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HomeMy WebLinkAbout03-5549IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION IN RE: PETITION OF JESSE SHORT : TO TRANSFER STRUCTURED : SETTLEMENT PAYMENT RIGHTS : No. 03' PETITION TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS Petitioner, JESSE SHORT, 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 (the "Act"), and in support states as follows: 1. The Petitioner is JESSE SHORT, an adult individual whose date of birth is September 10, 1982, and who resides at 1831 Walnut Bottom Road #2, 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. Some time prior to 1996, the Petitioner was injured in an accident. Thereafter, in or about February 1996, Petitioner by and through his parents and natural guardians, John and Cathy Short, entered into a Release and Structured Settlement Agreement with State Farm Mutual Automobile Insurance Company. The Agreement provided for 271 guaranteed monthly payments to Petitioner each in the mount of $687.89 compounded at 5% per year, commencing July 1, 2002, through and including January 1, 2025. 4. The obligation to make the monthly periodic payments is held by State Farm Mutual Automobile Insurance Company, the Structured "Settlement Obligor" as defined by 40 P.S. § 4002. State Farm Mutual Automobile Insurance Company is located at One State Farm Plaza, Bloomington, IL 61710. 5. State Farm Mutual Automobile Insurance Company funded the obligation by purchasing an annuity (Annuity Contract Number 1462-2169) from State Farm Life Insurance Company, the "Annuity Issuer." Id_~. True and correct copies of the Structured Settlement Annuity Application, and a portion of the Annuity Policy including confirmation of the schedule of payments, are attached hereto and referred to collectively as Exhibit "A." State Farm Life Insurance Company is located at One State Farm Plaza, Bloomington, IL 61710. 6. On October 13, 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 "B." The Transfer Agreement provides for the assignment of Petitioner's right and interest in receiving 235 monthly payments each in the amount of $200.00 commencing on April 1, 2004, through and including October 1, 2023 (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 principal place of business at 6501 Park of Commerce Blvd., Suite 140B, Boca Raton, Florida, 33487. 7. The Petitioner shall retain all right and interest in receiving the remaining balance not assigned of: the entire monthly payment (currently $722.28) through and including March 1, 2004; the balance of the monthly payments not assigned commencing on April 1, 2004 (then $522.28, compounding at a rate of 5% annually), through and including October 1, 2023; and the 2 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 $31,132.17. d. The federal discount rate used to determine the discounted present value is the effective annual rate of 4.4% as of 10/1/03. e. The gross amount payable to Petitioner in exchange of the transferred payments is $12,000.00. f. The good faith itemized listing of all broker's commissions, service charges, legal fees, notary fees, costs etc. deductible from the gross amount otherwise payable to the Petitioner is: Legal Fees of $2,000.00 and Processing fees of $200.00. g. The net amount payable to Petitioner after deduction of the above commissions, legal fees, etc., is $9,800.00 minus any advances made to Petitioner against the amount payable to Petitioner. h. The quotient is 31.48%. 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. 11. 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 "E." 12. Petitioner has expressly waived independent legal advice regarding the implications of the transfer, including tax ramifications of the transfer, as set forth in the acknowledgement dated October 13, 2003, attached as Exhibit "F." 13. 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 amends 26 U.S.C.A. § 5891 and now provides for favorable tax treatment of "structured 4 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 encumbrance 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 14. 26 U.S.C.A. § 5891 (d)(1) was also added by the Act and provides: [I]f the applicable requirements of sections 72, 104(a)(1), 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. (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. 15. 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). 16. The structured settlement did not arise out of a workers' compensation claim. 17. 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. 18. 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, Jesse Short 6 VERIFICATION I, Jesse Short, 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 to the penalties of 18 Pa.C.S.A. Section 4904 relating to the unsworn falsification to authorities. j~s~e ~ho%~t STATE FARM INSURANCE HOME OFFICE: ONE STATE FARM PLAZA, BLOOMINGTON, ILLINOIS 6171'0-0001 OWNER POLICY DATE ISSUE DATE POLICY NUMBER State Farm Mutual Autcmobile Insurance Ccmpany February 26, 1996 March 4, 1996 1462-2169 This policy is based on the application and the payment of the single premium. State Farm Life Insurance Company will make the annuity payments as shown in the application to the Payee designated by the Owner. The Payee is shown in the application, unless changed. If the Payee dies while payments are still due, payments after the Payee's death will be paid to the beneficiary, if living when payment is due. Otherwise, payments will continue to a beneficiary named by the Owner. The amount of each payment, number and frequency of payments, and the first payment date ~.re shown in the application. Payments may not be accelerated, advanced, assigned, decreased, deferred, or increased. The application and any amendments or endorsements are after page 2. 5ecretaxy President BASIC PLAN DESCRIPTION Single premium annuity certain. Exhibit A FORM 92050 PAGE 1 920520 APPLICATION FOR SINGLE PREMIUM ANNUITY CERTAIN Owner 2 Payee Short RD ~, ~x 293 3 Beneficiary FULL NAME ADD.ESS State Fa)~n Pbtua] Automobile Insurance Ccmpany FIRST NAME Jesse Carlisle, PA 17013-8935 John E. Short & Cathy A. Shor~ same address as payee 09-10.~32 Parents 4 Annuity Payments ~¢a87.89 $722.28 $758.39 $796.31 $83 . 13 $877.94 $921.84 $967.93 $I ,016.33 $1,067. I5 $1,120.51 $1,176.54 dLF3 7-1-2002 7-1-2003 7-1-2004 7-1-2005 7-1-2006 7-1-2007 7-1-2008 7-1-2009 7-1-2010 7-1-2011 7-1-2012 7-I-$13 thru 6-1-2003 6-1-2004 6 - 1-2005 6-1-2006 6-1-2007 6-1-2008 6-1-2009 6-1-2010 6-1-2011 6-1-2012 6-1-2013 6-1-2014 $1,235.37 $1 ,.297.14 $1,362.00 $1,430.10 $1,501.61 $1,576.69 $1,655.52 $1,738.30 $1,825.22 $1,916.48 $2,012~30 due 7-1-2014 7-1-2015 7-1-2016 7-1-2017 7-1-2018 7-1-2019 7-1-2020 7-1-2021 7-1-2022 7-1-2023 7-1-2024 thru 6-1-2015 6-1-2016 6-1-2017 6-1-2018 6-1-2019 6-1-2020 6-1-2021 6-1-2022 6-1-2023 6-1-2024 1-1-2025 27I monthly payments beg_inning 7-1-2002 with 5% increases each year payab]e as sh~m above. Da ed?~.n~ March 4, 1996 at Sigrla~e'0f-:C)}'¢c~er for ~fa'te Fa'r~![~l~U\ Bloomington, Illinois ABSOLUTE ASSIGNMENT AND UCC ARTICLE 9 SECURITY AGREEMENT (THE "AGREEMENT") October 13, 2003 I, Jesse Short, ("1", "Me" or "Assignor") residing at 1831 Walnut Bottom Rd Newville, PA 17241 am entitled to 271 monthly payments each in the amount of $687.89 commencing on July 1, 2002 increasing 5.00% every 12 payments through and including January 1, 2025. (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 (the "Settlement Agreement"). The Periodic Payments are due to me from State Farm Mutual Automobile Insurance Company (the "Settlement Obligor'') under the terms of the Settlement Agreement and are being funded by an annuity issued by State Farm Life Insurance Company (the "Annuity Issuer'') bearing annuity contract number '1462-2169. A. I hereby sell, assign and convey to Settlement Funding, L.L.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: 235 monthly payments each in the amount of $200.00 commencing on April 1, 2004 through and including October 1, 2023. (the "Assigned Payments"). In consideration for this assignment, Assignee shall pay to me the sum of: $12,000.00 (the "Assignment Pdce"). 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 rights 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 I and B 2 above are 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 Pdce: 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 the extent permitted by law Assignee and I intend to create a secudty interest under Article 9 of the Unif¢ he state designated in Paragraph F Exhibit B below, in my dghts to and interest in payments due to me under the Settlement Agreement, which rights 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 security agreement. This security interest secures payment of the rights 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 rights hereunder. F. Except as otherwise required by applicable statutory law, this Agreement shall be governed 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 arising 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 American Arbitration Association. The demand for arbitration shall be filed in writing with the other party to this Agreement and with the American 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 American 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 arising 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 wdtten 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 bdng 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 Pedodic 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 pdor 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. herewith. In witness whereof I hereunto set my hand. STATE OF ~ ¢'~ ~ '~jr~Lt) C:La, C, Ox ~ On this ~.~ dayof All disclosure statements are a material part of this Agreement and shall be read in pad materia ,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 t~t h~/.h- I~d~hio i~et;urn~nt and that the My Commission expires Accepted: instrument has been executed by him/her. PLEASE DO NOT EXECUTE THIS DOCUMENT UNTIL 10/13/2003 Settllment.Ful 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, Jesse Short residing at 1831 Walnut Bottom Rd #2, 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, Jesse Short, hereby request and authorize State Farm Mutual Automobile Insurance Company, State Farm 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, or any other documents deemed necessary by Settlement Funding, or any of its agents or designees. I specifically direct that State Farm Mutual Automobile Insurance Company, State Farm 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 ail documents requested by Settlement Funding or their agents or designees regarding my settlement. Dated: AFFIDAVIT I, Jesse Short, of full age, being duly sworn according to law, upon my oath depose and say: 1. I currently reside at 1831 Walnut Bottom Rd ~Y2, Newville, PA 17241. 2. I am the recipient of certain guaranteed payments under a structured settlement dated Mamh 4, 1996. The entity presently obligated to make the payments due under the structured settlement is State Farm Mutual Automobile Insurance Company. In order to fund its payment obligations under the structured settlement State Farm Mutual Automobile Insurance Company purchased an annuity contract 1462-2169 from State Farm Life Insurance Company. 3. I voluntarily entered into an Absolute Assignment and UCC Article 9 Security Agreement (the "Agraement") dated October 13, 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: 235 monthly payments each In the amount of $200.00 commencing on April 1, 2004 through and including October 1, 2023. (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. A. ~e/.~nitials: I chose not to retain or consult with such a professional. I understand that at all times, including at the time I entered tile Agreement and received the Disclosure Statement, and for all times, I knowingly waive the right to seek or obtain for myself independent professional advice regarding the Agreement. B. __ Initials: I chose to retain or consult with an attorney, accountant or other licensed professional advisor of my choice. ]~×hibit C 8. I am 21 years old and have supported myself for the last 3 years. I have no mental disabilities that would prevent me from working outside of the home. However, due to nerve damage in my legs, I am unable to work outside of the home. I will continue to receive tax-free monthly payments of $722.28, which increase 5.00% every 12 payments through and including March 2004, these payments will be reduced to $522.28 but will continue to increase 5.00% every 12 payments and will remain tax-free. Therefore I have another source of income other than those payments that I wish to transfer and assign to Settlement Funding. 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 repair my car, to pay off my medical bills, and to pay off my credit card debt. I have a 1994 Dodge Spirit and it needs a new transmission. I have been getting quotes from several repair shops and I have decided on one particular shop, which gave me a quote of approximately $2,200.00. I need my car so that I can get to and from doctor's appointments and just to do everyday errands such as grocery shopping and going to the pharmacy. Secondly, I would like to pay off my credit debt and my hospital bills. Both of these things add up to about $9,000.00 and once I have them paid off, I will have no debt. Therefore, I will be able to save my money and use it for everyday expenses. I do not have the financial wherewithal to accomplish these things on my own and that is why I have decided to pursue 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 dependents. The portion of the periodic payments I am not selling is 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: day of (~ C.--~ ~C~3Ar.- ,2003. PLEASE DO NOT EXECUTE THIS DOCUMENT UNTIL 10/13/2003 PENNSYLVANIA TRANSFER DISCLOSURE Payee: Jesse Short; resident of: PA A. Amounts and due dates of the structured settlement payments to be transferred: 235 monthly payments each in the amount of $200.00 commencing on April 1, 2004 through and including October 1, 2023. B. Aggregate amount of such payments: $47,000.00. C. (1) Discounted present value of such payments: $31,132.17. (2)The discount rate used in determining such discounted present value: 4.4 percent as of October 1, 2003. D. Gross amount payable to the Payee in exchange for such payments: $12,000.00. E. 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: $9,800.00 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: 31.48%. 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 D 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 that you received a copy of this disclosure at least 10 days prior to receipt of this contract. Dale ILLINOIS TRANSFER DISCLOSURE Payee: Jesse Short; resident of: PA A. Amounts and due dates of the structured settlement payments to be transferred: 235 monthly payments each in the amount of $200.00 commencing on April t, 2004 through and including October 1, 2023. B. Aggregate amount of such payments: $47,000.00. C. Discounted present value of the payments: $31,132.17; determined by applying the most recently published (discount) rate of 4.4% as of October 1, 2003. D. Gross amount payable to the Payee in exchange for such payments: $12,000.00. 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, c. osts, expenses and charges pa.yable by the Payee or deductible from the gross amount otherw;se 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: $9,800.00 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: 31.48%. 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 disc. l~sed 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. Date NOTICE {PA) Payee: Jesse Short 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. Date Exhibit E ACKNOWLEDGEMENT {PA) Payee: Jesse Short (Please Initial one of the following statements which applies to you) I have received independent legal advice regarding the implications of the transfer, including considerations of the tax ramifications of the transfer. (Initials) I expressly waive independent legal advice regarding the implications of the transfer, including considerations of the tax ramifications of the transfer. Dat~ / Exhibit F 26USCA § 5891 Page 1 26U.S.C.A. § 5891 I.R.C. § 5891 UNITED STATES CODE ANNOTATED TITLE 26. INTERNAL REVENUE CODE SUBTITLE 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. 107-136, approved 1-24-02 5891. Structured settlement factoring transactions (a) Imposition of tax.--There is hereby imposed on any person xvho 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 conttavene 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 issued-- {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 entry 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 G 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)(l), 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 "stmctured 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 settlement 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-- (A) the aggregate undiscounted amount of structured settlement payments being acquired in the structured settlement factoring transaction, over (B) the total amount actually paid by the acquirer to the person from whom such structured settlement 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 26 U.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 o f sections 72, 104(a)(1), 104(a)(2), 130, and 461 (hi were satisfied at the time the structured settlement involving structured sei~lement 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, § I 15(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. Pnb. L. 107-134, Title 1. § 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) &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. § 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 before, on, or after such 30th day. "(3) Transition rule.--In the case 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 settlement 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 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 structured settlement 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 stmctured 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 RE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION PETITI£ TO TRA SETTL[ AND NOW, th of the Petition to Tn Settlement Protection is set for the ~'~ before the Petitioner shal filed, and the Transfe in the Petition, and statute. iN OF JESSE SHORT NSFER STRUCTURED vlENT PAYMENT RIGHTS No. 0 ~ ~' ORDER OF COURT SCHEDULING HEARING DATE . ~ day of O ~ 2003, upon the filing and presentation ffer Structured Settlement Payment Rights pursuant to the Structured Act, 40 P.S. §§ 4001-4009, it is hereby ORDERED that a hearing thereon day of ]05~L~'~ , 2003 at 102.30 i~.#[ in Courtroom [onorable ~d L provide notice of the time and date set for hearing, a copy of the Petition , Disclosure, to the Settlement Obligor, and the Annuity Issuer, as set forth ;hall in all other respects comply with the terms of the aforementioned IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION 1N RE: PETITION OF JESSE SHORT TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS Civil Term No. 03 - 5549 ro~ NOTICE OF PROPOSED TRANSFER OF STRUCTURED SETTLEMENT PAYMENT RIGHTS State Farm Mutual Automobile Insurance Company One State Farm Plaza Bloomington, IL 61710 (Settlement Obligor) State Farm Life Insurance Company One State Farm Plaza Bloomington, IL 61710 (Aunuity Issuer) Settlement Funding, LLC 6501 Park of Commerce Boulevard Suite 140B Boca Raton, FL 33487 Attn: Jason Sutherland (Transferee) Jesse Short 1831 Walnut Bottom Road #2 Newville, PA 17241 (Payee) Please take notice that a Petition to Transfer Structured Settlement Payment Rights has been flied in the Court of Common Pleas of Chester 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 person or in writing at a hearing set for November 17, 2003 at 10:30 a.m. before the Honorable Ed Guido. (A copy of the Scheduling Order dated October 23, 2003 is included with this notice). Provided with this notice is a copy of the Petition to Transfer Structured Settlement Payment Rights, including as attachments thereto a copy of the Transfer Agreement, and a copy of the Transfer Disclosure Statement required by 40 P.S. § 4003 (2). Pursuant to 40 P.S. § 4003 (6) notice of the transferee's name, address and taxpayer identification number are as follows: Settlement Funding, LLC 6501 Park of Commerce Boulevard Suite 140B Boca Raton, FL 33487 (TiN: 58-2292928) Respectfully submitted, Jones, Gregg, Creehan & Gerace, LLP Robert L. Monks PA I.D.# 52760 411 Seventh Avenue Suite 1200 Pittsburgh, PA 152 l 9 412-261-6400 Attorney for Petitioner, Jesse Short CERTIFICATE OF SERVICE I hereby certify that a tree 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 Scheduling a Heating Date have been served via certified mail, return-receipt requested upon the persons and entities, and at the addresses listed above, this'~ day of October, 2003. 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 Attorney for Petitioner, Jesse Short IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION PETITION OF JESSE SHORT TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS Civil Term No. 03 - 5549 AFFIDAVIT OF SERVICE OF NOTICE OF PROPOSED TRANSFER~ NOTICE OF FIIiING OF PETITION AND NOTICE OF HEARING Before me, the undersigned authority, personally appeared, Robert L. Monks, who, after being first duly sworn according to law, deposes and says that on October 27, 2003, he served true and correct copies of the Petition of Jesse Short to Transfer Structured Settlement Payment Rights including a copy of the Transfer Disclosure, a copy of the Notice of Proposed Transfer of Structured Settlement Payment Rights, and a copy of the Order Scheduling the hearing thereon, via certified mail, return-receipt requested, upon the following: State Farm Mutual Automobile Insurance Company One State Farm Plaza Bloomington, IL 61710 (Settlement Obligor) State Farm Life Insurance Company One State Farm Plaza Bloomington, IL 61710 (Annuity Issuer) Settlement Funding, LLC 6501 Park of Commerce Boulevard Suite 140B Boca Raton, FL 33487 Attn: Jason Sutherland (Transferee) Copies of the certified mail return-receipts are attached hereto as Exhibit "A." Respectfully submitted, Jones, Gregg, Creehan & Gerace, LLP By: '~ ~-~ ~g(~2.~_~ /Robert L. Monks PA I.D. No. 52760 411 Seventh Avenue Suite 1200 Pittsburgh, PA 15219 412-261-6400 Counsel for Petitioner, Jesse Short Sworn to and subscribed before me this,5~ day of ~oed,m~-c?Z, 2003. NOTARY P~J~LIC My Commission Expires: · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. . . · Print your name and address on the reverse . so that we can return the card to you. : · Attach this card to the back of the mailpiece, or on the fiont if space permits. 1. Article Addressed to: State Farm Mutual Automobile Insurance Company One State Farm Plaza Bloomington, IL 61710 A. Signature X~ \, ~' [] Agent [] Addressee C. Date of Delivery B. Recetved by ( prlnted Narne) D. Is delivery address different from item'S; If YES, enter delivery address below: [] No 3. Se~i~e Type ~Certmed Mall [] ~ Mall [] Registered -2~aReturn Recalpt femW~Bll~e [] Insured Malt [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 2. Article Nu ' (~ 7003 1010 0004 1372 2735 PS Form 3811, August 2001 Domestic Return Receipt · Complete items 1,2, and 3. Also complete item 4 if Restricted Delivery Is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailplece, or on the flont if space permits. 1. A~ticleAddmssedto: State Farm Life Insurance Company One State Farm Plaza Bloomington, IL 61710 trifled Mall "~CReglstemd [] Insured Mail [] EXpress Mall ~%~RReturn Receipt [] C.O.D. 4. ResbJcted Delivery? (Extra Fee) [] Yes 2.~1~ 7003 1010 0004 1372 2728 PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-1540 · Complete items 1, 2, and 3. Also complete Rem 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that wa can return the card to you. · Attach this card to the back of the mailplece, or on the front If space pmmits. [] Agent B, Recalvedby(P#ntedName} C. Dateof Delivery D. Is d~lvery eddress different from item l? [] Ye~ if YES, enter delivery address below: [] No Settlement Funding, LLC 6501 Park of Commerce Boulevard Suite 140B Boca Raton, FL 33487 Attn: Jason Sutherland [] Ce~tifled Mall [] Express Mall : [] Registered [] Return Receipt for Momhand!se [] Insured Mal~ [] C.O.D~ -- ~4. Re~tflcted Delivery? (Extra Fee) [] Yes 7002 2410 0001 2999 1481 Exhibit A , PS Form 3811, August 2001 Domestic Return Rscelpt IN THE COLTRT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION PETITION OF JESSE SHORT TO TRANSFER STRUCTLTRED SETTLEMENT PAYMENT RIGHTS Civil Term No. 03 - 5549 FINAL ORDER OF COURT ~ e~ AND NOW, this ay of 2003, upon presentation of ~ P~itior~£/~f Jesse Short to Transfer Structured Settlement Payment Pcights pursuant to the Structured Settlement Protection Act, 40 P.S. §§ 4001-4009, it appearing to this Court that proper notice of the filing and presentation of this Petition was given to the Settlement Obligor, State Farm Mutual Automobile Insurance Company, and to the Annuity Issuer, State Farm Life Insurance Company; and it further appearing that State Farm Mutual Automobile Insurance Company and State Farm Life Insurance Company do not oppose the Petition; after due consideration, this Court finds as follows: 1. This Court has subject matter and personal jurisdiction. 2. The transfer complies with the requirements of the Structured Settlement Protection Act, 40 P.S. §§ 4001-4009, and will not contravene other applicable Federal or State statutes or regulations or any applicable law limiting the transfer of workers' compensation claims. 11. Pursuant to the terms of the Transfer Agreement, Petitioner Jesse Short shall retain all right and interest in receiving the remaining balance not assigned of the entire monthly payment (currently $722.28) through and including March 1, 2004; the balance of the monthly payments not assigned commencing on April 1, 2004 (then $5:22.28, compounding at a rate of 5% annually), through and including October 1, 2023; and the entire monthly payments, then $1,916.48, commencing November 1, 2023 through and including January l, 2025 (the "non- assigned payments"). NOW THEREFORE, in consideration of the foregoing findings, it is hereby ORDERED, ADJUDGED and DECREED that the Petition to Transfer Structured Settlement Payment Rights pursuant to the Structured Settlement Protection Act, 40 P.S. §§ 4001-4009 be and is hereby GRANTED as follows: A. The transfer by Petitioner, Jesse Short to Transferee, Settlement Funding, LLC of the Transferred Payments (consisting of 235 monthly payments each in the amount of $200.00 commencing on April 1, 2004, through and including October 1,, 2023) is hereby APPROVED. B. The Settlement Obligor, State Farm Mutual Automobile Insurance Company shall direct the Annuity Issuer, State Farm Life Insurance Company to send only the Transferred Payments to Settlement Funding and its successors and/or assigns care of the following address: P.O. Box 116476 Atlanta, GA 30368-6476 or such other address as Settlement Funding and its successors and/or assigns may designate upon written notice to Settlement Obligor, State Farm Mutual Automobile Insurance Company and the Annuity Issuer, State Farm Life Insurance Company. Settlement Obligor, State Farm Mutual Automobile Insurance Company and the Annuity Issuer, State Farm Life Insurance 4 Company shall not be required to change the address for the Transferred Payment absent payment of a reasonable administrative fee, which shall not be charged to or paid by the Payee. C. All remaining Periodic Payments (and/or portions thereof) that are not subject to the Proposed Transfer shall be made payable to Mr. Short and will be forwarded to his home address. D. Settlement Funding, LLC and its successors and/or assigns shall defend, indemnify and hold harmless (collectively, the "Indemnity") the Settlement Obligor, State Farm Mutual Automobile Insurance Company and the Annuity Issuer, State Farm Life Insurance Company from any claims, liability or damages, including, but not limited to, reasonable costs and attorneys' fees, arising from or in connection with (a) all liabilities arising from the factoring transaction; (b) all liabilities arising from the compliance or non-compliance with the Structured Settlement Protection Act; (c) any disclosures made in or related to this Order of Court; (d) compliance by the Settlement Obligor, State Farm Mutual Automobile Insurance Company and the Annuity Issuer, State Farm Life Insurance Company with this Order of Court; and/or (e) the Transferee's failure to comply with the Act. E. Settlement Funding and Petitioner Jesse Short agree that the terms of this Order of Court are based exclusively upon the facts, representations and circumstances of this particular case. Nothing in this Order of Court shall preclude Settlement Obligor, State Farm Mutual Automobile Insurance Company and the Annuity Issuer, Stat{: Farm Life Insurance Company from contesting any other proposed transfer of structured settlement payment rights, whether on the basis of applicable law. This Order of Court is entered without prejudice to the rights of Settlement Obligor, State Farm Mutual Automobile Insurance Company and the Annuity Issuer, State Farm Life Insurance Company and the Court makes no findings regarding the enforceability of any non-assignment provision(s) contained in the structured settlement agreement or related documents; provided, however, that the transfer of the Transferred Payments, as provided in this Order of Court shall be valid and enforceable against Settlement Obligor, State Farm Mutual Automobile Insurance Company mad the Annuity Issuer, State Farm Life Insurance Company in accordance with its terms. This Order of Court shall not serve as precedent in any way nor be cited in any matter. Nothing contained in this Order of Court shall be deemed to afford Petitioner Jesse Short and Settlement Funding, LLC any rights of ownership or control of the annuity or shall otherwise affect the exclusive ownership and control of the annuity by Settlement Obligor, State Farm Mutual Automobile Insurance Company. F. Pursuant to the Act, this Court orders that Settlement Obligor, State Farm Mutual Automobile Insurance Company and the Annuity Issuer, State Farm Life Insurance Company are hereby discharged and immune from all liability to the Petitioner, anyone claiming through the Petitioner, or to any other person or entity (except Settlement Funding, LLC per the terms of this Order) for the Transferred Payments and portions thereof, or for disclosures made in or related to this Order. G. Compliance with the requirements and fulfillment of the conditions set forth in the Act shall be solely the responsibility of the Transferee in the transfer of the Transferred Payments, and neither Settlement Obligor, State Farm Mutual Automobile Insurance Company nor the Annuity Issuer, State Farm Life Insurance Company shall bear any responsibility for, or any liability arising from, noncompliance with those requirements or failure to fulfill those conditions. H. All interested parties, including Petitioner, the Transferee, the Structured Settlement Obligor, and the Annuity Issuer shall abide by the te~xns of the Transfer Agreement in 6 all respects. This Order shall be considered a "qualified order" for purposes of 26 U.S.C.A. § 5891. Notice of the entry of this Order shall be served by Petitioner on all parties and Proof of Service shall be filed with the Court. Jurisdiction shall remain with this Court. 7 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION PETITION OF JESSE SHORT TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS Civil Term : No. 03 - 5549 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 18, 2003, he served a true and correct copy of the Final Order of Court dated November 17, 2003 approving the Petition of Jesse Short to Transfer Structured Settlement Payment via regular mail postage pre- paid, upon the following: State Farm Mutual Automobile Insurance Company c/o William Bamhart, Esquire One State Farm Plaza Bloomington, IL 61710 (Settlement Obligor) State Farm Life Insurance Company c/o William Bamhart, Esquire One State Farm Plaza Bloomington, IL 61710 (Annuity Issuer) Settlement Funding, LLC 6501 Park of Commerce Boulevard Suite 140B Boca Raton, FL 33487 Attn: Jason Sutherland (Transferee) Respectfully submitted, Jones, Gregg, Creehan & Gerace, LLP By: ~ Robert L. Monks PA I.D. No. 52760 411 Seventh Avenue Suite 1200 Pittsburgh, PA 15219 412-261-6400 Counsel for Petitioner, Jesse Short Swom to and subscribed before me this/g~-dayof /v,~va-r~t;r~ ~ 2003. My Commission Expires: ~ I _ra~v s. F~a~, No~ay put~