, at least 10 days prior to receipt of the Transfer Agreement, of the written "Important Notice" in bold print 12-point type required by 40 P.S. § 4003 (b). A true and correct copy of Petitioner's acknowledgement of the receipt of the § 4003 (b) notice is attached as Exhibit "G." 11. Petitioner has acknowledged that has obtained independent legal advice regarding the implications of the transfer, including tax ramifications of the transfer, as set forth in the acknowledgement attached as Exhibit "H." 12. On January 24, 2002, "The Victims of Terrorism Tax Relief Act," PL 107-134, 115 Stat. 2427, was enacted, which in part, amends the Internal Revenue Code of 1986. The Act 4 amends 26 U.S.C.A. § 5891 and now provides for favorable tax treatment of "structured settlement payment factoring transactions" that are approved in advance by a qualified court order approving the transaction. 26 U.S.C.A. § 5891 (b)(1). A "structured settlement payment factoring transaction" is defined as "a transfer of structured settlement payment rights (including portions of structured settlement payments) made for consideration by means of sale, assignment, pledge, or other form of encnmbrance or alienation for consideration." 26 U.S.C.A. § 5891 (c)(3)(A) (parentheses in original). A "structured settlement" is defined as an arrangement established by "agreement for the periodic payment of damages excludable from the gross income of the recipient under [Internal Revenue Code] section 104 (a)(2)..." and under which the periodic payments are "of the character described in subparagraphs (A) and (B) of section 130(c)(2)." A true and correct copy of 26 U.S.C.A. § 5891 is attached hereto as Exhibit 13. 26 U.S.C.A. § 5891 (d)(1) was also added by the Act and provides: [I] f the applicable requirements o f sections 72, 104(a)(1), 104(a)(2), ! 30, and 461(h) were satisfied at the time the structured settlement involving structured settlement payment rights was entered into, the subsequent occurrence of a structured settleraent factoring transaction shall not affect the application of the provislons of such sections to the parties to the structured settlement (including an assignee under a qualified assignment under section 130) in any taxable year. (Emphasis added). Accordingly, a favorable tax result is in effect at the time the Payee and the Transferee propose to enter into the Transfer Agreement. 14. Since a favorable tax result is in effect, approvals of the Settlement Obligor and the Annuity Issuer to the proposed transfer are not required. 40 P.S. § 4003 (a)(5)(i)(A). 15. The structured settlement did not arise out of a workers' compensation claim. 5 16. Petitioner has seriously contemplated this transaction, and due to his personal circumstances and needs, believes that this assignment is in his best interests, taking into account the welfare and support of Petitioner's dependents. 17. Petitioner acknowledges that counsel, Jones, Gregg, Creehan & Gerace, LLP has not been engaged to render professional advice with respect to the advisability, or the implications of the transfer, including the tax ramifications of the transfer. Counsel has been engaged solely to prepare and present the within Petition, based upon Petitioner's independent determination and/or professional advice obtained from others, with respect to the advisability and ramifications of the transfer. WHEREFORE, Petitioner prays that this Honorable Court grant this Petition to Transfer Structured Settlement Payment Rights. Respectfully submitted, Jones, Gregg, Creehan & Gerace, LLP Robert L. Monks PA I.D.# 52760 411 Seventh Avenue Suite 1200 Pittsburgh, PA 15219 412-261-6400 Counsel for Petitioner, James Hocker 6 VERIFICATION I, James Hocker, have read the foregoing Petition to Transfer Structured Settlement Payment Rights and hereby aver that the statements contained therein are true and correct to the best of my knowledge, information and belief. This Verification is made subject Pa.C.S.A. Section 4904 relating authorities. to the penalties of 18 to the unsworn falsification to es Hocker 08/09/2003 12:07 7177760060 PAT REED PAGE 02 SETTLEMENT AGREEMENT AND RELEASE This Settlement Agreement and Release ("Settlement Agreement") is entered into by and among the following parties: James M. Hocker and West American Insurance Company (herein after collectively referred to as "the parties"). "Plaintiff" shall collectively mean James M. Hocker and the heirs, executors, administrators, personal representatives, successors and assigns of same; "Defendant" shall collectively mean R&R Plaster and Drywatl and the heirs, executors, administrators, employees, personal representatives, successors and assigns of same; and "Insurance Company" shall collectively mean West American Insurance company and the successors and assigns of same. i. RECITALS A. On or about September 27, 1988, Plaintiff sustained personal and physical injuries as a result of the alleged tortious conduct of Defendant, all of which is hereinafter reran'ed to as the "Occurrence". In connection with the Occurrence, Plaintiff has filed suit against Defendant based upon tort or tort-type dghts ("Plaintiff's suit"). Defendant is insured by Insurance Company 'against liability arising from tho Occurrence, subject to the limitS set forth in the applicable liability insurance contract beh~veen Defendant and Insurance Company. B. The parties desire to enter ii, to this Sefflement Agreement to provide, among other things, for certain payment(s) in full settlement and discharge of all claims and actions of Plaintiff for damages arising out of or due to the Occun'ence, on the terms and conditions set forth herein. NOW THEREFORE. it is hereby agreed as follows: II. RELEASE In consideration of the lump sum payment set forth herein and the promise to make the periodic payment(s)set forth herein, Plaintiff has executed the release attached hereto as Exhibit A and incorporated herein by reference as ttlough same were set forth more fully at length. Exhibit A end this release are entered into in settlement of a legal suit or action based upon Plaintiff's tort dghts arising out of personal and physical injuries allegedly caused by Defendant (specifically including Plaintiff's Suit). III, UNKNOWN INJURIES Plaintiff fully understands that Plaintiff may have suffered personal and physical injuries that are unknown to Plaintiff at present and that unknown complications of present known injuries may arise, develop or be discovered in the future, including, but not limited, to, subsequent death or disability. Plaintiff acknowledges that the consideration received under this Settlement Agreement is intended to and does release and discharge Defendant and Insurance Company from any claims for, or consequences Exhibit A 08109/2003 12:07 7177760060 PAT REED PAGE 03 adsing from, such injudes and the Occurrence; and Plaintiff hereby waives any dghts to assert in the future any claims not now known or suspected even though, if such claims were known, such knowledge would materially affect the terms of this Seffiement Agreement. IV. PAYMENT(S) TO PLAINTIFF A. Lump Sum. Plaintiff has received One Hundred Seventy Thousand Dollars and No Cents ($170,000), receipt of which is hereby acknowledged. B. Pedodic Payment(s). Insurance Company hereby agrees to make the following monthly payment(s): The sum of One Thousand Five Hundred Twenty-Four Dollars and Forty-Eight Cents ($1,524.48) per month shall be payable to James Hocker commencing September 10, 2000 and shall continue through June 10, 2012 (142 monthly payments). If James Hocker dies before June 10, 2012, the payment(s) sat forth in this Paragraph IV_B. shall be made as due to Patricia May Reed, upon proof of death being furnished to insurance Company or its assignee, or to such other beneficiary or beneficiaries as James Hocker shall designate, in writing, pdor to his death, to Insurance Company or its assignee. No such beneficiary designation or revocation thereof shall be effective unless it is in writing and delivered to Insurance Company or its assignee. C. Nature of Payment(s). All sums paid to Plaintiff pursuant to this Settlement Agreement constitute damages on account of personal injudes or sickness, in a case involving physical injury or physical sickness adsing from the Occurrence and are intended to fall within the meaning of Section '104(a)(2) of the Internal Revenue Code of 1986, as amended. V. FINANCING OF PERIODIC PAYMENT OBLIGATION A. Assignment of ObligaUoj~. It is understood and agreed by and among the parties hereto that Insurance Company will assign its duties and obligations to make - such future payment(s) set forth in Paragraph IV.B to American Home Assurance Company (hereinafter sometimes referred to as "Assignee") pursuant to a "qualified assignment" within the meaning of the Internal Revenue Code Section 1:~0(c). A specimen of such qualified assignment is attached hereto as Exhibit B. Plaintiff hereby accepts such assignment without right of rejection and in full discharge and release of the duties and obligations of Insurance Company and all parties released by this Settlement Agreement with respect to such future payment(s). Upon the assignment of the duties and obligations of Insurance Company as provided herein, it is understood and agreed by and among the parties that Assignee or its designee shall make said future payment(s) directly to Plaintiff as designated in Paragraph IV. B. B. Third Party PaYment(s)~ It is understood and agreed by the parties that all future payment(s) as set forth in Paragraph IV.B will be financed by the purchase of an Annuity Contract from AIG Life Insurance Company (the "Annuity Contract"). Assignee shall be the owner of the Annuity Contract and shall have end retain all rights of ownership in the Annuity Contract. For its own convenience, Assignee shell direct AIG Life Insurance Company to make the periodic payment(s) directly to the respective 88/89/2883 12:87 7177768868 PAT REED PAGE 84 payees designated in Paragraph IV.B. Such Payment(s) will be applied against the obligation of Assignee to such payees as set forth in this Settlement Agreement and in the qualified assignment. C. Status of Plaintiff. Plaintiff acknowledges that Plaintiff has no right to receive the present value of the payment(s) due Plaintiff pursuant to Paragraph IV.B, or to control the investment of, or accelerate, defer, increase or decrease the amount of any payment(s) required to be made to Plaintiff. Plail~tiff shall only be entitled to receive the payment(s) specified in Paragraph IV.B when due. Plaintiff has no rights to the annuity contract or in any other asset of the Assignee. D. Date of Birth. Plaintiff hereby warrants and represents that James Hocker was bom on June 14, 1947. Notwithstanding anything to the contrary herein, if the actual date of birth is not as stated above, and if Insurance Company or Assignee relies or has relied to its detriment on the accuracy of the above-stated date of birth, then Insurance Company or Assignee may adjust the amount and/or timing or remaining periodic payment(s) so that no additional cost than that necessan/ to purchase the Annuity Contract is incurred by Insurance Company or Assignee. E- Assi(~nee As Obligor. The parties hereto expressly understand and agree that once an assignment of the duties and obligations to make said future payment(s) is made by Insurance Company to Assignee pursuant to this Settlement Agreement, all of the duties and responsibilities otherwise imposed upon Insurance Company by this Settlement Agreement with respect to such future payment(s) shall instead be binding solely upon Assignee. It is further understood and agreed that upon such assignment, Insurance Company shall be released from all obligations to make such future payment(s) and Assignee shall at all times remain directly and solely responsible for, and shall receive credit for, the future payment(s). VI. NONASSIGNMENT BY PLAINTIFF The periodic payment(s) to be received by Plaintiff pursuant to this Settlement Agreement are not subject in any manner to anticipation, alienation, sale, transfer, assignment, pledge or encumbrance by Plaintiff. i VII. ADEQUATE CONSIDERATION - DENIAL OF LIABILITY Plaintiff agrees and acknowledges that Plaintiff accepts payment(s) of the sums that Plaintiff is to receive pursuant to this Settlement Agreement as a full, complete, firlal and binding compromise of matters involving disputed issues; that payment(s) of the sums to Plaintiff shall not be considered admissions by any party hereto of any liability or wrongdoing; and that no past or present wrongdoing on the part of any party sllall be implied by any payment(s). 88/89/2883 12:87 7177768868 PAT REED PAGE 05 VIII. ENTIRE AGREEMENT This Settlement Agreement, together with Exhibit A attached hereto and incorporated by reference, contains the entire agreement between Plaintiff and Insurance Company on behalf of Defendant with regard to the matters set forth herein. There are no other understandings or agreements, verbal or otherwise, in relation thereto, between the parties except as herein expressly set forth. IX. READING OF AGREEMENT In entedng into this Settlement Agreement, Plaintiff represents that Plaintiff has completely read all terms hereof and that such terms are fully understood and voluntarily accepted by Plaintiff and that Plaintiff has been adequately represented by counsel of Plaintiff's choice. X. FUTURE COOPERATION All parties agree to cooperate fully, to execute any and all supplementary documents and to take all additional actions that may be necessary or appropriate to give full force and effect to the terms and intent of this Settlement Agreement which are not inconsistent with its terms. Xl. INDEMNIFICATION In accordance with the provisions of the Release Agreement attached hereto as Exhibit A and in further consideration of the payment(s) and the promise to make future pedodic payment(s) set forth herein, Plaintiff agrees to indemnify and to save and hold harmless Defendant, insurance Company and all parties released against any and ell medical or other liens, or claims that are, have been in the past, or may be in the future asserted against anyone as result of the aforesaid Occurrence. Xll. DRAFTING OF DOCUMENT AND RELIANCE BY PLAINTIFF This Seffiement Agreement has been negotiated by the parties. Plaintiff warrants, represents and agrees that Plaintiff is not relying on the advice of Defendant, Insurance Company, their counsel, or anyone associated with them as to the legal and income tax or other consequences of any kind arising out of this Seffiement Agreement. Accordingly, Plaintiff hereby releases and holds harmless Defendant, Insurance Company, and any and alt counsel or consultants for either of them, from any claim, cause of action or other rights of any kind which Plaintiff may assert because the legal, income tax or other consequences of this Settlement Agreement are other than those anticipated by Plaintiff. 0@/09/2003 12:07 7177780088 PAT REED PAGE 88 Xlll. COURT APPROVAL AND DISMISSAL OF LAWSUIT Plaintiff represents that Plaintiff has received any and all necessary court approvals to enter into this Settlement Agreement. Plaintiff shall secure an order dismissing Plaintiff's suit against all defendants with prejudice, with each party to bear its own costs. XlV. CONTROLLING LAW This Sefflement Agreement shall be construed and interpreted in accordance with the laws of tile Commonwealth of Pennsylvania. Dated: ~. Dated: Ja~Tes M. Hocker West American Insurance Company Title: 08/09/2003 12:07 7177780060 PAT REED PAGE 12 GE/~ERAL.RELEASE KNOW ALL THESE MEN THAT, James M. Hocker, his heirs, executor~, administrators and assigns (hereafter collectively referred to as "Releasors"), tbr and in consideration of the sum of 5320.000.00 ($170,000.00 of which is to be paid in cash to Releasors and the remaining $150,000.00 to be used to purchase an annuity naming James M. Hocker as the payee pursuant to a separate a~eement to be entered into by/lie tmdersigned), the receipt and sufficiency of which is hereby acknowledged, does hereby rem/se, release and forever discharge P.C.M. Construction, Inc., Harrisburg Airport Partnership, Jules Putt, Heinz Math.is and R & R Dry~vall & Plaster, their executors, administrators, assi~ens, successors, agents, employees and insurers, together with any and all other persons, firms, corporations and entities, both kno~vn ,~nd unknown, who are or subsequently may be determined to be liable for the claims referred to below, their heirs, executors, administrators, assigns, successors, agents, employees and insurers,;(hereinaffer collectively to as "Releasees"), of and from all, and all manner of actions and causes of action, debts, dues, aceoums, bonds, covenants, contracts, agreements, judgments, claims, damages, and demands whatsoever in law or equity, -known or unknown, arising from an incident which occurred on or about September 27, 1988, at the construction site formerly known as the Days Inn Airport, and located at 1815 l~isenhower Boulevard, Middletown, Pennsylvania, including any and all claims which were or could have been asserted in the civil action filed in the Court of Common Pleas of Cumberland County, Pennsylvania, at Civil Docket No. 3357-1990, which against the said Releasees, I ever had, now have or which my heirs, executors, administrators, successors or assigm or any one of them, hereafter can, shall or may have for, or by reason &the above described events and accident. 08/09/2003 12:87 7177780060 PAT REED PAGE 13 The undersigned understands said Releasers, by reason of agreeing to this compromise payment, neither actn~it liability but all expressly deny liability of any sort, and said Releasers have made no agreement or promise to do or o,nit to do any act or thing not herein set forth and we further understand that this Release is made as a compromise to avoid expense and to terminate all controversy and/or claims for injuries or d,'m~ages of whatsoever nature, known or unknown, irtcluding future developments thereo/in any way growing out of or connected with said events and accident. We admit that no representation of fact or opinion has been made by the said Releasers er anyoue on their belief to induce this compron~ise with respect to the extent, nature or permanency of said injuries or as to the likelihood of filture complications or recovery therefrom and that the sum paid is solely by way of compromise ora disputed claim, and that in deterrnin~ng said sum there has been taken into consideration the fact that serious or tme~pected consequences rr6ght result from the present injuries, known or unknown, from said incident: accident or medical trea~ent, and it is therefore specifically agreed that tiffs Release shall be a complete bar to all claims or suits for injuries or damages of whatsoever nature resulting or to result from said events and accident. We represent that we have the sole right and exclusive authority to execute this General Release and receive the sums specified in it; and that we have not sold, assigned, transferrecl, conveyed or otherwise disposed of any of the claims, demands, obligations or causes of action referred to in this General Release. To the extent there:exists any liens, workers compensation, ERISA or otherwise, as a result of the above described events and/or accident, Releasors do covenant and agree to satisfy same as a condition to this settlement and to provide eotmsel for Releasers with a letter of satisfaction of any such lien(s) prior to the distribution of the consideration specified herein. As further consideration for this settlement, we also agree to immediately file PraeeJpes 08/0~/2003 12:07 71777800G0 PAT REED PAGE discontinuing and ending the above referenced litigation in the Court of Common Pleas and fl)e Pennsylvania Superior Coua. [t is further understood and agreed that Releasors will indemnify and hold Releasees harmless ~'om any and all liability, damages, costs, fees and expenses arising from any subrogation, indemnity or other claims/suits made by any person or emity as a result of any payments made on behalf of Releasors, or as the result of any benefits received by Releasors, arising from or related to any injuries, losses and/or damages incurred by Releasors due to fl~e above described events and accident. Tiffs promise of Releasor$ to indemrfify arid hold Releasees harmless extends, but is not limited to, the claims of all persons, insurers or entities which have paid Workers' Compensation benefits, Private Disability benefits, Healfl~ Insurance benefits (regardless of whether said benefits ,are paid by a privately funded plm~ or otherwise), or other similar benefits who are, or may claim an entitlement to indemni~'/reimbursement from Releasors under any cont,'act, or pursuant to Federal or State law or Regulation. It is further understood and agreed and made part hereof, that neither we, nor our heirs, executors, administrators, successors or assigns nor our Attorneys or other representative, will in any way publicize in any news or coramunieafion~ media, i~cluding but not limited to newspapers, magazines, radio or television, the facts or terms and conditions of tlxis settlement. Re!easors and their counsel expressly agree to decline comment on any aspect oft?ds settlement to any member of the news media. This para~'aph is intended to become part of the consideration for the settlement of this claim. The laws of the Commonwealth of Permsylvania shall be applied to all issues in any way affecting the parties' agreements and obligations under this Release. 08/09/2003 12:07 7177760080 PAT REED PAGE iS of IN WITNESS WHEREOF, we have hereunto Set our hands and seals this -~'"~ 2000. day SIGNED, SEALED AND DELIVERJE_D in the pr,~senee of,a ]~tlies M. H~)cker (SEAL) the above named ('Relcas~s") before me personally appeared, known to me (or satisfactorily* proven) to be the person(s) named herein and who executed the foregoing Release. "---" Notary Pu~Iic (My term expires: CAUTION: READ BEFORE SIGNING - YOU ARE SIGNING A GENERAL RELEASE OF ALL CLAIMS AGAINST THE RELEASEE. 08/09/2003 12.'07 7177768060 PAT REED PAGE 07 EXHI I I Uniform Qualified Assignment "Claimant" "Assignor" "Assignee" "Annuity Issuer" "Effective Date" James M Hocker West American Insurance Company American Home Assurance Company AIG Life Insurance Company August 10, 2000 This Agreement is mede end entered into by and between the parties hereto as of the Effective Date with reference to the following facts: A. Claimant has executed a settlement agreement or , tales.se dated ~'%C~tr, I.~'~ , 2000~~' (the Settlement AgYeement") that provides for thc~ Assignor to make certain periodic payments to or for the benefit of the Claimant as stated in Addendum No, 1 (the "Periodic Payments"}; and 8. The parties desire to effect a "qualified assignment" withi~ the meaning and subject to the conditions of Section 130(c) of the internal Revenue Code of 1986 (the "Code"), NOW, THEREFORE, in consideration of the foreg.oing and other good and valuable consideration, the parties agree as follows: 1, The Assignor hereby assigns and tho Assignee hereby assumes all of the Assignor's liability to make the Periodic Payments, The Assignee assumes no liability to make any payment not specified in Addendum NO. 1. 2. The Periodic Payments constitute damages on account of personal injury or sickness in a case involving physical injury or physical sickness within the meaning of Section 104ta)(2) and 130(c) of the Code. The Assignee's liability to make the Periodic Payments is no greater than that of the Assignor immediately preceding this Agreement, Assignee is not required to s&t aside specific assets to secure the Period;o Payments. The Claimant has no rights against the Assignee greater than a general creditor. None of the Periodic Payments may be ~ccelerated, deferred, ;ncreased or decreased and may not be anticipated, sold, assigned or encumbered. The obligation assumed by Assignee with respect to any required payment shall be discharged upon the mailing on or before the due date of a valid check in the amount specified to the address of recoFd. This Agreement shall be governed by and interpreted in accordance with the laws of the State of PA. Tile Assignee may fund the Periodic Payments by purchasing a "qualified funding asset" within the meaning of Section 130rd) of the Code in the form of an annuity contract issued by the Annuity Issuer. All right~ of ownership and control of such arlnuity contract shall be and remain vested in the Assignee exclusively. The Assignee may have the Annuity Issuer send payments under any "qualified funding asset" purchased hereunder directly to the payeels) specified in Addendum No. 1. Such direction of payments shall be solely for the Assignee's convenience and shall not provide the Claimant or any payee with any rights of ownership or control over the "clua[ified funding asset" or against the Annuity issuer. Exhibit B 08/09/2003 ~2:07 7177780088 PAT REED II II PAGE 88 Assignee's liability to make the Periodic Payments shall continue without diminution regardless of any bankruptcy or insolvency of the Assignor. 9. In the event the Settlement Agreement is declared terminated by a court of law or in the even[ that Section 130(c) of the Code has not been satisfied, this Agreement shall terminate. The Assignee shall then assign ownership of any 'qualified funding asset" purchased hereunder to Assignor, and Assignee's liability for the Periodic Payments shall terminate. 10. 'J'bis Agreement shall be binding up0~ the respective representatives, heirs, successors and assigns of the Claimant, the Assignor and the Assignee and upon any person or entity that may asser~ any right hereunder or to any of the Periodic Payments. Assignor; West American Insurance Company Assignee: American Home Assurance Company Autt~or/z~ Represen['a~t/ve National Structured Scttlem~rits Trade Association 08/0g/2003 12:87 71777G8860 PAT REED PAGE Addendum No. 1 Description of Periodic Payments Bene. fits~ for]ames Hocker MONTHLY CERTAIN PAYMENTS: t/1,524.48 payable monthly beginning September 10, 2000 for 11 years and 10 months certain only (~.42 monthly payments). Last guaranteed payment is due .lune lO~ 2012. ]:nitials Assignor: Assignee:/~ ~ 08/09/2003 12:07 71777GOOBO PAT REED PAGE 22 Application For An Individual AIG UFE INSURANCE COMPANY Home Office/Pittsburgh, Pennsylvania 15222 Annul'b/T,, Incorporated as A CAPITAL STOCK COMPANY by Ihs Commonwealth of Pennsylvania Administrative Office: One ALICe Plaza, Wilmington, DE 19899 ~1~ Pu~r, chase~ (Prin3 Name in Full) 2). Po§c. yownee, r-Sam.e as Purchas..er or e unto ~asual~y Insurance Company american ~ome assurance company ApL // Zip Cocle Street City or Town State Social Security No. (ID # of Purchaser) 3) Annuitant (Print, Name in Fulr)... '.. .... , : 60 Mountain View Terrace Apt. City or Town State Zip Code &OO Tnterpsce Parkway Street Apt. # Parsiopanv NJ. 07054 City or Town State Zip Code 13-5124990 Social Securitv No, (ID ~, of Policy owner) 4) Social Security No, 5) Sex 6} Date of Birth (ID No.) of Annuitant of Annu- of Annuitant itant 202-36-7668 Male 6/14/1947 Proof of each Annuitant's age should be submitted'with this application and must be furnished to the Company before the first intern? payment. 7) Name of Annuitants in birth records if different from Section 3 Annuitant (if Joint) 8) Dates and Amounts of Each Income Payment. 51,524.48 payable monthly begimning September 10, 2000 for U years and 10 months certain only (142 monthly payments). Last guaranteed paymenk is due June 10, 2012. 9) Income Payments to be Made To C) Policyowner [] Annuitant E3 Annuit~ts Jointly ~ Other (Specify)- The Farmers National Bank Acct. ~ 0[-399847-[[ 1 t) Type of Annuity (Check One) [] Life annuity without guaranteed period E) Life annuity with months minimum guarantee [] Life annuity with installmeht refund guarantee 12) Will the annuity applied for replace or change any existing life]nsurance or annuities? If yes, give complete details.' ~ Amount Year Issued 10) 'Address to which income payments are to be sent [] Purchaser's Address [] Primary Annultant's Address [] Policyowner's A~dress ~ Other(Specify) - P.O. Box 156, Newvllle, : 17: [] Joint and % survivorship annuity With., month~ guarantee Montt~s Certain Funding Agreement I~ Other (Describe Fully)- Pay~a~:s certain for years and ]0 m~nc~, Y~ X No 13) Special Provisions / Beneficiary Ms, Pacrfcla Y~ay Reed The purchaser named in this application is applying for an annuity contract as outlined above. The purchaser and the policyowner agree that: 1. This application together with the policy form the entire contract. . , 2. if the poli~y has been delivered and the po!icyown?.r has accepted the policy as issued ~n accordance w~th this applica tion then all provisions of the policy will be bindmg. 3. Any change in amount, classification of risk., age.~e,t issue,, plan or benefits must be agreed to in writing. 4. The policyowner has the right to change.the ~enenc~ary and to exercise a~l other rights and privileges ,without the con sent of the beneficiary, subject to any statUtorY restrictions end the right of any irrevocable beneficmry. Amount Paid Primary Annuitant - ,' Witness Purchaser (Must be licensed Resident Agen~ if required by Statute) If the purchaser or polioyowner is a corporation it mu." 88/89/2883 PAGE 23 12:07 7177760060 PAT REED Request to Change BeneficlarylAddresslElectronic Funds Transfer Under a Structured Settlement Annuity Owner: Insurer: Annui~ Contract No.: Annuitant/Payee: Social Security Number: Date: I, me undersigned Annuitant/Payea acl(nowtedge that I am a petty to a Release and ~ettlemant Agreement (the "Agreement~) and thai I art bound Dy the temps and conditions of that AgraamsnL Further. I undsrstnnd that the Owner has purchased the Annuity to fund its obligations under the Agreement In exchange fo~ a release of all claims against it. TI~a Annuity is issued by the Insurer and all rights of ownership ere ve-~ted exclusively ir the Ow~e~. Further. I understand and agree thai the Owner and Insurer are participating In this transactJcx.~ solely as an accommodation to me and thai neither the Owner nor the Insurer have provided any legal of tax advice lo me, I em hereby requesting that the beneficiary of the Annuity be changed to: Name: Relationship: I em hereby requesting that the address to which con'espondenco is sent be changed to: I am hereby requesting that the address to which payment is sent be changed to; Address: City/State: I hereby authorize the company to initiate credit entries to my checking/savings account indicated below and the repository financial institution named below to credft the payment to such an account: Name Of Financial Institution: Street Address: City, State, Zip Code: Account Name (Payee): Account Number And Type: 9-Digit Bank Transit Routing Number: [3 Checking [] Savings Please at~arh a voided che,~k or a savings deport slip fo Initiate thio request. I authorize the company to correct any overpayments credited to my account during or after my lifetime, I authorize and direct the bank designated above to debit the account and to ~efund any such overpayment to the company. This authorization will remain in effect for not more than 30 days fOllowing receipt by the company of my wriffen revocation. **In consideration of the above request, I hereby represent and warrant to the Owner and Insurer that this request is not in breach of any of the terms, conditions or provisions of the Agreement which, by way of example and not in limitation of the foregoing, may Include restrictions of the Annuitant/Payee's ability to accelerate, defer, increase, decrease, sell, assign, pledge or otherwise encumber any payment due under the captiohed Annuity or arising out of the Agreement. Further. ~ agree to indemnify and hold Insurer and Owner harmless from any claims, losses, or expenses, including affomey's fees, arising out of or resulting from any brea=h of the terms of the Agreement.** Signature of Annuitant/Payee Given under my hand and seal this __ day of ,200 , [Notaq/Seal] Notary Public My commission expires: 12:07 7177760858 PAT REED PAGE 10 AIG[JFE AIGLIFE'INSURANCE.COMPANY On'e Allco.Way ~WIImlngton, DE. 19801. A CAPITAL. STOCK COMPANY Si,gle Premium Peri~3d Certain Immediate. Funding Agreement, This policy is a legal contract between AIG Life Ir surance Company (we. us or our) and the I~olicy owner (YOU. or your). PLEASE READ YOUR POLICY CAREFULLY. We agree, subject to the provisions of this policy to pay the contract payments as stated on th p~licy information page to/he party designate(3 on the aplication: Ten Day Right to In,:peet This'Policy. ~rhis policy can be returned for any reason within 10 day after receiving it. Return *itby mail Or Jn ~3erson to uS or the agent who Sold.it. We will refund ac premium Daid and'treat the policy as if were never issue(3. Secratary This Is a single premium peMod certain mined ate funding agreement. No dividends are payable 88/89/2883 12:87 7177768868 PAT REED PAGE 19 POLICY INFORMATION PAGE ISSUE DATE: OCTOBER 26, 2000 POLICY NUMBER: T00005140I OWNER; AMERICAN HOME ASSURANCE COMPANY ANNUITANT: JAMES MATTHEW HOCKER BENEFICIARY: AS STATED ON APPLICATION SINGLE PREMIUM: $1.00 AND OTHER VALUABLE CONSIDERATION FIRST ANNUITY PAYMENT DUE: SEPTEMBER 10, 2000 PERIOD CERTAIN: 11 YEARS AND 10 MONTHS ANNUITY PAYMENTS: $1,524.48 MONTHLY 41100 (9/84) (PERIOD CERTAIN ANNUITY CONTRACT) 3 AIGLIFE 88/89/2883 12:87 7177768868 PAT REED PAGE 28 GENERAL PROVISIONS The Contract This policy with the attached' application is the entire contraCt. This contract may not be modified or changed except in writing by the President or Secretary of the company. No agent may change this policy or waive any of its provisions. All statements contained in the application shall be deemed representations and not warranties. Any request, or notice of proof required under this policy must be in writing. It must be mailed or given to us at our Home Office by the persons entitled to do so. Method of Payment We will make the contract payments by check. We will require satisfactory evidence of the survival of the Contract Payee on the due date of each contract payment. If the check for the contract payments is drawn to the order of the Contract Payee, the personal endorsement by the Contract Payee will be accepted as evidence of survival. Afl sums payable by us under this contract are payable at our Administrative Office in the city of Wilmington, Delaware. Payment of Premium The Single Premium is due and payable in advance, as shown on the policy information page. . If any check or other instrument given in payment is not honored When presented for payment, the premium will remain unpaid. Ownership While the Contract Payee is living, you may exercise ail the rights and privileges granted by this policy. These rights and privileges may be limited by: 1. Any StatutOry restrictions; 2. The rights of any beneficiary that you have appointed irrevocably; or 3. The rights of any assignees. Beneficiary You have appointed in the application for this policy one or more beneficiaries to receive the Contract Payments on the death of the Contract Payee. You may change the beneficiary by giving Us a written notice. If the appointment of the previ- ous beneficiary was irrevocable, we wilt require that beneficiary's consent. The change of beneficiary will be effective as of the date you sign the notice of cha~ge. We will not be bound by any notice of change until it is registered at our Home Office. If no beneficiary is alive when the Contract Payee dies, you, or your estate if you are also the Contract Payee, will reCeive the Contract Payments. A~slgnment We will not be bound by an assignment of any interest in this policy until the original of the assignment form has been registered at our Home Office. We take no responsibility for the validity or effeCt of any assignment. Contract Payments Contract payments will be paid to the pally designated on the Application. You may change the party receiving the pay- ments by giving us written notice. We will not be bouncl by any notice of change until it is registered at our Home Office. 08/09/2003 12:07 7177760060 PAT REED PAGE 21 contesting ThiS Policy We rely on the statements made in the application, Legally, they are ~onsidered representations and not warranties. We can contest this policy if any material misstatement is made in the application and a copy of the application is attached to this policy. After this Policy or a rider has been in effect during the Contract Payee's life for 2 years frdm the issue date. we will not contest this policy. Underpgyment or Overpayment If for any ~ an overpayment or underpay~'~nt of the Contract Paymant~ is made to the Contract Payee or any Beneficiary, we will: (1) In case of underpayment, pay the full am~, unt due the payee with interest at the ra~e of six per centum per annum with the next payment clue; (2) In case of overpayment, deduCt the amount dueus from future payments with interest at the rate of six per cent cantum per annum; deductions will be spread over the payment period. Non-Participating In Divldend~ This policy .will not participate in any divisible surplus of the Company, ABSOLUTE ASSIGNMENT AND UCC ARTICLE 9 SECURITY AGREEMENT (THE "AGREEMENT") October 9, 2003 I, James Hocker, ("1", "Me" or "Assignor") residing at 60 Mountain View Terrace Newville, PA 17241 am entitled to 142 monthly payments each in the amount of $1,524.48 commencing on September 10, 2000 through and including June 10, 2012. (the "Periodic Payments") on account of the settlement of a certain personal injury claim, the settlement of which is memorialized in that certain settlement agreement dated September 1, 2000 (the "Settlement Agreement"). The Periodic Payments are due to me from American Home Assurance Company (the "Settlement Obligor") under the terms of the Settlement Agreement and are being funded by an annuity issued by AIG Life Insurance Company (the "Annuity Issuer") beadng annuity contract number T000051401. A. I hereby sell, assign and convey to Settlement Funding, LL.C. (the "Assignee") or its assigns all of my rights to and interest in and to the following payments due or to become due under the Settlement Agreement: 97 monthly payments each in the amount of $1,524.48 commencing on June t 0, 2004 through and including June 10, 2012. (the "Assigned Payments"). In consideration for this assignment, Assignee shall pay to me the sum of: $74,205.95 (the "Assignment Price"). I hereby make the following unconditional representations, warranties and promises: 1. No one other than me has any interest or claim of any kind or nature in, to or under the Assigned Payments I am assigning hereunder. 2. I am not indebted to anyone that would affect in any way either the assignment of the Assigned Payments referenced above or Assignee's absolute dghts to receive same. 3. I agree to conduct my affairs so as to ensure that Assignee obtains all of the benefits of the assignment contemplated hereby. C. I agree that the following shall be considered an event of default by me under this Absolute Assignment Agreement: 1, The representations set forth in Paragraphs B 1 and B 2 above ara at any time not true. 2. Failure by me to perform the promise set forth in Paragraph B 3 above. 3. Failure by the Settlement Obligor or the Annuity Issuer to make any one or more of the Assigned Payments as a result of any act by me, my estate or any of my heirs. 4. Failure by the Settlement Obligor or Annuity Issuer to forward one or more Assigned Payments to Assignee as a result of any act by me, my estate or any of my heirs. 5. Failure by me to forward promptly to Assignee any Assigned Payment received by me from the Settlement Obligor or the Annuity Issuer. 6. Failure by me to fulfill any other obligation of mine under this Agreement. D. The following are conditions precedent to Assignee's obligation to pay me the Assignment Price: 1. Assignee shall be satisfied, in its sole discretion, that there are no claims or interests of any kind or nature whatsoever that do or may affect Assignee's dghts to or interest in the Assigned Payments and Assignee's ability actually to receive same on the dates and in the amounts set forth herein. 2. Assignee shall have received a final non-appealable court order, or a signed acknowledgment from Settlement Obligor and the Annuity Issuer satisfactory to Assignee in its sole discretion (such court order or acknowledgement together ara hereinafter referred to as the "Order"), authorizing the transfer by assignment of the Assigned Payments (which may continue to be made out to my name) to Assignee, and directing that the Pedodic Payments due on or after the day of the Order be forwarded, or authorizing the forwarding of the Periodic Payments, directly to Assignee. E. Under this Agreement and only to ~' =,v~,,, ~,~.-~;.,.,~ h,, law Assignee and I intend to create a security interest under Article 9 of the Unif Exhibit C the state designated in Paragraph F below, in my rights to and interest in payments due to me under the Settlement Agreement, which dghts have been assigned to Assignee as General Intangibles under Article 9 of the Uniform Commercial Code of the state designated in Paragraph F below. This Agreement shall also function as a secudty agreement. This secudty interest secures payment of the dghts assigned and performance of my obligations under Paragraph B above. Assignee may direct any account debtor, obligor on an instrument, including, without limitation, the Settlement Obligor or Annuity Issuer, to make pedodic payments directly to Assignee as contemplated by the Uniform Commemial Code. Assignee may file a UCC-1 financing statement to perfect its dghts hereunder. F. Except as otherwise required by applicable statutory law, this Agreement shall be govemed by and interpreted in accordance with the law of the state of residence of the Assignor on the date of this Agreement. ARBITRATION Any and all controversies, claims, disputes, rights, interests, suits or causes of action adsing out of or relating to this Agreement and the negotiations related thereto, or the breach thereof, shall be settled by binding arbitration administered by the Amedcan Arbitration Association. The demand for arbitration shall be filed in writing with the other party to this Agreement and with the Amedcan Arbitration Association offices in your state of residence. The arbitration shall be held in the largest city in your state of residence. The arbitration shall be held before a single arbitrator selected in accordance with the Commemial Arbitration Rules of the Amedcan Arbitration Association in effect at the time that the demand for arbitration is filed. Discovery, specifically including interrogatories, production of documents and depositions shall be at the discretion of the arbitrator and to the extent permitted shall be conducted in accordance with, and governed by the Federal Rules of Civil Procedure. A demand for arbitration shall be made within a reasonable time after the claim, dispute or other matter in question has arisen. In no event, shall the demand for arbitration be made after the date when institution of legal or equitable proceedings based on such claim, dispute or other matter in question, would be barred by the applicable statute of limitations. No arbitration adsing out of or relating to this Agreement shall include, by consolidation or joinder or in any other manner, an additional person or entity not a party to this Agreement, except by written consent of the parties hereto, containing a specific reference to this Agreement and signed by the entity sought to be joined. Consent to arbitration involving an additional person or entity shall not constitute consent to arbitration of any claim, dispute or other matter in question not described in the written consent or with a person or entity not named or described therein. The foregoing agreement to arbitrate and other agreements to arbitrate with an additional person or entity duly consented to by parties to this Agreement, shall be specifically enforceable in accordance with applicable law in any court having jurisdiction thereof. The award rendered by the arbitrator shall be final, and judgment may be entered upon it in accordance with applicable law in any court having jurisdiction thereof. Such arbitrator shall identify the substantially prevailing party and shall include legal fees and expenses for the substantially prevailing party. This provision does not apply to the extent inconsistent with applicable state law regarding the transfer of structured settlement payments. In such case any disputes between the parties will be governed in accordance with the laws of the domicile state of the payee and the domicile state of the payee is the proper venue to bring any cause of action adsing out of a breach of the agreement. G. I hereby grant to Assignee an Irrevocable Power of Attorney with full powers of substitution to do all acts and things that I might do regarding the Assigned Payments and any and all rights I have under the Settlement Agreement, including, without limitation, the power to endorse checks, drafts or other instruments; the power to alter, edit and change payment instructions and/or beneficiary designations and any other act which, in the sole discretion of Assignee as my Attorney-in-Fact is necessary or expedient for it to obtain all of the benefits of the bargain contemplated by this transaction. This power of attorney is coupled with an interest and shall survive my death or disability. H. In the event that prior to the consummation of the transaction contemplated hereby I receive any of the Assigned Payments, or any portion thereof, the Assignment Price shall be reduced in like amount and the terms of this Agreement regarding the payments to be assigned shall be deemed to be adjusted accordingly. In the event Assignee receives or otherwise comes into possession of any of the Periodic Payment(s) or portion(s) thereof which are not included in the payments being absolutely assigned to Assignee hereunder, Assignee shall forward such amount(s) to me at the address set forth above within seven (7) days of receipt of such amount(s). I. Assignee shall be entitled to discharge any adverse claims against Assignor or any of the Assigned Payments whether or not such adverse claims are disclosed. Assignee may, provided Assignee furnishes prior written notice to Assignor, pay any and all amounts necessary or, if the Assignment Pdce has been deposited into an escrow account, instruct the escrow agent to pay any and all amounts necessary to discharge such liens or other adverse claims, and the Assignment Pdce shall be reduced by the amount of any such payment. Adverse claims may include disclosed amounts to be deducted by Assignee from the Assignment Price to pay Assignee, as servicer for Peachtree Finance Company, LLC, to enable Assignor to obtain Peachtree Finance Company, LLC's release of its encumbrance on a portion of the Assigned Payments, which portion of Assigned Payments relate to pdor transfer transaction(s) consummated pdor to the effective date of the applicable transfer act(s) which encumbrance must be released for the transaction contemplated herein to be consummated. J. Since I know that it will take some time for the Settlement Obligor and the Annuity Issuer to receive and process my court order once it is granted, I hereby authorize you to hold an amount equal to the sum of the first six payments assigned by me or 20% of the first lump sum payment assigned by me to you under this Agreement until such time as the Settlement Obligor and the Annuity Issuer acknowledge the terms of my court order. At such time, I understand that you will send the escrow to me minus any payments that the Annuity Issuer inadvertently sent to me while the Settlement Obligor and the Annuity Issuer were processing my court order. K. This Agreement shall take effect on the date it is signed by me (the Assignor) or on such later date prescribed by applicable statutory law. L. All disclosure statements are a matedal part of this Agreement and shall be read in pad materia herewith. In witness whereof I hereunto set my hand. STATE OF ~® r~ (', ~¥ ~. u o..c~i COUNTY OR CITY OF /afnes Hocker On this ~ day of 0c--~k'~36-6'' ,200...~_, the above person, known to me to be the person whose name is subscribed to this instrument, personally appeared before me and acknowledged to me that he/she has read this instrument and that the instrument has been executed by him/her. My Commission expires on Accepted: '7 - 30-- o b PLEASE DO NOT EXECUTE THIS DOCUMENT UNTIL 10/09/2003 Settlement Funding, L.L.C. N~rl~l S~sl My ~ ~ l~ly 30, 2O86 Authorization For Deductions Pursuant to the terms of the Agreement, Assignee may deduct from the Purchase Price the full amount due to any and all third party creditors, judgment holders, holders of child support obligations, the holder of any other outstanding lien or claim (collectively the "Judgments/Claims") including life insurance policy payment(s) or any attorney fees in connection with the consummation of this transaction. If Assignee is able to satisfy in full the Judgments/Claims for less than the full amount due, Assignee shall be entitled to keep the difference between the amount deducted and the amount actually paid. Authorization to Conduct Credit and Criminal Back(~round Checks I, James Hocker residing at 60 Mountain View Terrace, Newville, PA 17241, hereby authorize Settlement Funding or any of its agents or designees, to conduct any and all criminal background reports, searches or checks and any and all credit history reports, searches or checks which it in its sole discretion and judgment deems necessary or advisable. Authorization to Release Information I, James Hocker, hereby request and authorize American Home Assurance Company, AIG Life Insurance Company, or any of their successors, assigns, designees, agents or administrators, or my attorney to disclose, or any other parties that may possess any information deemed necessary by Settlement Funding, or any of its agents or designees to be disclosed, make available and furnish to Settlement Funding, or any of its agents or designees any and all information pertaining to my personal injury settlement as set forth in a certain Release dated September 1, 2000, or any other documents deemed necessary by Settlement Funding, or any of its agents or designees. I specifically direct that American Home Assurance Company, AIG Life Insurance Company, or any of their successors, assigns, designees, agents or administrators or any other person or entity that this authorization is given to, cooperate with Settlement Funding or any of their agents or designees regarding disclosure of information pertaining or related to my settlement or other required documentation. Please provide copies via fax or otherwise of any and all documents requested by Settlement Funding or their agents or designees regarding my settlement. AFFIDAVIT I, James Hocker, of full age, being duly sworn according to law, upon my oath depose and say: 1. I currently reside at 60 Mountain View Terrace, Newville, PA 17241. 2. I am the recipient of certain guaranteed payments under a structured settlement dated October 26, 2000. The entity presently obligated to make the payments due under the structured settlement is American Home Assurance Company. In order to fund its payment obligations under the structured settlement American Home Assurance Company purchased an annuity contract T000051401 from AIG Life Insurance Company. 3. I voluntarily entered into an Absolute Assignment and UCC Article 9 Security Agreement (the "Agreement") dated October 9, 2003 with Settlement Funding, LLC d/b/a Peachtree Settlement Funding ("Peachtree"). Under that Agreement, I agreed to sell and assign to Peachtree the following payments due to me under the structured settlement: 97 monthly payments each In the amount of $1,524.48 commencing on June 10, 2004 through and including June 10, 2012 (the 'Assigned Payments"). 4. I understand I will forego receipt of the Assigned Payments under the Agreement. I understand that my beneficiaries/heirs and I will no longer receive any of the Assigned Payments or any portion of the Assigned Payments. I understand that all of the Assigned Payments will go to Peachtree or the assigns of Peachtree. 5. I also understand that this Affidavit is submitted for use in the court approval process initiated by Peachtree and myself to seek court approval of the transfer of payments to Peachtree. 6. I also received from Peachtree a Disclosure Statement detailing the terms of the Agreement, which I signed and returned to Peachtree. I carefully reviewed the Disclosure Statement and fully and completely understand all terms of the Disclosure Statement. 7. in the Disclosure Statement, Peachtree advised me to seek professional advice regarding the Agreement from an attorney, accountant or other professional of my choice. I have either received said advice or fully intend to receive independent professional advice. 8. I am 56 years old and have supported myself for the last 36 years. I have no mental disabilities that would prevent me from working outside of the home. However, I am physically disabled, due to my accident on a construction site, I have limited use of my left arm and left hand. Therefore, I do not work outside of the home. I receive $767.00 per month in social security disability and I will continue to receive tax-free monthly payments of $1,524.48 through and including May 2004. Therefore, I have another source of income other than those payments that I wish to transfer and assign to Settlement Funding. Exhibit D 9. I have thoroughly considered this transaction, my alternatives and the use to which I will put the proceeds of this sale. I have considered the impact of this transaction on my life. I will be able to improve my present standard of living if I am permitted to transfer and assign my right to receive the Assigned Payments to Settlement Funding as described in this Affidavit. After considering these factors I believe that this transaction is in my best interest. 10. I intend to use the proceeds I receive from Peachtree under the Agreement to buy a new house and a new car. I am planning on moving to North Carolina so that I can be closer to my daughter and my grandchildren. I have been researching the cost of houses in the North Carolina area and I have found that I should be able to get a small house for approximately $56,000.00. I intend to use the proceeds from this transaction so that I will be able to purchase the home in full. By buying the house out right I will have no mortgage payment and I will not be adding any stress to my monthly budget. Also, I will be building equity in my purchase instead of wasting money on rent, which would be my only other choice. I also think that living in North Carolina will be better for me because I am lonely living in Pennsylvania with no family around. In addition, I am looking forward to being able to spend more time with my grandchildren and getting to know them better. Secondly, I plan on using the remaining portion of the proceeds from this transaction, about $15,000.00, to buy a new car. I will be buying the car outright as well so I will have no monthly car payment. I plan on trading in my current car and then adding the $15,000.00 onto the trade-in, which should allow me to buy a good car that should last me for quite awhile. I do not have the financial wherewithal to accomplish this on my own and that is why I have decided to complete this transaction with Settlement Funding. 11. I will not be using any portion of the proceeds from the Agreement for day-to-day expenses. I have never assigned, sold or pledged any of the structured settlement payments that I am receiving from the aforementioned structured settlement, to any party or entity. In addition, I have no minor dependents. The portion of the periodic payments I am not selling and my social security disability benefits are sufficient to support myself. I have determined that the proceeds from the Agreement with Peachtree is in my best interests and will improve my quality of life. Sworn and Subscribed before me this My Commission Expires: "~ - ,.~ (~ __ dayof 0(2'Jd3b~d'- ,2003. PLEASE DO NOT EXECUTE THIS DOCUMENT UNT1L 10/09/2003 IPA STATEMENT James Hocker, (hereinafter "1" or "Me") being duly sworn upon my oath depose and say: I am over the age of 18 and am of sound and disposing mind. I reside at 60 Mountain View Terrace, Newville, PA 17241 I am aware that, pursuant to the DE ST TI 10 {}6601 (4) Structured Settlement Transfer Act, I must obtain independent professional advice regarding the legal, tax and financial implications of the proposed transfer that we would like to have occur with Settlement Funding, LLC, its successors and assigns. I state that on ~, ~, .~ 0'0'5 I received the required independent professional advice from -~"~ VVl,~ .~. ~f'l~ O~ J ~.~ (Attorney) of located at~,'~ ,"~'~ '4'/,~.,9~:J-~ ,,~V¢. ~P~'+~q h~,,~ p~, /.., ( J'/'/,.~ ) ~/'7 ,/- ~/~ J..~ regarding the Absolute Assignment and UCC Article 9 Security Agreement dated October 9, 2003. I am aware of the legal, tax and financial implications of the proposed transfer and I desire to have the court approve said transfer of structured settlement payment rights as proposed in the Absolute Assignment and UCC Article 9 Security Agreement dated October 9, 2003 before the court. mes Hocker Exhibit E FROM : FRX NO, : Ma~. 31 20~0 OB:33F~ P2 Jame~ IL Moyle~ Suite ~ ~ Bld~. · ~ ~ Av~ * ~, PA 15219 ~ (412) 4~62. Fax (412) 261-1~ Pa.=hb~ SMtlthx;nt Funding 6501 Pwk of Comn~n~ B~vO. Boc~ R~ton, FI~. 33483 Attend.' K~thy or Jenlce Re: Jame~ Hocker Dear Jsnlce: Please be advised that I mfxtermt pm~ advice to Jame~ Hocker regwding the tegll, tm( ~ finanabl implications of the Absolute AWgnmant and UGC.)ulJcJe e 8euurlty,Aomermmt rel~i~r<l to the ~le of hie structur~ ~Mtlement annuit~ to Plz~hbL~ on C)etolx,, e. 2003. Mr. Hocker exl~d a clear and ~ c~l with Iny queltiofl8. ~ly Yourz, PENNSYLVANIA TRANSFER DISCLOSURE Payee: James Hocker; resident of: PA A. Amounts and due dates of the structured settlement payments to be transferred: 97 monthly payments each in the amount of $1,524.48 commencing on June 10, 2004 through and including June 10, 2012. B. Aggregate amount of such payments: $147,874.56. C. (1) Discounted present value of such payments: $122,453.42. (2)The discount rate used in determining such discounted present value: 4.2 percent as of September 29, 2003. D. Gross amount payable to the Payee in exchange for such payments: $74,205.95. Itemized listing of all brokers' commissions, service charges, application or processing fees, closing costs, filing or administrative charges, legal fees, notary fees and other commissions, fees, costs, expenses and charges payable by the Payee or deductible from the gross amount otherwise payable to the Payee: Legal Fees: $2,000.00; Processing Fee: $200.00 F. Net amount payable to Payee after deduction of all commissions, fees, costs, expenses and charges described above: $72,005.95 minus any advances made to Payee against the amount payable to Payee. G. The quotient, expressed as a percentage, obtained by dividing the net payment amount by the discounted present value of the payments: 58.80%. H. Amount of any penalty and the aggregate amount of any liquidated damages, inclusive of penalties, payable by the Payee in the event of any breach of the transfer agreement by the Payee: NONE Exhibit F I. Payee acknowledges receipt of, and acknowledges to have read and understood, the above disclosure statement and information required to..b.e disclosed Payee's applicable state statute(s). lint;als: ~ by By signing below you are confirming that you received a copy of this disclosure at least 10 days prior to receipt of this contract. J~nes Hocker Date DELAWARE TRANSFER DISCLOSURE Payee: James Hocker; resident of: PA A. Amounts and due dates of the structured settlement payments to be transferred: 97 monthly payments each in the amount of $1,524.48 commencing on June 10, 2004 through and including June 10, 2012. B. Aggregate amount of such payments: $147,874.56. C. Discounted present value of the payments: $122,453.42; determined by applying the most recently published (discount) rate of 4.2% as of September 29, 2003. D. Gross amount payable to the Payee in exchange for such payments: $74,205.95. Itemized listing of all 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 the Payee or deductible from the gross amount otherwise payable to the Payee: Processing Fee: $200.00. Legal Fees: $2,000.00. F. Net amount payable to Payee after deduction of all commissions, fees, costs, expenses and charges described above: $72,005.95 minus any advances made to the Payee or on Payee's behalf, or claims satisfied, against the amount payable to Payee. G. Quotient (expressed as a percentage) obtained by dividing the net payment amount by the discounted present value of the payments: 58.80%. H. Amount of any penalty and the aggregate amount of any liquidated damages (inclusive of penalties) payable by the Payee in the event of any breach of the transfer agreement by the Payee: NONE I. Payee acknowledges receipt of, and acknowledges to have read and understood, the above disclosure statement and information required to be disclosed by Payee's applicable state statute(s). Initials: ~ By signing below you are confirming receipt of this disclosure at least 10 days prior to receipt of this contract. es Hocker Date NEW YORK TRANSFER DISCLOSURE Payee: James Hocker; resident of: PA A. Amounts and due dates of the structured settlement payments to be transferred: 97 monthly payments each in the amount of $1,524.48 commencing on June 10, 2004 through and including June 10, 2012. B. Aggregate amount of the structured settlement payments to be transferred: $147,874.56. C. The discounted present value of the payments to be transferred: $t22,453.42. This is the calculation of current value of the transferred structured settlement payments under federal standards for valuing annuities determined by applying the most recently published (discount) rate of 4.2% as of September 29, 2003. D. The price quote from the original annuity issuer or, if such price quote is not readily available from the original annuity issuer, then a price quote from two other annuity issuers that reflects the current cost of purchasing a comparable annuity for the aggregate amount of payments to be transferred: $137,824.34 and $126,031.00. E. Gross advance amount: $74,205.95 and the annual discount rate, compounded monthly, used to determine the gross advance amount: 17.28%. F. Itemized listing of all commissions, fees, costs, expenses and charges payable by the payee or deductible from the gross amount otherwise payable to the payee and the total amount of such fees: Processing Fee: $200.00. Legal Fees: $2,000.00. G. Net advance amount: $72,005.95. The net cash payment you receive in this transaction from the buyer was determined by applying the specified discount rate to the amount of future payments received by the buyer, less the total amount of commissions, fees, costs, expenses and charges payable by you. H. Amount of any penalties or liquidated damages payable by the payee in the event of any breach of the transfer agreement by the payee: NONE Payee has the right to cancel the transfer agreement, without penalty or further obligation, not later than the third business day after the date the agreement is signed by the payee. J. Payee is advised to seek independent professional from an attorney, certified public accountant, actuary or other professional advisor regarding the legal, tax and financial implications of the transfer. An independent professional advisor is engaged by you and is not affiliated with or compensated by Settlement Funding of New York, LLC. His or her compensation is not affected by whether the transfer occurs or does not occur. K. Payee acknowledges receipt of, and acknowledges to have read and understood, the above disclosure statement and information required to be disclosed by Payee's applicable state statute(s). Initials: L. Date Prepared and Mailed: September 29, 2003. By signing below, you are confirming that you received a copy of this disclosure at least 10 days prior to receipt of this contract. J~htes Hocker Date NOTICE (PA} Payee: James Hocker IMPORTANT NOTICE: You are strongly urged to consult with an attorney who can advise you of the potential tax consequences of this transaction. I acknowledge receipt of the above notice. By signing below you are confirming that you received a copy of this disclosure at least 10 days prior to receipt of this contract. J~nes Hocker Date Exhibit G ACKNOWLEDGEMENT (PA) Payee: James Hocker I have received independent legal advice regarding the implications of the transfer, including considerations of the tax ramifications of the transfer. n~ltlals) J~hes Hocker Date Exhibit H 26USCA§ 5891 Pagel 26 U.S.C.A. § 5891 I.R.C. § 5891 UNITED STATES CODE ANNOTATED TITLE 26. INTERNAL REVENUE CODE SUBTYI'LE E--ALCOHOL, TOBACCO, AND CERTAIN OTHER EXCISE TAXES CHAPTER 55--STRUCTURED SETTLEMENT FACTORING TRANSACTIONS Copt. © West Group 2002. No claim to Orig. U.S. Govt. Works. Current through P.L. 10%136, approved 1-24-02 § 5891. Structured settlement factorimz transactions (a) Imposition of tax.--There is hereby imposed on any person who acquires directly or indirectly structured settlement payment rights in a structured settlement factoring transaction a tax equal to 40 percent of the factoring discount as determined under subsection (c)(4) with respect to such factoring transaction. (b) Exception for certain approved transactions.-- (1) In generaL--The tax under subsection (a) shall not apply in the case of a structured settlement factoring transaction in which the transfer of structured settlement payment rights is approved in advance in a qualified order. (2) Qualified order.--For purposes of this section, the term "qualified order" means a final order, judgment, or decree which-- (A) finds that the transfer described in paragraph (1)-- (i) does not contravene any Federal or State statute or the order of any court or responsible administrative authority, and (ii) is in the best interest of the payee, taking into account the welfare and support of the payee's dependents, and (B) is issned-- (i) under the authority of an applicable State statute by an applicable State court, or (ii) by the responsible administrative authority (if any) which has exclusive jurisdiction over the underlying action or proceeding which was resolved by means of the structured settlement. (3) Applicable State statute.--For purposes of this section, the term "applicable State statute" means a statute providing for the entxy of an order, judgment, or decree described in paragraph (2)(A) which is enacted by-- (A) the State in which the payee of the structured settlement is domiciled, or (B) if there is no statute described in subparagraph (A), the State in which either the party to the structured settlement (including an assignee under a qualified assignment under section 130) or the person issuing the funding asset for the structured settlement is domiciled or has its principal place of business. (4) Applicable State court.--For purposes of this section-- (A) In general.--The term "applicable State court" means, with respect to any applicable State statute, a court of Copt. © West 2002 No Claim to Orig. U.S. Govt. Works Exhibit I 26 USCA § 5891 Page 2 26U.S.C.A. § 5891 the State which enacted such statute. (B) Special rule.--In the case of an applicable State statute described in paragraph (3)(B), such term also includes a court of the State in which the payee of the structured settlement is domiciled. (5) Qualified order dispositive.--A qualified order shall be treated as dispositive for purposes of the exception under this subsection. {c) Definitions.--For purposes of this section~- (1) Structured settlement.~-The term "structured settlement" means an arrangement-- (A) which is established by-- (i) suit or agreement for the periodic payment of damages excludable from the gross income of the recipient under section 104(a)(2), or (ii) agreement for the periodic payment of compensation under any workers' compensation law excludable from the gross income of the recipient under section 104(a)(1), and (B) under which the periodic payments are-- (i) of the character described in subparagraphs (A) and (B) of section 130(c)(2), and (ii) payable by a person who is a party to the suit or agreement or to the workers' compensation claim or by a person who has assumed the liability for such periodic payments under a qualified assignment in accordance with section 130. (2) Structured settlement payment rights.--The term "structured settlement payment rights" means rights to receive payments under a structured settlement. (3) Structured settlement factoring transaction.-- (A) In general.--The term "structured settlement factoring transaction" means a transfer of structured settlement payment rights (including portions of structured serdement payments) made for consideration by means of sale, assignment, pledge, or other form of encumbrance or alienation for consideration. (B) Exception.--Such term shall not include-- (i) the creation or perfection of a security interest in structured settlement payment rights under a blanket security agreement entered into with an insured depository institution in the absence of any action to redirect the structured settlement payments to such institution (or agent or successor thereof) or otherwise to enforce such blanket security interest as against the structured settlement payment rights, or (ii) a subsequent transfer of structured settlement payment rights acquired in a structured settlement factoring transaction. (4) Factoring discount.--The term "factoring discount" means an amount equal to the excess of-~ fA) the aggregate undiscounted amount of structured settlement payments being acquired in the structured settlement factoring transaction, over (B) thc total amount actually paid by the acquirer to the person from whom such structured seffiement payments are acquired. (5) Responsible administrative authority.--The term "responsible administrative authority" means the Copr, © West 2002 No Claim to Orig. U.S. Govt. Works 26USCA § 5891 Page 3 26U.S.C.A. § 5891 administrative authority which had jurisdiction over the underlying action or proceeding which was resolved by means of the structured settlement. (6) State.--The term "State" includes the Commonwealth of Puerto Rico and any possession of the United States. (d) Coordination with other provisions.-- (1) In general.--If theapplicable requirements of sections 72, 104(a)(l), 104(a)(2), 130, and 461(h) were satisfied at the time the structured settlement involving structured settlement payment rights was entered into, the subsequent occurrence of a structured settlement factoring transaction shall not affect the application of the provisions of such sections to the parties to the structured settlement (including an assignee under a qualified assignment under section 130) in any taxable year. (2) No withholding of tax.--The provisions of section 3405 regarding withholding of tax shall not apply to the person making the payments in the event of a structured settlement factoring transaction. CREDIT(S) 2002 Pocket Part (Added Pub. L. 107-134, Title I, § 115(a~, Jan. 23, 2002, 115 Stat. 2436.) <General Materials (GM) - References, Annotations, or Tables> HISTORICAL AND STATUTORY NOTES Revision Notes and Legislative Reports 2002 Acts. Statement of President, see 2001 U.S. Code Cong. and Adm. News, p. 1812. Effective and Applicability Provisions 2002 Acts. Pub. L. 107-134, Title L § 115(c), Jan. 23, 2002, 115 Stat. 2438, provided that: "(1) In general.--The amendments made by this section [enacting this chapter] (other than the provisions of section 5891(d) of the Internal Revenue Code of 1986, as added by this section [26 U.S.C.A. § 5891(d)]) shall apply to structured settlement factoring transactions (as defined in section 5891(c) of such Code (as so added) [26 U.S.C.A. § 5891(c)]) entered into on or after the 30th day following the date of the enactment of this Act [Jan. 23, 2002]. "(2) Clarification of existing law.--Section 5891(d) of such Code (as so added) [26 U.S.C.A. § 589l(d)] shall apply to structured settlement factoring transactions (as defined in section 5891(c) of such Code (as so added) [26 U.S.C.A. § 5891(c)]) entered into before, on, or after such 30th day. "(3) Transition rule.--In the ease of a structured settlement factoring transaction entered into during the period beginning on the 30th day following the date of the enactment of this Act [Jan. 23, 2002] and ending on July 1, Copr. © West 2002 No Claim to Orig. U.S. Govt. Works 26 USCA § 5891 Page 4 26U.S.C.A. § 5891 2002, no tax shall be imposed under section 5891 (a) of such Code [26 U.S.C.A. § 5891(a)] if-- "(A) The structured serdement payee is domiciled in a State (or possession of the United States) which has not enacted a statute providing that the structured settlement factoring transaction is ineffective unless the transaction has been approved by an order, judgment, or decree of a court (or where applicable, a responsible administrative authority) which finds that such transaction-- "(i) does not coniravene any Federal or State statute or the order of any court (or responsible administrative authority); and "(ii) is in the best interest of the structured seitlement payee or is appropriate in light of a hardship faced by the payee; and "(B) the person acquiring the structured settlement payment rights discloses to the structured settlement payee in advance of the structured settlement factoring transaction the amounts and due dates of the payments to be transferred, the aggregate amount to be transferred, the consideration to be received by the structured settlement payee for the transferred payments, the discounted present value of the transferred payments (including the present value as determined in the manner described in section 7520 of such Code [26 U.S.C.A. ~ 7520]), and the expenses required under the terms of the structured settlement factoring transaction to be paid by the structured settlement payee or deducted from the proceeds of such transaction." 26 U.S.C.A. § 5891 26USCA§ 5891 END OF DOCUMENT Copr. © West 2002 No Claim to Orig. U.S. Govt. Works IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION IN RE: PETITION OF JAMES HOCKER TO T ~RiANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS ORDER OF COURT SCHEDULING HEARING DATE No. AND NOW, th Petition to Transfer St Protection Act, 40 P.S the I"~day of Court. is ~ day of O~,~ ~ ,2003, upon the filing and presentation of the uctured Settlement Payment Rights pursuant to the Structured Settlement §§ 4001-4009, it is hereby ORDERED that a hearing thereon is set for ,2003 at ~23 ~,Jl[in Courtroom '~ before this · Petitioner shall filed, and the Transfer in the Petition, and st statute. ~rovide notice of the time and date set for hearing, a copy of the Petition )isclosure, to the Settlement Obligor, and the Annuity Issuer, as set forth all in all other respects comply with the terms of the aforementioned BY : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION IN RE: PETITION OF JAMES HOCKER TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS Civil Term No. 03 - 5551 To: NOTICE OF PROPOSED TRANSFER OF STRUCTURED SETTLEMENT PAYMENT RIGHTS American Home Assurance Company 70 Pine Street New York, NY 10270 (Settlement Obligor) AIG Life Insurance Company Annuity Administration P.O. Box 1277 Wilmington, DE 19899-1277 (Annuity Issuer) Settlement Funding, LLC 6501 Park of Commeme Boulevard Suite 140B Boca Raton, FL 33487 Attn: Jason Sutherland (Transferee) James Hocker 60MountainViewTerrace Newville, PA17241 (Payee) Please take notice that a Petition to Transfer Structured Settlement Payment Rights has been filed in the Court of Common Pleas of Cumberland County, Pennsylvania. An Order has been issued by the court requiring that responses or objections of the transferee, structured settlement obligor or the annuity issuer, be brought before the court either in writing or in person at a hearing set for November 17, 2003 at 2:30 p.m. before the Honorable Ed Guido. (A copy of the Scheduling Order dated October 23, 2003, is included with this notice). CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of this Notice of Proposed Transfer of Structured Settlement Payment Rights, the Petition to Transfer Structured Settlement Payment Rights and the Transfer Disclosure Statement, and the Order of Court Scheduling a Hearing Date have been served via certified mail, return-receipt requested upon the persons and entities, and at the addresses listed above, thi~ 5r~ day of October, 2003. Respectfully submitted, Jones, Gregg, Creehan & Gerace, LLP By: A~~'~ Robert L. Monks PA I.D.# 52760 411 Seventh Avenue Suite 1200 Pittsburgh, PA 15219 412-261-6400 Attorney for Petitioner, James Hocker IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION PETITION OF JAMES HOCKER TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS Civil Term No. 03-5551 Order Approving Petition for Approval to Transfer Structured Settlement Payment Rights Upon consideration of the Petition for Approval of Transfer of Structured Settlement Payment Rights (the "Petition") by James Matthew Hocker (the "Payee" or "Mr. Hocker") to Settlement Funding LLC ("Peachtree" or "Transferee"), pursuant to 40 P.S. §5 4001 et seq. (the "Pennsylvania Structured Settlement Protection Act"), and any response thereto, the Court hereby makes the following findings: 1. The transfer complies with the requirements of the Pennsylvania Structured Settlement Protection Act and will not contravene other applicable Federal or State statutes or regulations or any applicable law limiting the transfer of workers' compensation claims, as required by 40 P.S. § 4003(A)(1); 2. Peachtree has provided to Mr. Hocker a disclosure statement meeting the requirements of 40 P.S. § 4003(A)(2). Peachtree has also provided Mr. Hocker disclosure statements meeting the requirements of N.Y. GEN. OBLIG. § 5-1703 and DEL. CODE ANN. Title 10 § 6601(2). PHLIT\463770\I 3. Mr. Hocker has established that the transfer is in his best interests, taking into account the welfare and support of Mr. Hocker's dependents as required by 40 P.S. § 4003(A)(3); 4. Mr. Hocker has been advised in writing by Peachtree to seek independent professional advice regarding the transfer and Mr. Hocker has obtained independent legal advice regarding the implications of the transfer in a separate written acknowledgement, as required by 40 P.S. § 4003(A)(4); 5. The transfer has been expressly approved in writing by the Payee, and at the time the Payee and the Transferee proposed to enter into the Transfer Agreement, a favorable tax result was in effect. The approvals of the Annuity Issuer and the Structured Settlement Obligor are not required, 40 P.S. § 4003(A)(5)(i)(A); 6. Peachtree has given written notice of Peachtree's name, address, and taxpayer identification number to the American Home Assurance Company ("AHAC") and AIG Life Insurance Company ("AIG Life") and filed a copy of that notice with this Court, as required by 40 P.S. § 4003(A)(6). Based on the foregoing findings, it is hereby ORDERED and ADJUDGED that said Petition is GRANTED as follows: 1. Pursuant to the Pennsylvania Structured Settlement Protection Act, the assignment by Mr. Hocker to Peachtree, its successors and/or assigns, of all of his right, title and interest in: monthly payments of $1,524.48 from June 10, 2004 through and including June 10, 2012 ( he Factored Payments ) m~d funded by AIG Life under annuity policy number T00005140I is hereby approved. AIG Life is hereby directed to deliver the Factored Payments to Peachtree at the following address: P.O. Box 116476 Atlanta, Georgia 30368-6476 (the "Designated Address"). 2. Peachtree, and its affiliates and assigns, shall defend, indemnify, and hold harmless AHAC and AIG Life and their successors and assigns, parents, affiliates, and subsidiaries, from and against any and all liability for all claims in connection with, related to, or in any way arising out of the issuance of the Factored Payments to Peachtree, whether such claims are brought by Mr. Hocker (including his heirs, beneficiaries, contingent beneficiaries or executors), Patricia May Reed (including her heirs, beneficiaries, contingent beneficiaries or executors), by any individual or entity to which Peachtree subsequently assigns or transfers the Factored Payments or any portion thereof, or by any other individual or entity. 3. Neither the fact of the entry of this Order, nor any term or action taken hereunder, shall be admissible at any time in any action or proceeding for any purpose, except if required in connection with the enforcement of any parties' rights hereunder. 4. Peachtree is authorized by this Order to make subsequent assignments or transfers of the Factored Payments, except that regardless of any such subsequent assignment or transfer, all Factored Payments will continue to be serviced by Peachtree, in other words the payments will continue to be made from AIG Life to Peachtree at the Designated Address regardless of any subsequent transfer or assignment of the Factored Payments. In the event that Peachtree is merged with or acquired by another person or entity, the Factored Payments shall be sent directly to that person or entity. 5. AHAC and AIG Life are hereby discharged from all liability for the payments and portions thereof transferred as to all parties except Peachtree, its :successors and/or assigns. This Order is entered without prejudice to the rights of AHAC and AIG Life, and the court makes no finding regarding the enforceability of any non-assigmnent provisions contained in the original Settlement Agreement or related documents. This Order in no. way modifies or negates the ownership or control over the underlying annuity contract by thrtAC and AIG Life. 6. Neither AHAC nor AIG Life shall be required to divide any periodic payment between the Payee and any transferee or assignee or between two or more transferees or assignees. 7. Peachtree shall be liable to AHAC and AIG Lift; if the transfer contravenes the terms of the structured settlement; for any taxes incurred by those parties as a consequence of the transfer; and for any other liabilities or costs, including reasonable costs and attorney's fees, arising from compliance by those parties with the order of the court or responsible administrative authority or arising as a consequence of Peachtree's failure to comply with this act. DONE IN OPEN COURT this ~.,2003. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION IN RE: PETITION OF JAMES HOCKER TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS Civil Term No. 03 - 5551 AFFIDAVIT OF SERVICE OF FINAL ORDER APPROVING PETITION TO TRANSFER Before me, the undersigned authority, personally appeared, Robert L. Monks, who, after being first duly sworn according to law, deposes and says that on November 19, 2003, he served a true and correct copy of the Final Order of Court dated November 17, 2003 approving the Petition of James Hocker to Transfer Structured Settlement Payment via facsimile and regular U.S. mail postage pre-paid, upon the following: American Home Assurance Company 70 Pine Street New York, NY 10270 (Settlement Obligor) AIG Life Insurance Company Annuity Administration P.O. Box 1277 Wilmington, DE 19899-1277 (Annuity Issuer) Settlement Funding, LLC 6501 Park of Commerce Boulevard Suite 140B Boca Raton, FL 33487 Attn: Jason Sutherland, Esquire (Transferee) Respectfully submitted, Jones, Gregg, Creehan & Gerace, LLP Robert L. Monks PA I.D. No. 52760 411 Seventh Avenue Suite 1200 Pittsburgh, PA 15219 412-261-6400 Counsel for Petitioner, James Hocker Sworn to and subscribed before me this :20~:~day of t~omz~ , 2003. My Commission Expires: