HomeMy WebLinkAbout08-4194MARO & MARO, P.C.
By: Robert A. Maro, Esquire
Attorney I.D. No.: 89585
1115 West Main Street
Norristown, PA 19401
(610) 275-9600
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
nn
RE: Joint Petition of 321 Henderson NO;
Receivables Origination, LLC and
Nicholas Montague
JOINT PETITION FOR PARTIAL TRANSFER OF STRUCTURED
SETTLEMENT PURSUANT TO STRUCTURED SETTLEMENT PROTECTION
ACT. 40 P.S. 4000, ET SEQ.
TO THE HONORABLE JUDGES OF SAID COURT:
And now comes your petitioner, 321 Henderson Receivables Origination, LLC,
by and through its attorneys, Maro & Maro, P.C., and joint petitioner, Nicholas
Montague, and in accordance with the applicable rules of Pennsylvania Civil Procedure,
hereby represents as follows:
1. Petitioner is 321 Henderson Receivables Originations, LLC. ("Buyer" or
Transferee"), with an office address located at 40 Morris Avenue, Bryn Mawr,
Pennsylvania, 19010.
2. Joint Petitioner is, Nicholas Montague ("Payee"), an adult individual who
resides at 173 E Penn St, Carlise, PA 17013.
3. This Joint Petition has been verified by the Transferee, 321 Henderson
Receivables Origination, LLC. and the Petition includes all necessary information as
prescribed by PA R.C.P. 229.2(d) et al and Section 3 of the Act, 40 P.S. §4001 et seq.
4. Pursuant to PA. R.C.P. No. 229.2(d)(3) there are four (4) attachments
incorporated herein as follows:
a. PA R.C.P. 229.2(d)(3)(i) Payee's Affidavit in Support of Petition.
Please see Attachment/Exhibit "I"; and
b. PA. R.C.P. 229.2(d)(3)(ii) An Initial Order of Court Scheduling
Hearing;
c. PA. R.C.P. 229.2(d)(3)(iii) A certification by Robert A. Maro, Esquire,
attorney for transferee, 321 Henderson Receivables Originations,
LLC.; and
d. PA. R.C.P. 229.2(d)(3)(iv) A Final Order of Court Granting
he Petition.
5. Joint Petitioner, Nicholas Montague, is the beneficiary of an annuity
owned by Hartford Cebsco and issued by Hartford Life Insurance Company. The
structured settlement provides payment to the petitioner as described on
Attachment/Exhibit "2".
6. Joint Petitioner, Nicholas Montague, was represented by independent counsel
in this transaction. Joint Petitioner, Nicholas Montague and his attorney have reviewed
and discussed the terms of this transaction together and fully understating the terms
therein, freely and voluntarily executed the Purchase Agreement, Exhibit "A" to the
Purchase Agreement and the Disclosure Statement. A letter of representation from the
attorney for Nicholas Montague is attached hereto, incorporated herein and marked
Attachment/Exhibit "3".
7. Joint Petitioner, Nicholas Montague, proposes to enter into a purchase
agreement with 321 Henderson Receivables Origination L.L.C.., its nominees,
successors, or assigns, whose address is 40 Morris Avenue, Bryn Mawr, Pennsylvania,
19010, who will purchase the following from Petitioner's structured settlement as
follows:
A) 1 payment of $15,000.00 on August 12, 2011 B) 1
payment of $20,000.00 on August 12, 2016
8. The structured settlement is currently owned by Hartford Cebsco and issued by
Hartford Life Insurance Company, and the net amount in return payable to Nicholas
Montague is $14,000.00 from Buyer. A copy of the Purchase Agreement, Exhibit "A' to
the Purchase Agreement and Disclosure Statement is attached hereto, made apart hereof,
and designated Attachment/Exhibit "411
.
9. The net amount payable to the payee after deduction of all commissions,
fees, costs, expenses, and charges is $14,000.00.
10. Based on the net amount that the payee will receive from this transaction
$14,000.00 and the amounts and timing of the structured settlement payments that
would be assigned, the payee is, in effect, paying interest at a rate of 17.36% per
year.
11. The Buyer furnished Nicholas Montague with a Disclosure Statement
pursuant to 40 P. S. 4003 See Attachment/Exhibit "4") at least ten (10) days prior to the
date on which Nicholas Montague first incurred any obligation to the Buyer.
12. PA R.C.P. 229.2(b) requires the petition to be filed in the county in which the
payee is domiciled See also Section 4 of the Act 40 P.S. §4004). PA.R.C.P. 229.2(c)
also requires both the Transferee and Payee to be parties to the Joint Petition. Both
requirements have been fulfilled herein.
13. Written notice of the Transferee's Names, address and taxpayer identification
number has been given to the Annuity Issuer and Structured Settlement Obligor. A copy
of the Notice to the structured settlement obligor is attached hereto as Attachment/Exhibit
115". Joint Petitioners wills also serve written notice as required by 40 P.S. 4004 upon
all interested parties.
14. The Joint Petitioner's best interest would be served by granting the relief
requested herein for the following reasons. Joint Petitioner is currently single and has no
minor children. Unfortunately, Joint Petitioner has a substantial amount of debt as a
result of his accident. The debt has severely effecedt his credit and being a young man,
Mr. Montague does not want this to effect him for the rest of his life. Mr. Montague
wants to clear up his debt. The following are a list of debts that Mr. Montague currently
has:
a. SVPO - $8,000.00
b. Verizon - $600.00
c. Sprint - $750.00
d. Giant- $1,000.00
e. Cumberland County $1,100.00
f. SmartMed- $900.00
g. TOTAL- 12,350.00
With the additional money received, Mr. Montague will purchase a used vehicle.
Mr. Montague wants to obtain employment, however it has been very difficult with the
amount of debt he is along with having no transportation. If this court approves this
transfer, Mr. Montague will be debt free, have transportation and be able to move
forward in life in a manner that is in his best interest and possibly, the best interest of a
family some day. Based upon the foregoing which will be expanded upon at the time of
trial, the transfer is clearly within the best interest of Mr. Montague.
WHEREFORE, Joint Petitioner's respectfully requests this Honorable Court to
enter the Initial Order attached to this petition which shall schedule a hearing so that
Transferee and Payee shall have the opportunity to discuss the purpose and reasons for
the transfer and after hearing thereon, respectfully request that this Honorable Court enter
a Final Order approving the Transfer of Structured Settlement Payments Rights as is
mentioned herein.
Maro & Maro, P.C.
By:
Attorney for Transferee
VERIFICATION
I, Maureen Healy, Vice President of 321 Henderson
Receivables Origination LLC, have read the foregoing Petition to Transfer Structured
Settlement Payment Rights between 321 Henderson Receivables Origination LLC and
NcVNn`a C Mon -'q g v e 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.
45?j??
Maureen Healy, VP
7, 11- aLoo8
Date
CERTIFICATION OF ATTORNEY FOR TRANSFEREE
I, Robert A. Maro, Esquire, attorney for Transferee, 321 Henderson Receivables
Origination L.L.C., hereby certify to the best of my knowledge, information and belief,
formed after reasonable inquiry, that the Transfer will comply with the requirements of
the Act (40 P.S. § 4000 et seq.) and will not contravene any other applicable federal or
state statute or regulation or the order of any court or administrative authority.
I, Robert A. Maro, Esquire, attorney for Transferee, 321 Henderson Receivables
Origination L.L.C., hereby verify that the facts and statements set forth herein are true
and correct to the best of my knowledge, information and belief. I understand that false
statements made herein are subject to the penalties of 18 Pa. C.S.A. Section 4904 relating
to unworn falsification of authorities. n / /I
711tloe
Date
Attorney for Transferee, 321
Henderson Receivables Origination
L.L.C.
MARO & MARO, P.C.
By: Robert A. Maro, Esquire
Attorney I.D. No.: 89585
1115 West Main Street
Norristown, PA 19401
(610) 275-9600
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
RE: Joint Petition of 321 Henderson NO:
Receivables Origination, LLC and
Nicholas Montague
CERTIFICATE OF SERVICE
I, Robert A. Maro, Esquire, hereby certify that a true and correct copy of the
Petition for Transfer of Partial Structured Settlement has been served upon the following
entities via first class mail and/or certified return receipt requested and/or email on :
Hartford Cebsco
Attn. Legal Department-Structured Settlements
200 Hopmeadow Street
Simsbury, CT 06089
Hartford Life Insurance Company
Attn. Legal Dept/structured Settlements
200 Hopmeadow Street
Simsbury, CT 06089
Lawrence J. Rosen
Attorney for Nicholas Montague
1101 N Front Street
Harrisburg, PA 17102-3324
Nicholas Montague
173 E Penn St
Carlise, PA 1701 3?1
Date: ? ( 111,08
By:
Attorney for 321 Henderson Receivables
Origination L.L.C.
MARO & MARO, P.C.
By: Robert A. Maro, Esquire
Attorney I.D. No.: 89585
1115 West Main Street
Norristown, PA 19401
(610) 275-9600
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
RE: Joint Petition of 321 Henderson NO:
Receivables Origination, LLC and
Nicholas Montague
Entry of Appearance
TO THE PROTHONOTARY/CLERK OF SAID COURT
Enter my appearance on behalf of 321 Henderson Receivables Origination, LLC
Papers may be served at the address set forth below.
Respectfully Submitted:
Maro & Maro-P.C.
By:
Attorney I.D. No 89585
Maro & Maro, P.C.
1115 W. Main Street
Norristown, PA 19401
(610) 275-9600(office)
(610) 275-9666(Fax)
ATTACHMENT/EXHIBIT "1"
Account ID: 375731
Payee's Affidavit in Support of
Petition to Transfer Structured Settlement Rights
I, Nicholas Montague, the payee, verify that the statements below are true and correct:
Payee's name, address and age: Nicholas Montague / 173 E. Penn St.
Carlisle, PA 17013/ 21.
1. Marital Status:
X Never Married; _ Married; Separated; Divorced
If married or separated, name of spouse: N/A
3. Minor Children and other dependents:
Names, ages, and places of residence: N/A
4. Income:
I receive a monthly income of $680.00 from Social Security.
If presently married, spouse's monthly income and sources: N/A
5. Child support, alimony or alimony pendente lite:
Obligation to pay: Yes X No
If yes, state the amount of the obligation, to whom payable, and whether there are
arrearages:
6. Previous transfers:
Have you previously filed a petition to transfer payment rights under the
structured settlement that is the subject of this petition? Yes X No
If yes, for each petition that you filed,
(a) If the transfer was submitted for court approval, list the
court, the case caption and case number, and state whether the
Account ID: 375731
court approved or disapproved the transfer:
(b) If the transfer was approved,
(i) State the name of the transferee and identify (listing due
dates and payment amount(s)) the payments involved in the
transfer:
State the amount of money and the manner in which the
money was used:
(c) Have you ever transferred payments without court approval? If so,
please explain: No
7. Reasons for transfer:
. Describe in detail you reasons for the proposed transfer, including an
explanation as to why a sale of a lesser amount of the structured settlement
amount will better serve your interests: I want to use the money from this transfer
to pay off my debt. Paying off this debt will allow me to clear my credit. The
remaining amount of money I will use to purchase a vehicle.
8. Payment of debts:
If you seek the transfer in order to pay debts, list each debt, including the name of
the creditor and the amount presently owed:
Debt Creditor Amount Owed
Outstanding bill SVPO $8,000.00
Account ID: 375731
Outstanding bill Verizon $600.00
Outstanding bill Sprint $750.00
Credit card Giant $1,000.00
Fine Cumberland County $1,100.00
Outstanding bill SmartMed $900.00
Verification
I verify that the statements made in this affidavit are true and correct. I understand
that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904, relating
to unworn falsification to authorities.
DATED:
Signature
ATTACHMENT/EXHIBIT 66299
G1UIWIlh
"Claimant"
"Assignor"
Uniform Qualified Assignment and Release
Nicholas Ryan Montague, a minor, by his parent and natural guardian, Stephanie Montague
Nationwide Mutual Insurance Company
"Assignee" Hartford Comprehensive Employee Benefit Service Co
"Annuity Issuer" Hartford Life Insurance Company
".Effective Date" 06 -/ 7 - a o0...
This Agreement is made and 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
release dated . 2002 (the
"Settlement Agreement") that provides for the
Assignor to make certain periodic payments to or
for the benefit of the Claimant as stated in
Addendum No.1 (the "Periodic Payments"); and
B. The parties desire to effect a "qualified
assignment" within 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 foregoing
and other good and valuable consideration, the
parties agree as follows:
1. The Assignor hereby assigns and the 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 Sections 104(a)(2) and
130(c) of the Code.
3. 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 set aside specific assets to
secure the Periodic Payments. The Claimant has
no rights against the Assignee greater than a
general creditor. None of the Periodic Payments
may be accelerated, deferred, increased or
decreased and may not be anticipated, sold,
assigned or encumbered.
4. The obligation assumed by Assignee with respect
to any required payment shall be discharged
upon the malting on or before the due date of a
valid check in the amount specified to the
address of record.
5. This Agreement shall be governed by and
interpreted in accordance with the laws of the
Commonwealth of Pennsylvania.
6. The Assignee may fund the Periodic Payments by
purchasing a "qualified funding asset" within the
meaning of Section 130(d) of the Code in the form
of an annuity contract issued by the Annuity
Issuer. All rights of ownership and control of
such annuity contract shall be and remain vested
in the Assignee exclusively.
7. The Assignee may have the Annuity Issuer send
payments under any "qualified funding asset"
purchased hereunder directly to the payee(s)
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 "qualified funding asset" or
against the Annuity Issuer.
8. Assignee's liability to make the Periodic
Payments shall continue without diminution
regardless of any bankruptcy or Insolvency of the
Assignor.
8. In the event the Settlement Agreement Is declared
terminated by a court of law or in the event 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. This Agreement shall be binding upon the
respective re presentatives, helm, successors
and assigns of the Claimant, the Assignor and
the Assignee and upon any person or entity that
may assert any right hereunder or to any of the
Periodic Payments.
Ass r: Id Mutual Iu nce Com n
By: V?L)
Audxk*ed Representadve
Title
a:64L . >%
Stephanie Montague, as parent and natural gua(dian
of Nicholas Ryan Montague, a minor
Approv s to Fonn and Content:
By:
C imanew Attorney
Robert J. Muolo
11. The Claimant hereby accepts Assignee's
assumption of all liability for the Periodic
Payments and hereby releases the Assignor
from all liability for the Periodic Payments.
Assignee:
Hartford C ro ee Beneft Service Co
By:
authorised resenteave
Title yQI
Addendum No.1
Description of Periodic Payments
The following Periodic Payments:
(1) To Nicholas Ryan Montague ("Payee'l, the following guaranteed lump sum payments:
Five Thousand Three Hundred Forty Dollars ($5,340) on or about August 12, 2004.
Ten Thousand Dollars ($10,000) on or about August 12, 2007.
Fifteen Thousand Dollars ($15,000) on or about August 12, 2011.
Twenty Thousand Dollars ($20,000) on or about August 12, 2016.
(2) Should Nicholas Ryan Montague die before August 12, 2016, then any remaining guaranteed
Periodic Payments set forth in paragraph (1) shall instead be paid, subject to the provisions of
paragraph (3) below, as they become due, to the estate of Nicholas Ryan Montague
("Beneficiary'), with the last payment to be on or about August 12, 2016.
(3) The Payee shall have the right, after reaching the age of majority, to submit a request to
change the Beneficiary by filing a written request with the owner of the Annuity Contract. The
change will be effective when approved by both the owner of the Annuity Contract and the Annuity
Issuer. Any change in the Beneficiary shall not in any way affect or alter any of the provisions of
this Agreement.
Initials
Claimant:
Assn nor:
Ass nee• •
HARTFORD LIFE INSURANCE COMPANY
200 HOPMEADOW STREET
SIMSBURY, CT 06089 .
1-800-678-2282
(A stock Insurance company)
Will make Income Payments according to the frequency shown on Page 3 Payments
will begin on the Date of First Payment Payments will be made to the Annuitant until the
Owner directs otherwise
Nil, upon receipt at our office in Simsbury. Connecticut of due proof of the Annuitant's
death before the end of the Certain Period, continue Income Payments to the Beneficiary
for the balance of the Certain Period
This Policy has no Cash Surrender Value
Signed for the Company
L141-7 IVT +7-
oj?. ?* . 7L?.
Christine Hayer Repasy. Secretary
Thomas M Marra, President
TEN DAY RIGHT TO EXAMINE CONTRACT
We want you to be satisfied with the contract you have purchased We urge you to
examine it closely If, for any reason, you are not satisfied. you may return the contract to
us or to the agent from whom it was purchased within ten days after you receive d It will
be cancelled and any premium paid will be refunded in full
Single Premium Annuity Certain
Income Payments Payable for a Certain Period
With Death Benefit
Non-Participating
Single Premium shown on Page 3
Hartford Life
HL-16948 C304RO FRM
This page intentionally left blank
Page 2 O002RO FIRM
CONTRACT SPECIFICATIONS
AGE AND SEX OF 15 Male
FIRST ANNUITANT
AGE AND SEX OF NIA
SECOND ANNUITANT
DATE OF FIRST PAYMENT 08/12/2004
FIRST ANNUITANT Nicholas Ryan Montague
SECOND ANNUITANT N/A
INCOME PAYMENT $5,34000
INCOME PAYMENT Annually
FREQUENCY
DATE OF ISSUE 0810542002 ANNUITY NUMBER CCX0027047
OWNER Hartford CEBSCO
SCHEDULE OF BENEFITS AND PREMIUMS
FORM NUMBERS DESCRIPTION OF BENEFIT SINGLE
HL- PREMIUM
16948. 9352. 15692 Paid In Full
15693
Single Premium Annuity Certain
Lump Sum Payments
$5.340 00 On 08/12/2004
$10,000 00 On 08/12/2007
$15,000 00 On 08/12/2011
$20,000 00 On 08/12/2016
HL-9352 Page 3
ATTACHMENT/EXHIBIT "3"
COUNSELORS AT LAW
1101 NORTH FRONT STREET
HARRISBURG, PENNSYLVANIA 17102-3324
Sanford A. Krevsky
Lawrence J. Rosen
Joshua M. Goldberger
July 7, 2008
J.G. WENTWORTH
40 MORRIS AVENUE
BRYN MAWR, PA 19010
To Whom it May Concern:
I have provided representation to Nicholas Montague on the structured settlement
matter. I have provided him with legal, tax and financial advice regarding same.
Sincerely,
Lawrence J. Rosen
Tel. (717) 2344583
Fax (717) 234,3650
LJR:alr
ATTACHMENT/EXHIBIT 66499
Account ID: 375731
PURCHASE AGREEMENT
This is a Purchase Agreement. The date of this Agreement is , 200. Nicholas Montague is
the Seller. 321 Henderson Receivables Origination LLC, a Nevada Limited Liability Company, its
successors and/or assigns is the Buyer. In this Agreement, Nicholas Montague is referred to as "You" or
"Your" and 321 Henderson Receivables Origination LLC or its nominee, is referred to as "We", "Us" or
111.19.
BACKGROUND OF THIS AGREEMENT
1. You or someone on your behalf signed a Settlement Agreement (the "Release" or the
"Settlement Agreement'). in connection with the resolution of a personal injury claim.
2. The insurer funded the Payments by buying an annuity contract (the "Annuity") issued by
Hartford Life Insurance Company (the "Annuity Company").
3. A list of the Payments being sold under this Agreement is attached to this Agreement as
Exhibit "A".
4. You desire to sell and assign to Us all of Your rights to receive all or a portion of the Payments
under the Release, as described on Exhibit "A", all of the other rights You have under the Release and the
other rights as described in Section 1(a) below. We desire to purchase all of Your rights and benefits, on
the terms and under the conditions described in this Agreement.
You and We agree as follows:
1. Purchase and Sale.
a. You now sell, transfer and assign to Us all of Your rights in the "Assigned Assets" as
listed in Exhibit "A". By Our signing this Agreement, We are hereby purchasing and
accepting the sale and assignment of all of the Assigned Assets described above.
b. The Gross P)11 hase Price is Fourteen Thousand Five Hundred Dollars a 00/100 Cents
($14,500.00 The Net Purchase Price payable to You is $14,000.06 (the "Purchase
Price"). The Net Purchase Price will be paid to You when both You and We sign this
Agreement and We have completed Our internal process.
2. Acknowledgment.
a. You will agree after Your signing of this Agreement to deliver to Us, addressed as We
may require, other notices, instructions or documents, and copies of them, as We think
are necessary or proper to carry out this Agreement.
b. When You and We sign this Agreement, You will also deliver to Us: (1) a letter
addressed to the Annuity Company directing that all payments of the Assigned Assets
after Your death shall be sent directly to Us, and (2) a Change of Beneficiary Form
changing the beneficiary of the Assigned Assets, after Your death, to "321 Henderson
Receivables Origination LLC", as sole beneficiary [(1) and (2) above are referred to as
the Change of Beneficiary Form]. The Change of Beneficiary Form will state that the
instructions may never be revoked and that no change may be made in the instructions or
02008 321 Henderson Receivables Origination LLC
Account ID: 375731
in the payments (including as to the payee or the manner or place of making such
payments) without Our prior written consent. You will also, when this Agreement is
signed by You and Us, deliver to Us, addressed as We may require, such other notices,
instructions or documents, and copies of them, as We think are necessary or proper to
carry out this Agreement.
c. Before You and We sign this Agreement, You will deliver to Us an acknowledgment of
The Estate of Nicholas Ryan Montague, as primary beneficiary of the Assigned Assets,
of the terms of this Agreement. The Estate of Nicholas Ryan Montague will agree that
they are not entitled to any rights to any of the Assigned Assets.
d. You agree to sign all other documents which We may request forever naming Us as the
only beneficiary of the Assigned Assets, including but not limited to an agreement to
provide in Your Last Will and Testament that all of Your rights to the Assigned Assets
were sold to Us (a "Testamentary Agreement").
e. You acknowledge that We advised You to obtain independent professional tax advice to
determine whether this transaction will result in any adverse federal and/or state tax
consequences.
f. You acknowledge that We advised You must obtain independent legal representation
prior to executing this Agreement and that We have advised you that We may not refer
You to any specific attorney for such purpose.
Your Representations and Warranties. You now represent and warrant to Us that:
a. You own (and are selling and assigning to Us under this Agreement) all of the
Assigned Assets, free and clear of all claims, liens, charges, security interests,
encumbrances, and agreements of any nature (other than this Agreement), and
when You and We sign this Agreement, no one other than Us shall have any
present or future right to the Assigned Assets.
b. This Agreement and all of the other documents signed in connection with this
Agreement have been properly signed by You, and they represent Your legal,
valid and binding obligation, enforceable against You in accordance with their
terms.
c. The signing and performance of this Agreement by You and the transactions
described in this Agreement:
L do not conflict with any other obligations of Yours;
ii. will not cause a violation under (or create any right of termination,
cancellation or acceleration or similar right under) any contract or
agreement by which You or Your assets, including the Release, are
bound or may be affected;
iii. will not create, or give any party (other than Us) the right to create, any
lien, charge, security interest or encumbrance in, to or on any of the
Assigned Assets; and
iv. will not create a present or future right in any other party to make any
claim against You or Your assets, or any of the Assigned Assets.
2
02008 321 Henderson Receivables Origination LLC
Account ID: 375731
d. You understand the terms and provisions of this Agreement and You have been
represented by tax and accounting advisors and a lawyer in the signing of this
Agreement.
e. Neither You nor anyone else have to do anything else for (1) the proper signing
and performance by You of this Agreement and any transactions intended to be
done in this Agreement, or (2) the carrying out by Us of any of Our rights and
remedies under this Agreement. No other person has made a claim in any rights
in or to the Assigned Assets.
f. You have valid reasons for selling Your interest in the Assigned Assets rather
than obtaining a loan with the Assigned Assets as collateral, and You agree that
the transaction set forth in this Agreement is not a loan or other financing
transaction.
g. This Agreement is a valid sale, transfer and assignment to Us of the Assigned
Assets.
h. Your residence and legal address is as described in Paragraph 11 of this
Agreement. During the last years, You have lived at such address.
i. No representation or warranty of Yours in this Agreement or in any of the
documents delivered in connection with this Agreement or in any agreement
required by this Agreement, is inaccurate or contains any untrue or misleading
statement.
j. The signing by You of this Agreement will not violate any other promise or
agreement you have made with anyone else. You understand that any and all
restrictions on the assignability of the Scheduled Payments were included in the
Release and/or Annuity at Your request, for Your benefit and not for the benefit
of any other person. These restrictions, if any, were included by You as a
precautionary measure to make sure You were allowed favorable tax treatment
under the Internal Revenue Code. You understand that by entering into this
Agreement, you may be giving up this favorable tax treatment. You understand
that any income earned by You on any investment or use of the Purchase Price
may be taxable to You. You may have to pay more in taxes as a result of this
Agreement. For Our benefit and the benefit of Our assigns or successors, You
agree to WAIVE AND RELEASE all of Your rights in, to, or under, such
restrictions on assignability, if any.
k. You have not before the date of this Agreement, sold or assigned Your right to the
Assigned Assets or any part of the Assigned Assets. You do not owe any money
to Your present or former spouse for support maintenance or similar obligations,
nor do You owe any money to any of Your children or guardians of Your
children. The Assigned Assets are not subject to any community property or
similar marital rights of any person.
02008 321 Henderson Receivables Origination LLC
Account ID: 375731
1. Your right to the Assigned Assets is not affected by any mortgage, pledge, lien,
charge, security interest, encumbrance, restriction or adverse claim of any
nature. You understand that any violation of any of Your representations in
this agreement will result in an act of fraud by You which could result in
You being held responsible for damages in favor of Us, with money to be
paid by You to Us.
m. You are not in violation of any obligations concerning child-care, alimony or
support.
n. You now give up forever all Your rights in any agreement that says that You
cannot assign or sell Your rights in the Assigned Assets to Us. You have not
requested and You do not expect to receive from Us, a Form 1099 or any other
documentation which could make the transaction described by this Agreement
taxable to You in any way. You further understand that We have not given to
You any advice about any of Your taxes in this transaction. You have relied on
Your own professional advisors concerning taxes.
o. As of the date of this Agreement, You are of legal age in the state noted as Your
address in Section 11 of this Agreement, mentally sane, and of a sound mind.
You have never been convicted of a felony or any other crime involving
dishonesty.
p. You are very familiar with Your financial affairs and condition. With that full
understanding, You certify that (1) on the date We pay You the Purchase Price
and You sell to Us the Assigned Assets, the fair value of Your assets are and
will be greater than all of Your debts; (2) You presently intend to pay all of
Your creditors when such payments are due; and (3) You have not intentionally
hidden the fact from any creditor of Yours that You have entered into this
Agreement and the other documents referred to in this Agreement.
q. You do not intend to file for bankruptcy and there are no lawsuits or other
efforts by any of Your creditors to put You into bankruptcy or to take the
Assigned Assets.
r. The Purchase Price is not Your only or most important source of income and
You do not have any mental or physical problems that would prevent You from
having a paying job.
s. You promise to us that no broker, finder, or other person other than those
persons named in the broker statement signed by you in connection with this
Agreement was involved in or important in arranging the purchase transaction in
this Agreement. No other person has a right to any fee, payment, commission,
or other compensation because of this Agreement.
t. You agree that We have not forced You to give to Us copies of any confidential
documents. You agree that We told You that We only needed to see those
documents which described the Assigned Assets so we could buy from You the
Assigned Assets. You agree that We do not intend to tell any other party about
what is included in those documents. You understand that if We do so, it will
only be for the sole purpose of buying the Assigned Assets.
4
02008 321 Henderson Receivables Origination LLC
Account ID: 375731
u. You understand that it usually takes six to eight weeks to complete this process,
but that it could take longer. You understand that you have to obtain court
approval of this transfer. YOU UNDERSTAND THAT, DUE
TO OCCASIONAL DELAYS, WE WILL HOLD
BACK THE AMOUNT EQUAL TO THE NEXT
TWO MONTHLY PAYMENTS DUE TO YOU
FROM THE ANNUITY COMPANY TO INSURE
THAT WE RECEIVE ALL OF THE PAYMENTS
THAT WE PURCHASE. YOU UNDERSTAND
THAT WE MAY EITHER PAY OR HOLD BACK
FUNDS TO SATISFY ANY JUDGMENTS, TAX
LIENS OR CHILD SUPPORT AGAINST YOU OR
THE ASSIGNED ASSETS AND DEDUCT THOSE
AMOUNTS FROM THE PURCHASE PRICE. YOU
UNDERSTAND THAT WE WILL DEDUCT FROM
THE PURCHASE PRICE ANY AMOUNTS OF
PAYMENTS RECEIVED BY YOU PRIOR TO
FUNDING, IF SUCH AMOUNTS ARE NOT
COVERED BY THE HOLD BACK FUNDS.
4. You promise Us that:
a. You will not, and will not allow any other party (except Us or Our assignee,
if applicable) to take funds away from the Assigned Assets. You will not
do anything else to affect the Assigned Assets. You will not say You still
own the Assigned Assets. You will not do anything or allow anyone else
to do anything that could in any way interfere with or lessen Our rights in
the Assigned Assets.
b. You will not do anything that will, or could in the future, violate the
Release, or any of the agreements required to be executed by this
Agreement. You also agree to cooperate with Us to help Us to obtain all of
the rights that We are buying from You in this Agreement and in the
Release.
c. You will give to Us at least thirty (30) days written notice of Your intention
to move Your residence or change Your legal address from the address in
Paragraph 11 of this Agreement. You also agree that we can do background
checks, including from the credit bureaus derived from credit bureau data,
in order to verify your legal address and other contact information for
purposes of this transaction.
d. You will not make any change in Your instructions to the Annuity
Company regarding payments to be made to You.
5
02008 321 Henderson Receivables Origination LLC
Account ID: 375731
e. You understand that the Annuity and the Release may say that You agree
not to sell Your rights to the Assigned Assets.
f. You agree to continue to cooperate with Us. This includes Your obligation
to immediately deliver to Us any checks, funds or other form of Payment
received after the date of this Agreement by You or anyone other than Us. If
any Payment is ever denied, delayed, or withheld from Us, as determined by
Us in our reasonable discretion, directly or indirectly on account of any act
or omission by You or any person acting for You, then You shall be in
default under this Agreement (and an Event of Default under §8 shall be
deemed to have occurred). Immediately upon such default, and without any
finther notice to You, You will pay to Us the following amounts:
(i) the full, dollar value of all remaining Assigned Assets as they
become due after the date of the default;
All of the remedies specified under this section shall be cumulative with all
of the remedies for default pursuant to § 8.
g. If You learn before or after the signing of this Agreement of the threat or
actual beginning of any lawsuit or proceeding that has anything to do with
Our rights under this Agreement or the Assigned Assets, then You will
immediately notify Us of that and You will give Us copies of all notices and
other writings relating to it promptly after You receive them.
h. If You receive any notice relating to any supposedly unpaid claim affecting
the Annuity or the Assigned Assets or to any other claim against the
Annuity or the Assigned Assets, then You will promptly notify Us and will
promptly give Us copies of all notices and other writings relating to it
received by You promptly after You receive them.
5. RIGHT TO CANCELLATION YOU MAY CANCEL THIS TRANSACTION NO
LATER THAN THE THIRD BUSINESS DAY FOLLOWING THE DATE YOU EXECUTE THE
PURCHASE AGREEMENT, WITHOUT PENALTY OR FURTHER OBLIGATION. In order for the
cancellation to be effective, You must provide written notice of cancellation to US, c/o Manager of
Operations at 3993 Howard Hughes Parkway, Suite 250, Las Vegas, NV 89169-6754.
6. Your Further Promises, You agree that, from time to time, at Your expense, you will
promptly sign and give to Us any and all documents to help Us realize our rights and benefits under this
Agreement. This promise includes signing, filing or allowing Us to file financing or continuation
statements, or amendments or assignments of those documents. You permit Us or others acting for Us to
sign our name and/or your name and file without Your signature such financing statements, if that is
permitted in Your state of residence. When you sign this Agreement, you will also sign and deliver to Us
a "Special Irrevocable Power of Attorney-- You must retain the services of an attorney and deliver an
opinion of Your attorney about the sale of Assigned Assets to Us, in a form acceptable to Us.
6
02008 321 Henderson Receivables Origination LLC
Account ID: 375731
7. Continuation of Representations. Warranties and Covenants. All of Your
representations, warranties and promises made in this Agreement will continue to be relied on by Us after
this Agreement is signed.
8. Event of Default. Your failure to comply with any term of this Agreement or Your
breach of any of Your representations in this Agreement will mean that You will be in default. We refer to
this as an "Event of Default." If there is an Event of Default, We have the right to sue You in court to make
You perform Your promises or to get money from You. Your failure to comply with any material terms of
this Agreement will be a default.
In Paragraph 4 (c) You agree to give US at least thirty (30) days written notice after Your move to
a new residence or change of Your legal address from the address in Paragraph 11 of this Agreement. If we
are purchasing from You certain lump sum payments, We will contact you at least 3 months before the
scheduled payment is due to determine if the address change We have effected with the annuity company is
in place and to determine if Your legal address has remained the same. If We cannot contact you because
You have changed Your legal address or moved Your residence We will consider our inability to
contact you to be an EVENT OF DEFAULT and We will exercise all of our legal rights under this
Agreement. OUR RIGHT TO PROCEED AGAINST YOU UNDER THIS AGREEMENT SHALL
BE SOLELY LIMITED TO WHEN YOU HAVE COMMITTED AN EVENT OF DEFAULT. WE
SHALL NOT HAVE THE RIGHT TO SUE YOU IF OR BECAUSE THE ANNUITY COMPANY IS
NOT ABLE TO MAKE PAYMENTS BECAUSE IT IS NOT FINANCIALLY ABLE TO DO SO.
9. Controlling Law. This Agreement shall be governed, construed and enforced in
accordance with the internal laws of the State of your domicile without regard for the conflicts of law rules
thereof or elsewhere. (For Court Orders or Notice Transfers obtained in the following jurisdictions: AK,
AR, AL, AZ, CA, CO, CT, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO,
MS, MT, NC, NE, NJ, NM, NV, OH OK, OR, RI, SC, SD, TN, TX, UT, VA, WA, WV and WY the laws
of those jurisdictions shall be applied in the event of a dispute regarding the transfer.) Your domicile is the
proper place of venue to bring any action arising out of a breach of this Agreement.
10. Responsibility for this Agreement This Agreement will hold responsible Your heirs,
executors, successors and assigns and will benefit Our representatives, successors, beneficiaries and
permitted assigns. Nothing in this Agreement is intended to give anyone other than You or Us or each of
Our successors or assigns any benefits.
11. Notices. All notices and other communications under this Agreement will be in writing
and will be made by delivery by means by which the sender obtains a receipt of delivery from the carrier
(including without limitation, certified mail return receipt requested or overnight courier services),
addressed to the party to whom a request or demand is to be made. Such demand or notice or request shall
be deemed given on the date which is one business day after the date sent by overnight mail or three days
after the date sent by certified mail.
The addresses of the parties are as follows:
If to You:
Nicholas Montague
173 E Penn St
Carlise, PA 17013
7
02009 321 Henderson Receivables Origination LLC
Account ID: 375731
If to Us:
321 Henderson Receivables Origination LLC
3993 Howard Hughes Parkway
Suite 250
Las Vegas, NV 89169-6754
Attention: Manager - Operations
12. Past Actions. Anything either You or We did or said before this Agreement was signed
will not affect Your or Our rights under this Agreement in any way.
13. Expenses. Except as otherwise affirmatively set forth in this Agreement, You and We
agree that we will each pay our respective costs and expenses in connection with the carrying out of this
Agreement.
14. Headings . The section and subsection headings contained in this Agreement are for
reference purposes only and will not affect in any way the meaning or interpretation of this Agreement.
15. Counterparts. One or more originals of this Agreement may be signed with Your or Our
signature. When put together they will make one agreement and the Agreement will be considered signed
by all parties that need to sign. A facsimile signature will be considered an original.
1.6. Assignment. We and anyone to whom We assign this Agreement may assign Our right,
title and interest in and to this Agreement, the Annuity and the Assigned Assets without Your approval.
You and We agree that if there is an assignment by Us to someone else, We shall not be responsible to
You. You must look only to the person or company that We assign this Agreement to for any payment (for
example, of the Purchase Price) and performance of this Agreement. When asked by Us or any assignee,
You will sign and deliver any such documents as We may require to perform this transaction, as assigned.
17. Your spouse. You and Your spouse are fully aware of Your rights in the Assigned
Assets. You and Your spouse fully give up those rights. You and Your spouse understand that by selling
the Assigned Assets to Us, You and Your spouse are not receiving the same amount of money as You
would if You waited for all of the scheduled Payments of the Assigned Assets but, rather, are receiving a
discounted value in return for receipt of the Purchase Price immediately. You and Your spouse have valid
reasons for selling the Assigned Assets. You and Your spouse fully understand the terms of the Purchase
Agreement and understand that the sale of the Assigned Assets is final. You also understand that Your
spouse gives up any property right he or she may have in the Assigned Assets that Your spouse could claim
because of Your marriage.
18. Entire Agreement. This Agreement and the Exhibits and other documents You signed
make up the entire understanding and agreement between You and Us about this Agreement. This
Agreement replaces all prior agreements, whether written or oral, about this Agreement. This Agreement
may not be changed unless in a writing signed by You and Us.
19. Limitation of Liability of Buyer. You understand that Our liability to You under this
Agreement is strictly limited to the requirement to pay the Purchase Price and under no circumstances will
We be responsible for consequential damages.
20. Court Approval. You understand that court approval is required for this transfer.
You agree that you will obtain such court approval.
02009 321 Henderson Receivables Origination LLC
Account ID: 375731
21. Exhibits, Attached to this Purchase Agreement are the following Exhibits:
Exhibit "A" List of What Payments We are Buying.
Intending to be legally bound, You and We have signed this Agreement as of the date at the top of
the fast page of this Agreement.
321 HENDERSON RECEIVABLES ORIGINATION LLC
By:
45;41?? cgn
Vice President-Operations
ilm- - A -n
lcholas Monta a SIGN HERE
Spouse
Sworn to and ribed
before me this o, 2001
r.? , 4
Notary
IIa1mY.. P !
WAR it l
ilAr
9
02009 321 Henderson Receivables Origination LLC
Account ID: 375731
Exhibit A
We are hereby purchasing from You under the Annuity: /
A) 1 "yment of $15,000.00 on August 12, 201'1 B)1 payment of $20,000.00 on August 12, 2016
A--- A-1-9
N c olas Montague SIGN HERE
STATE OF
COUNTY OF
On this day of 201 v before me, the above signed personally appeared before me, personally known to
me to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed it.
Notary
NOMI K NAL
MM L WAND
'a1K OMININN ?,. "
?? Ap? f>?. t011
Account ID: 375731
SCHEDULE 1
DISCLOSURE STATEMENT
PLEASE BE ADVISED THAT THE PROPOSED TRANSACTION IS A
SALE, NOT A LOAN, AND THAT YOU WILL BE SELLING ALL RIGHTS
AND TITLE TO THE ASSIGNED ASSETS ONCE THIS TRANSACTION
IS CONSUMMATED. PLEASE BE ADVISED THAT YOU MAY BE
SUBJECT TO ADVERSE FEDERAL AND STATE INCOME TAX
CONSEQUENCES AS A RESULT OF THE PROPOSED TRANSACTION.
YOU SHOULD CONSULT YOUR OWN COUNSEL, ACCOUNTANT, OR
FINANCIAL ADVISOR REGARDING ANY FEDERAL OR STATE
INCOME TAX CONSEQUENCES ARISING FROM THE PROPOSED
TRANSFER.
YOUR PURCHASE PRICE WAS DERIVED ASSUMING A DISCOUNT
RATE SIGNIFICANTLY HIGHER THAN THE PRIME INTEREST RATES
CHARGED BY COMMERCIAL BANKS, THEREFORE, WE URGE YOU
TO EXPLORE ALL FINANCIAL OPTIONS. /
.0
0 on August
WE WIL P CHASE FROM YSKJ A) 1 payment of 000
12 2011 l ,payment of $20,000.00 on August 12, 2016
[THE REMAINDER OF THIS PAGE LEFT BLANK INTENTIONALLY]
Account ID: 375731
SCHEDULE 1, PAGE 2
THE AGGREGATE AMOUNT OF THE PURCHASED PAYMENTS IS
$359000.00.-/
THE DISCOUNTED PRESENT VALUy OF THE AGGREGATE
PAYMENTS AT 3.80% IS $289101.8V THE DISCOUNTED PRESENT
VALUE IS THE CALCULATION OF THE CURRENT VALUE OF THE
TRANSFERRED STRUCTURED SETTLEMENT PAYMENTS UNDER
FEDERAL STANDARDS FOR VALUING ANNUITIES. THE GROSS
AMOUNT PAYABLE TO SELLER IS $149500.00./
THE FOLLOWING EXPENSES ARE INCURRED BY THE SELLER
(YOU) AND WILL BE DEDUCTED FROM THE PURCHASE PRICE:
COMPLIANCE AND ADMINISTRATIVE FEE: $0.00
LEGAL FEES TO PROCURE COURT APPROVAL (THIS IS AN
ESTIMATE OF WHAT/ YOU WILL BE CHARGED TO OBTAIN COURT
APPROVAL): $500.00"
FILING AND RELATED EXPENSES FEE: $0.00
THE NET AMOUNT PAYABLE TO THE SELLER(YOU) IS $149000.00.
NO OTHER EXPENSES ARE INCURRED BY YOU.
THE DISCOUNTED PRESENT VALUE OF PAYMENTS SHALL BE
CALCULATED AS FOLLOWS: THE APPLICABLE FEDERAL RATE
USED IN CALCULATING THE DISCOUNTED PRESENT VALUE IS
3.80%.
THE EFFECTIVE ANNUL DISCOUNT RATE FOR THIS
TRANSACTION IS 17.36 o. THE CASH PAYMENT YOU RECEIVE IN
THIS TRANSACTION FROM US WAS DETERMINED BY APPLYING
THE SPECIFIED EFFECTIVE ANNUAL DISCOUNT RATE,
COMPOUNDED MONTHLY, TO THE TOTAL AMOUNT OF FUTURE
PAYMENTS TO BE RECEIVED BY US9 LESS THE TOTAL AMOUNT OF
COMMISSIONS, FEES, COSTS, EXPENSES AND CHARGES PAYABLE
BY YOU.
Account ID: 375731
SCHEDULE 1. PAGE 3
THE NET AMOUNT THAT YOU WILL RECEIVE FROM US IN
EXCHANGE FOR YOUR FUTURE STRUCTURED SETTLEMENT
PAYMENTS REPRESENTS 49.80% OF THE ESTIMATED CURRENT
VALUE OF THE PAYMENTS BASED UPON THE DISCOUNTED VALUE
USING THE APPLICABLE FEDERAL RATE.
THE QUOTIENT OBTAINED BY DIVIDING THE NET PAYMENT BY
THE DISCOUNTED PRESENT VALUE IS 49.80%.
BASED ON THE NET AMOUNT THAT YOU WILL RECEIVE FROM US
AND THE AMOUNTS AND TIMING OF THE STRUCTURED-
SETTLEMENT PAYMENTS THAT YOU ARE TURNING OVER TO US9
YOU WILL, IN EFFECT, BE PAYING INTEREST TO US AT A RATE OF
17.36% PER YEAR. THE NET AMOUNT PAID TO YOU (THE PAYEE)
BY US (THE TRANSFEREE) REPRESENTS AN ESTIMATE OF THE
FAIR MARKET VALUE OF THE FUTURE PERIODIC PAYMENTS
TRANSFERRED UNDER THE STRUCTURED SETTLEMENT
AGREEMENT.
NOTICE OF CANCELLATION RIGHTS:
YOU MAY CANCEL THIS TRANSACTION NO LATER THAN THE
THIRD BUSINESS DAY FOLLOWING THE DATE YOU EXECUTE THE
PURCHASE AGREEMENT, WITHOUT PENALTY OR FURTHER
OBLIGATION.
THIS CANCELLATION RIGHT CANNOT BE WAIVED IN ANY
MANNER.
YOU MAY CANCEL THIS TRANSACTION NO LATER THAN THE
THIRD BUSINESS DAY FOLLOWING THE DATE YOU EXECUTE THE
PURCHASE AGREEMENT, WITHOUT PENALTY OR FURTHER
OBLIGATION.
Account ID: 375731
SCHEDULE 1. PAGE 4
IN ORDER FOR THE CANCELLATION TO BE EFFECTIVE, YOU MUST
PROVIDE WRITTEN NOTICE OF CANCELLATION TO US:
321 HENDERSON RECEIVABLES ORIGINATION LLC
3993 HOWARD HUGHES PARKWAY
SUITE 250
LAS VEGAS, NV 89169-6754
ATTENTION: MANAGER - OPERATIONS
IMPORTANT NOTICE: YOU ARE STRONGLY URGED TO CONSULT
WITH AN ATTORNEY WHO CAN ADVISE YOU OF THE POTENTIAL
TAX CONSEQUENCES OF THIS TRANSACTION.
PLEASE BE ADVISED THERE ARE NO PENALTIES OR LIQUIDATED
DAMAGES PAYABLE BY YOU IN THE EVENT OF ANY BREACH OF
THE TRANSFER AGREEMENT BY YOU. THERE ARE NO BROKERS
COMMISSIONS, SERVICE CHARGES, APPLICATION FEES,
PROCESSING FEES, CLOSING COSTS, FILING FEES,
ADMINISTRATIVE FEES, LEGAL FEES, NOTARY FEES AND OTHER
COMMISSIONS, FEES, COSTS, EXPENSES AND CHARGES PAYABLE
BY YOU OR DEDUCTED FROM GROSS AMOUNT OTHERWISE
PAYABLE TO YOU OTHER THAN THE COMPLIANCE AND
ADMINISTRATIVE FEE AND THE FILING AND RELATED EXPENSES
FEE.
IF YOU BELIEVE YOU WERE TREATED UNFAIRLY OR WERE
MISLED AS TO THE NATURE OF THE OBLIGATIONS YOU ASSUMED
UPON ENTERING INTO THIS AGREEMENT, YOU SHOULD REPORT
THOSE CIRCUMSTANCES TO YOUR LOCAL DISTRICT ATTORNEY
OR THE OFFICE OF THE ATTORNEY GENERAL.
THE EFFECTIVE DATE OF THE TRANSFER AGREEMENT SHALL BE
DEEMED TO BE THE DATE THAT THE AGREEMENT WAS SIGNED
BY THE YOU (PAYEE).
PLEASE BE ADVISED THAT PAYMENT TO YOU PURSUANT TO THE
TRANSFER AGREEMENT IS CONTINGENT UPON COURT APPROVAL
OF THE TRANSFER AGREEMENT, WHICH YOU MUST OBTAIN.
Account ID: 375731
SCHEDULE 1. PAGE S
PLEASE BE ADVISED THAT PAYMENT TO YOU WILL BE DELAYED
UP TO 30 DAYS OR MORE IN ORDER FOR THE COURT TO REVIEW
AND APPROVE THE TRANSFER AGREEMENT.
BY SIGNING BELOW YOU ARE CONFIRMING RECEIPT OF THIS
DISCLOSURE AT LEAST 10 DAYS PRIOR TO RECEIPT OF THIS
CO RACT.
LA MO TAGUE SIGN HERE
ATTACHMENT/EXHIBIT 665"
321
HENDERSON RECEIVABLES ORIGINATION, LLC
July 9, 2008
Hartford Life Insurance Company
200 Hopmeadow Street
Simsbury, CT 06089
Attn: Legal Department/Structured Settlements
Hartford Cebsco
200 Hopmeadow Street
Simsbury, CT 06089
Attn: Legal Department/Structured Settlements
RE: Notice of Sale/Assignment of Payment Rights
Your Contract #: CCX0027047
Payee: Nicholas Montague
SS #: 370-98-1772
Dear Insurer:
Please be advised that 321 Henderson Receivables Origination LLC and/or its successors and
assigns, have entered into a transaction with the above-referenced annuitant who is seeking to
transfer certain of his/her rights to the payments scheduled to be received under the above-
referenced annuity policy. We are currently seeking court approval pursuant to the applicable
structured settlement transfer statute. Pursuant to the statute, please note the following
information about the Purchaser:
321 Henderson Receivables Origination LLC
40 Morris Ave
Bryn Mawr PA 19010
Tax ID # 20-4728885
PLEASE NOTE: No payments under this annuity should be held until the courts have entered a
final order and we have forwarded this order to you.
Very truly yours,
321 Henderson Receivables Origination LLC
By: 04Z -
Maureen Healy, Vice Pre ent
3993 Howard Hughes parkway • Suite 250 • Las Vegas, NV 89169-6754
PHONE: (800) 454-9368 • FAX: (215) 567-7525 • E-MAIL:
JGW@JGWFUNDING.COM
WEB SITE: WWW.JGWFUNDING.COM
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MARO & MARO, P.C.
By: Robert A. Maro, Esquire
Attorney I.D. No.: 89585
1115 West Main Street
Norristown, PA 19401
(610) 275-9600
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA //
RE: Joint Petition of 321 Henderson NO: 08 " ,41 q v
Receivables Origination, LLC and
Nicholas Montague .
NOTICE OF HEARING ON PETITION TO TRANSFER STRUCTURED
SETTLEMENT PAYMENT RIGHTS
To: Hartford Life Insurance Company
Attn. Legal Dept/structured Settlements
200 Hopmeadow Street
Simsbury, CT 06089
Hartford Cebsco
Attn. Legal Department-Structured Settlements
200 Hopmeadow Street
Simsbury, CT 06089
M44 zooe?
c, :C7 i. ,
Lawrence J. Rosen
Attorney for Nicholas Montague
1101 N Front Street
Harrisburg, PA 17102-3324
Nicholas Montague
173 E Penn St
Carlise, PA 17013
You are hereby given notice that 321 Henderson Receivables Origination L.L.C. has filed
a petition to transfer structured settlement payment rights. A hearing in this matter has been
scheduled on , 2008 at o'clock in courtroom no. courthouse,
Cumberland County Court of Common Pleas, Pennsylvania.
You are entitled to support, oppose or otherwise respond to the payee's petition, either in
person or by counsel, by filing written comments with the court prior to the hearing or by
attending the hearing. A
The Name, Address and Tax Identification number of th fere i
Receivables Origination L.L.C.. 40 Morris Avenue, Bryn Ma , P 19 In,
4728885
}}'' ii BY:
Date
Attorney for 321 Henderson
Receivables Origination, LLC.
1115 W. Main Street
Norristown, PA 19401
(610) 275-9600
(610) 275-9666(facsimile)
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
RE: Joint Petition of 321 Henderson NO: Q a-, y/
Receivables Origination, LLC and
Nicholas Montague
INITIAL ORDER OF COURT
On this / Ftrday of 2008, it is ordered that a hearing on this
M tion to Transfer Structured S ement Payment Rights will be held on
' o2W T , in Courtroom It" at //11.5 o'clock. The payee shall bring
inc me tax returns for the prior two (2) years to the hearing.
Within sever (7) days, the transferee shall give notice of the hearing date to the
payee, the structured settlement obligor, the annuity issuer, the payee's spouse and any
person receiving child support, alimony, or alimony pendente lite. The transferee shall
attach a certificate of service to the notice of hearing date. A copy of the notice with the
certificate of service shall be filed with the court prior to the hearing.
BY THE COURT:
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Maro & Maro, P.C.
By: Robert A. Maro, Esquire
Attorney I.D. No.: 89585
1115 W. Main Street
Norristown, PA 19401
(610) 275-9600 Attorney for 321 Henderson Receivables Origination, LLC
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
IN RE: Joint Petition of 321 Henderson Receivables NO: 2008-04194
Origination, LLC and Nicholas Montague
CERTIFICATE OF SERVICE
I, Robert A. Maro, Esquire, hereby certify that a true and correct copy of the
Initial Order of Court was served upon the Payee, The Structured Settlement Obligor,
The Annuity Issuer, the Payee's Spouse and any person receiving child support, alimony
or alimony pendente lite.
A copy of the Notice is attached hereto.
Date: July 23, 2008 By -
Ro rt A. Maro, Esquire
Attorney for 321 Henderson Receivables
Origination, LLC
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
RE: Joint Petition of 321 Henderson NO: c) b _ t I ct (.?
Receivables Origination, LLC and
Nicholas Montague
INITIAL ORDER OF COURT
On this day of , 1, Li 2008, it is ordered that a hearing on this
Petition to Transfer Structured Settlem t Payment Rights will be held on
in Courtroom _ at S o'clock. The payee shall bring
in a tax re s for the prior two (2) years to the hearing.
Within sever (7) days, the transferee shall give notice of the hearing date to the
payee, the structured settlement obligor, the annuity issuer, the payee's spouse and any
person receiving child support, alimony, or alimony pendente lite. The transferee shall
attach a certificate of service to the notice of hearing date. A copy of the notice with the
certificate of service shall be filed with the court prior to the hearing.
BY THE COURT:
TREE COPY FROM PECORU
In Testmirny whereof, I here w ft set mY hank
and t4e .a<c? o! : h;d'cup Carlisle, Pa.
This S`f- A
- 19
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
RE: Joint Petition of 321 Henderson NO: oe- q111
Receivables Origination, LLC and
Nicholas Montague
FINAL ORDER OF COURT
On this 2 to Day of ?4y r , 2008, it is ordered that the Petition to
Transfer of Structured Settlement Payment Rights is granted.
The court specifically finds that:
(1) the payee has established that the transfer is in the best interests of the payee
or the payee's dependents;
(2) based on the certification by an attorney for the transferee, and the court
having not been made aware of any statute, regulation or order that would be
incompatible with the proposed transfer, the transfer will not contravene any
applicable federal or state statue or regulation, or the order of any court or
administrative authority;
(3) the transfer complies with the remaining requirements of the Structured
Settlement Protection Act, including Sections 3(a)(2), 3(a)(4), 3(a)(5) and
3(a)(6);
(4) the payments that are to be transferred are designated as
follows:
A) 1 payment of $15,000.00 on August 12, 2011 B) 1
payment of $20,000.00 on August 12, 2016
(5) the terms of this order shall survive the death of the payee and shall be
binding on the payee's heirs, beneficiaries and assigns;
(6) the payee shall receive from the transferee, as of 1' Z z.nQ, the amount of
$14,000.00, from which no funds are owed for counsel fees, administrative
fees, or other costs, fees or expenses.
BY THE COURT:
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