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HomeMy WebLinkAbout10-1721N a IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION IN RE: PETITION OF STONE STREET CAPITAL, LLC TO TRANSFER No. /D I / 7°? r CJ STRUCTURED SETTLEMENT 1 PAYMENT RIGHTS . (PAYEE, DANIEL G. CHARNEY) Q 7 Ti PETITION TO TRANSFER rn -r, Fn STRUCTURED SETTLEMENT PAYMENT RIGHTS _ o Petitioner, Stone Street Capital, LLC, hereby su4v tsC-:?_h E h `ollowing Petition to Transfer Structured Settlement Pa ?FfNen t< Rights pursuant to the Structured Settlement Protection Act, 40 P. S. §§ 4001-4009 ("the Act"), and Pa.R.C.P. 229.2, and in support states: 1. Pursuant to Rule 229.2, Petitioner herein is Stone Street Capital, LLC ("Stone Street"), a company in the business of purchasing future periodic payments and therefore a "transferee" as defined by 40 P.S. § 4002. Stone Street is a Delaware limited liability company having a place of business at 731.6 Wisconsin Avenue, Fifth Floor, Bethesda, Maryland 20814. 2. The "Payee" is Daniel G. Charney, an adult individual whose date of birth is August 12, 1983, and who resides at 121 Fairview Drive, Carlisle, Pennsylvania 1701.3. 3. This Court has jurisdiction to determine the merits of the petition pursuant to the Act, because the Payee is domiciled i.n Cumberland County, Pennsylvania. 40 P.S. § 4004. 1_9z•00 Pd,.#y ck&.3Y3G Re a-3 fr 7v 3 ? r 4. As the result of a wrongful death claim, Payee is entitled to receive lump sum payments in the amount of $60,000.00 due on August 12, 2008; $95,000.00 due on August 12, 2013; and $150,000.00 due on August 12, 2018 (Payee's Annuity "Schedule of Payments" is attached hereto as Exhibit "A"). 5. By operation of a Uniform Qualified Assignment, the obligation to make these payments is held by Erie Indemnity Company, the Structured "Settlement Obligor" as defined by 40 P.S. § 4002. Erie Indemnity Company is located at 100 Erie Insurance Place, Erie, Pennsylvania 16530. 6. The obligation was funded through the issuance of an annuity by Allstate Life Insurance Company (the "Annuity Issuer"). Allstate Life Insurance Company is located at 544 W. Lakeview Parkway, L1B, Vernon Hills, Illinois 60061. 7. On March 3, 2010, Payee executed a "Purchase, Transfer and Assignment Agreement," (the "Transfer Agreement"), a true and correct copy of which is attached hereto as Exhibit "B". The Transfer Agreement provides for the assignment of Payee's right and interest in receiving one lump sum payment of $50,000.00 due and payable on August 12, 2018, to Stone Street.' 8. The rl_ghts to receive the payments described above at paragraph 4, and reflected in Exhibit "A", are exclusive to the Pursuant to Rule 229.2(d), Stone Street Capital, LLC is the Petitioner and has attached a Verification in support thereof. Pursuant to Rule 229.2 (c), the Payee is also a party to this petition, as reflected in the caption, but is not represented by counsel for Petitioner. Page 2 of 6 7 Payee, who owns them. He has never pledged, sold, assigned, transferred, or otherwise encumbered the rights to receive these payments. 9. The Transfer Agreement was executed by the Transferee on or about March 3, 2010. 10. Payee shall retain all. right and interest in remaining annuity payments not assigned. 11. Payee has completed the "Payee's Affidavit in Support of Petition" required by Rule 229.2, a copy of which is attached hereto as Exhibit "C". As set forth in further detail in the Affidavit, the purpose of this transaction is to pay off debt and repair a vehicle. 12. Payee is twenty-six years old, and is married with one child. 13. Payee has been provided, and has acknowledged receipt at least 10 days prior to receipt of the 't'ransfer Agreement, the "Disclosure Statement" required by 40 P.S. § 4003 (a)(2), attached and incorporated herein by reference as Exhibit "D". As set forth in greater detail. in the Disclosure Statement, the following terms have been. disclosed to the Payee: a. The amounts and due dates of the structured settlement payments to be transferred are: one lump sum payment of $50,000.00 due and payable on August 12, 2018. Page 3 of 6 b. The aggregate amount of the structured settlement payments to be transferred is $50,000.00. 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 $38,381.89. d. The federal discount rate used to determine the discounted present value is 3.20 percent as of the most recently published IRS rate. e. The gross amount payable to Payee in exchange for the transferred payments is $11,932.70. f. The net amount payable to Payee after deduction of processing and legal fees is $11,932.70 (legal and processing fees waived). g. The quotient is 31.09%. h. The amount of penalty and 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 Petitioner is: NONE. 14. Based on the net amount that the Payee will receive from this transaction ($11,932.70), and the amounts and timing of the structured settlement payments that would be assigned, the Payee is, in effect, paying interest at the rate of 18.90% per year. (Exhibit "D", para. 8). 15. Payee has been provided, and has acknowledged receipt, at least 10 days prior to receipt of the Transfer Agreement, the written "Important Notice" in bold print 12-point type as Page 4 of 6 required by 40 P.S. § 4003 (b). A true and correct copy of the § 4003 (b) Notice is attached as Exhibit "E". 16. Payee acknowledges that he has been advised to obtain independent professional advice regarding the consequences, .implications, and tax effects of the transaction, and has waived such advice as set forth in the "Statement on Independent Professional Advice" attached to this Petition as Exhibit "F". 1'7. The transfer complies with the requirements of the Act, and will not contravene other applicable Federal or State statutes or regulations or any applicable law limiting the transfer of workers' compensation claims. (Certification of Ronald E. Reitz, attached as Exhibit "G"). 18. Transferee and Payee respectfully request that the Court sign an order approving this transfer which constitutes a "qualified order" for purposes of 26 U.S.C.A § 5891. 19. Payee has seriously contemplated this transaction, and due to his personal circumstances and needs, believes that this transfer is in his best interests. 20. Pursuant to Cumberland County Local Rule 208.3(a) (2), Payee has had another matter decided by this Honorable Court, in which a previous structured settlement transfer was approved. This matter was filed at No. 04-4026 (Civil Term), and the judge was Honorable Kevin Hess. Page 5 of. 6 21. Payee acknowledges that Swartz Campbell LLC 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 Payee's independent determination and professional advice obtained from others, with respect to the advisability and ramifications of the transfer. WHEREFORE, Store Street Capital, LLC, and Daniel G. Charney, pray that this Honorable Court grant this Petition to Transfer Structured Settlement Payment Rights. Respect submitted, Swart 1 LLC By: _ Ronal Reitz Attorney for Transferee Page 6 of 6 VERIFICATION I, Patricia LaBorde, Division Counsel for the Structured Settlement Division of Stone Street Capital, LLC, have read the foregoing Petition for Daniel Charney to Transfer Structured Settlement Payment Rights, and hereby aver that the statements therein are correct to the best of my personal knowledge, information and belief. This statement is made subject to the penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities. Date: -7/7 /1.. Pat icia LaBorde CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing PETITION TO TRANSFER STRUCTURED SETTLEMENT PAYMENT R"GH'iS was served by certified mail., return-receipt requested, postage pre-paid, on this jtday of March, 2010 on: Erie Indemnity Company 100 Erie Insurance Place Erie, PA 16530 ("Settlement Obligor") Allstate Life Insurance Company ATT'N: LISA STERNER 544 W. Lakeview Pkwy, L1B Vernon Hills, IL 60061 ("Annuity Issuer") and by regular U.S. mail, postage prepaid to: Monica Saunders, Paralegal Stone Street Capital, LLC Structured Settlement Division 7316 Wisconsin Avenue, Suite 500 Bethesda, MD 20814 ("Transferee") Daniel G. Charney 121 Fairview Dr. Carlisle, PA 17013 ("Payee") Swa. pbell LLC By: ? Rbnald EAB,efitz Attorney for Transferee Y ? C a _ s v t? S7; O ? o a da x Allstate We Insurance Company = - AStock Company - Home Office: Northbrook, Illinois OW2 POLICY CERTTD'rrAgv AUg. =2, 2008 Aug. 12, 2023 Aug. 12, -018 SCIUMM OF PAYM MS • AMG?7N'x $60,vG..OQ 00 i ny? i e y 3• 2, 1.983 FIRST PAS: $ 60,000.00 IASr PAM W; $150Pt}00.00 al Aug. .l, ODEA' MM KIM; 90-•800--252 1 : L=, inde..::ity. C. . LWM DATE: Jm- 11, 1987 Stoliestrnt Capital PURCHASE, TRANSFER AND ASSIGNMENT AGREEMENT This Purchase, Transfer and Assignment Agreement, which along with the Terms and Conditions attached hereto is referred to herein as the "Agreement", is a contract between Stone Street Capital, LLC its successors and/or assigns (..Stone Street" or "we," "us", or "our"), a Delaware Limited Liability Company, and Daniel Cbarney (referred to as "you" or "your"). The purpose of this Agreement is to set forth the terms of a legally binding contract where you agree to sell us your structured settlement payments. SUMMARY OF KEY TERMS; You agree to sell, and Stone Street agrees to purchase the following payments: One lump sum payment of $50,000.00 due and payable tin August 12, 2018 ("the Assigned Payments") You have agreed to accept the following purchase price in exchange for the Assigned Payments: $11,932.70 (the "Purchase Price") Qisctasure_Statement. To comply with state and federal law, we gave you a Disclosure Statement that explained the financial terttts of this Agreement. Among other things, the Disclosure Statement describes the fees that you will be responsible for at the time of funding. The terms set forth of the Disclosure Statement, including any later amendments to the document, are considered a part of this Agreement. You agree that you had the opportunity to read and review the Disclosure Statement, and that you agree to itb terms. Date of the Agreement. The date of this Agreement is March 13, 2010, and you have no obligation under this Agreement before that date. By signing below, the parties agree to be bound to the terms of the agreement, including the provisions set forth in the "terms and Conditions attached hereto and incorporated herein by reference. 5EL o S ler Signature ' This to Q1 instrument was acknowledged before uie this day of M_g&._, 201_t2 by Daniel Charaey who is either (i) personally known to me or tit) who has produced identification. STONE STREET CAPITAL, LLC: sy: ? ? Duvid M. Lewis, Senior Vice President `? U ca01Nw ATH of PEWIMVM _ad - N lgnature ?.a Arb WTARIAt SEAL Notary Public in and for the State of aµ OtJR90N, Now, Put* My Commission Expires: _I 1 pig Is, 2011 00164718 wad r' . i. TERMS AND CONDITIONS The purpose of this Terms Summary is to set forth additional terms of a legally binding contract where you agree to sell structured settlement payments to Stone Street Background A. You (or someone acting on your behalf} settled a lawsuit or a claim sometime before the date of this Agreement, and as a result of that settlement, you became entitled to receive payments payable over time. The terms of that agreement are documented in a Settlement Agreement or a similar document (the "Seulernent Agreement"). The defendants or their insurers in your lawsuit or claim assigned their obligation to make those payments to a third party, the Settlement Obligor (the "Obligor"). The Settlement Obligor purchased an annuity (the "Annuity") from an insurance company (the "Issuer") to make sure that you would receive the payments according to the terms of the Settlement Agreement. You are entitled to receive payments froth the Annuity. R You have decided that receiving your payments according to the timetable set forth in the Settlement Agreement does not satisfy your financial needs. After thinking about other ways of addressing your Financial situation, you have decided to sell some of your payments to Stone Street in exchange for a cash payment. I . The Sale and Purchase. You agree to sell the settlement payments identified as the "Assigned Payments" on the Summary of Key Terms to which this "Terms Summary was attached. Stone Street agrees to pay you, and you agree to accept, cash in the amount identified as the "Purchase Price" stated on the Summary of Key Terms to which this Terms Summary was attached 2. How the Purchase Price Will be Paid to You. We will pay you by any means you choose, including an electronic wire transfer directly to your bank account or by check. If you elect an electronic wire transfer, we will only make payment to a bank account in your name. 3 What Must Han er?Before Fundins, Before the Assigned Payments are transferred to Stone Street, a court must approve this Agreement. After court approval, there are additional conditions that must be met before we can pay you your Purchase Price. First, the Issuer must acknowledge, in writing, the receipt of a court order that; (a) directs the Obligor and Issuer to make the Assigned Payments to Stone Street to the address and entity that we name; (b) makes all findings required by applicable law; and (c) cannot be appealed. Second, we must confirm that all of your obligations under the Agreement have been satisfied including providing us with all necessary documentation. Gast, we must review the transaction, the supporting documents, lien, judgment, bankruptcy and other searches to verify that there is no right or condition that exists that would require us to terminate this Agreement. When these steps are satisfied, your transaction will close and fund. 4. The Payments We Do Not Buy. If you decided to sell us only a portion of your payments, this Agreement does not affect the payments that you did not sell. You will continue to receive the unsold portion of the payments unless those payments were previously sold, encumbered or subject to court ordered garnishment or execution. In some cases, the court, the Obligor or the Issuer may require that the entire structured settlement payment be paid to us, and, upon receipt, we shall remit the unassigned portion of the structured settlement payment back to you. If such a circumstance arises in your transaction, you agree to this payment servicing arrangement. 5. Otter Documents. Stone Street will expeditiously and diligently work to get a corm order approving this Agreement. To assist us in this process, you agree to execute additional documents that may be required by the court, the Obligor or the Issuer. You agree to provide us with complete copies of your Settlement Agreement and Annuity, and other documents necessary to complete the transaction. 6. You Own nd Can Sell Xour Payments. We must establish that you own the payments that you are selling to us, and that no one else could claim an interest in the Assigned Payments. Unless you tell us in writing otherwise, you represent and promise to us that: (a) YOU have the right to receive and sell the Assigned Payments; (b) This Agreement does not conflict with any of your other obligations; (c) The Assigned Payments are not subject to any community property or spousal rights of any person; (d) There is no dispute, lawsuit, or challenge relating to your right to receive the payments under the Settlement Agreement; (e) Neither you nor anyone else has sold, pledged or othcrwise transferred the Assigned Payments nor attempted to do so; (f) No other person or business claims a security interest, lien, right, title, or interest of any kind in the Assigned Payments; (g) All applicable child support, alimony, and tax obligations are up to date; (h) There are no unsatisfied judgments against you; (i) You are not in bankruptcy; and (j) if one or more of these statements becomes untrue before the Purchase Price is paid to you, you agree to notify us in writing. In all events, you authorize us to conduct credit checks, judgment and lien searches, and criminal background searches to confirm that there are no claims against the Assigned Payments. 7. Your Promises to Us. Stone Street is relying upon the statements you have made to us and the documents you have provided trgarding you, your situation, the payments you are receiving, and the payments you are now selling, including the following: (a) You completed and signed an application along with this Agreement, and the information contained in the application is complete and correct; (b) You believe that selling the Assigned Payments is in the best interest of you and your dependents; (c) You are 18 years of age or older, arc of sound mind, not under the influence of drugs or alcohol; (d) You underslarxi and agree that you are not considered a "consumer" in this transaction, and that you waive the protection of various consumer protections laws; (e) You understand that we are not assuming any of your obligations under the Settlement Agreement, Annuity, Uniform Qualified Assignment or other related documents; (f) You understand and agree to the terms of this Agreement; (g) No one has forced you to sign this Agreement nor has anyone promised you anything other than what is stated in this Agreement in an effort to persuade you to sign it. 8. independent Advisor. Before you sign this Agreement, you may wish to consult with an independent advisor to seek legal, financial or other expert advice regarding the legal, financial, and tax coosequesim of this Agreement. By signing this Agreement, you acknowledge that Stone Street has advised you of this right in writing. 9. Douctions from the Purchase Price. We will deduct from your Purchase Price any fees that are set forth on your Disclosure Statement. In addition, you may have elected to sell payments to pay off debts, liens, and past due obligations. If you owe back taxes, past due child support, or have judgments or liens recorded against you or your assets, we may require that some of those debts, claims, or liabilities be paid at the time the transaction is funded. If it is reasonably necessary to pay certain debts before funds are released to you so that the Assigned Payments are not subject to such debts, Stone Street will pay those debts for your account and deduct the payment from your Purchase Price. Also, you may have received a partial advance of the Purchase Price. Any advances that you may have received prior to Closing will also be deducted from the Purchase Price. 10. Payments Received Before Funding. You acknowledge that it may take some time for the 11 M)647tr-A LL:?.®- .- - - - - Obligor and Issuer to ruccive and process the wort order. Accordingly, you could reccivc payments that were supposed to be shad to Stone Street. If you receive some payments before we pay you the Purchase Price, the amount of payments received by you will be deducted from the Purchase Price. 11. Amount Hetdback from Purchase Price. As set forth above, it may take the Obligor and Issuer some time to process the court order. We may withhold an amount from the Purchase Price equal to the amount of the paymwtts to be paid within two to six months of the closing (depending upon the insurer and its practices). When the Assigned Payments begin to be received by Stone Street, the amount withheld will be released to you, less the amount of any payments paid over to you in error while the insurance company was processing the address change. 12. Receivin Payments In Error. The Obligor and Issuer may send an Assigned Payment to you in error. In the event that you receive a payment that you have sold to Stone Street, you agree to hold those payments in trust and immediately turn them over to Stone Street. IT Limited Potter of Attorney. Some insurance companies will continue to make the Assigned Payments payable in your name after the transaction is closed. You hereby grant Stone Street, or its successors, assigns or agents, an irrevocable limited "power of attorney" granting us the right to cash these checks and to deposit the money into our collection account- 14. Grant of Security Interest. You intend to sell and Stone Street intends to purchase your rights, title and interest in and to the Assigned Payments. This Agreement is not a loan. Subject to the court's approval of the sale, you grunt to Stone Street a security interest under Article 9 of the Uniform Commercial Code in your rights and interest in the Assigned Payments. These tights have been assigned to Stone Street as a payment intangible or general intangible under Article 4 of the Uniform Commercial Code. This Agreement shall function as a security agreement, and the security interest secures payment of the rights assigned and performance of your obligations under this Agreement. In the event that the transaction is fur any purpose churacteriiud as a loan, a financing or extension of credit or anything other than a true sale by any court, you grant us a security interest and all rights of a secured party lender under the Uniform Commercial Code. We may file a UCC-l financing statement or continuation statement evincing and perfecting our rights in the jurisdictions that we deem appropriate, 15. Testamentary Agreement. if you should die prior to the due date of the last Assigned Payment, Stone Street will continue to receive the Assigned Payments on the dates set forth in the Summary of Key Terms. You are giving up your rights to the Assigned Payments, and the rights of your heirs, successors, beneficiaries, and/or any other person claiming by, through or under you. Accordingly, this Agreement is a 'testamentary Agreement in which you irrevocably agree to name Stone Street or its assigns as the party that will inherit the Assigned Payments upon your death. You understand that you no longer have the power to amend, modify, alter or otherwise change this beneficiary designation. Also, you agree to sign a form designating Stone Street as the sole beneficiary under the Annuity during the term of the Assigned Payments. 16. Restrictions on Assignment, Your Settlement Agreement may contain language prohibiting your right or power to accelerate, defer, increase, decrease or assign your payments. You hereby waive and release any such restriction if your Settlement Agreement or the Annuity contains this or similar language, As such, you understand and agree that you will never claim or assert that the payments you arc now selling were not transferable, or that this language renders this Agreement void. 17, Arbitration. Any claim or disputu ("Claim") by either you or us against the other, or against, the employees, agents, successors or assigns of the other, arising from or relating in any way to this Agreement or any prior agreement (whether under a statute, in contract, tort, or otherwise and whether for money damages, penalties or declaratory or eyuitabie relief) including Claims regarding the applicability of this arbitration clause or the validity of the entire Agreement or any prior agreement, shall be resolved by binding arbitration. The arbitration shall be conducted by National Arbitration Forum ("NAF") under the Code of Procedure in effect at the time the Claim is filed. NAF Rules and founs may be obtained and Claims may be filed at any NAF office, www.arb-fvrtitrt.com, or at PO Box L 50191, Minneapolis, Minnesota 55405, telephone (800) 474-2371. We or you may, upon approval of the other, substitute another nationally recognized, independent arbitration organization that uses a similar code or procedure. This arbitration agreement is made pursuant to a transaction involving interstate commerce, and shall be governed by the Federal Arbitration Act, 9 U.S.C. §§ 1-16 ("FAA"). Any arbitration award shall be final, and judgment upon the award may be entered in an court having jurisdiction. No Claim submitted to arbitration is heard by a jury, and no Claim may be brought as a class action or as a piivate attorney general. You do not have the right to act as a class representative or participate as a member of a class of claimants with respect to any Claim. 1 KNOWINGLY, INTENTIONALLY AND VOLUNTARILY WAIVE MY RIGHT TO A JURY TRIAL UNDER THIS AGREEMENT. 18. Construction of this A reement. All of the headings contained in this Agreement are for convenience only. They are not part of this Agreement, and that shall not affect its meaning, construction or interpretation. This Agreement, the Disclosure Statement, and the attached exhibits make up the entire agreement between you and Stone Street and replace all prior arrangements and understandings, written or spoken. If we amend this Agreement, the tenns of the amendment shall control over terms that set forth herein. 19. Severability. Should any provisions of this Agreement is held to be invalid, illegal, unenforceable or in conflict with the law or any jurisdiction, that provisions shall be deemed to bu modified to the extent necessary to render it lawful and enforceable. If such a modification is not possible, that provisions shall be severed from the Agreement and shall not in any way affect or impair the validity, legality and enforceability of the remaining provisions in this Agreanent. 20. Future Assizarnent By Stone Street. Stone Street (and any future assignee) may assign all of its right, title, and interest in and to this Agreement, the other related documents, the Annuity, and the Assigned Payments either before or after the closing and without any requirement of prior consent from or notice to you. 21. Annlieable Law. Except as otherwise required by applicable statutory law, this Agreement shall be governed by and interpreted in accordance with the law of the jurisdiction where we sought court approval of this Agreement. i 1 14 1N THE COURT OF COMMON PLEAS OF Cumberland COUNTY, PENNSYLVANIA PETITION OF STONE STREET CAPITAL, ) LLC T01RANSFER STRUCTURED ) No. SETTLEMENT PAYMENT RIGHTS ) PAYEE'S AFFIDAVIT IN SUPPORT OF PETITION TO TRANSFER yEI RU D SETTi.EMENT PAYMENT RIGHTS I, Daniel Garc;a Charney, the Payee, verify that the statements below are true and correct. 1. Payco's same, address and age: Daniel Garcia, 121 Fairview Dr. Carlisle, PA 17013, 26yrs old. 2. Marital Status- - Never Married; X Married; Separated; Divorced If married or separated, name of spouse: Jennifer Myer. 3. Minor children and other depeadenb: Names., ages, and places of residence: Daniel David Chamey, 3 yrs old, 121 Fairview Dr. Carlisle, PA 17013 4. Income: (a) Paycc's monthly income and sources: Actively scvking employment and I live with my mother. (b) If presently married, spouse's monthly income and sources: i , No .5. Child support, alimony or alimony pendente life: Cum Obligation to pay: _---_Yes __/No. 6-670 If yes, state the amount of the obligation, to whom payable, and whether there are wmarages: ***To the best of [nr knowledge, I du not currently have any child support 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? X Yes 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 court approved or disapproved the transfer: Cumberland County in 2004 approved. (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: $60,000 due 10112/2008 and $95,000 due 10/12/13. (c) Have you over transferred payments without court approval? If so, please explain: I l1 7. Reasons for transfer: Describe in detail your reasons for the proposed transfer, including an explanation as to why a sale of a lesser amount of the structured settlement amount will not better serve your interests: I want to be able to pay off some back debt and fix my car. 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 Exmark Credit Card $-6,000- -Visa Credit Card $ 2,200 I , Ik* Verification t 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 unsworn falsifications to a4iganatuirc DATE: 1201V I f `w DISCLOSURE STATEMENT This Disclosure Statement is being provided by Stone Street Capital, LLC ("Stone Street") to you, Daniel Charney, on March 3, 2010 in connection with your agreement to transfer and assign to Stone Street Capital, LLC, or its assigns, certain structured settlement payment rights. 1. Amounts and Due Dates of Payments to be Transferred. You will assign to Stone Street all of your right, title and interest in and to one lump sum payment of $50,000.00 due and payable on August 12, 2018 out of those certain payments due under a certain Settlement Agreement. 2. Aggregate Amount of Payments Transferred. The aggregate amount of the payments to be transferred to Stone Street totals $50,000.00. 1 Calculation of Current Value of the Transferred Structured Settlement Payments Under Federal Standards for Valuing Annuities. The Internal Revenue Service discounted present value of the payments to be transferred is $38,381.89 determined by discounting the future payments to be transferred using a rate most recently published for determining the present value of an annuity by the Internal Revenue Service, which rate is 3.20%. This is a calculation of the current value of the transferred structured settlement payments under federal standards for valuing annuities. THIS IS NOT THE RATE USED TO CALCULATE YOUR PURCHASE PRICE. It is also not the market rate for transfers of annuity payments of structured settlement payments. 4. Gross Amount Payable. The gross amount payable to you in exchange for the transferred payments is $11,932.70. 5. Good Faith Estimate of Fees and Expenses. You will be responsible for paying the following commissions, fees, expenses, charges, and costs in connection with the closing of this transaction: Processing fees of $0.00. 6. Net Amount Payable. The net amount payable to you in exchange for the transferred payments is $11,932.70. 7. Quotient. The quotient (expressed as a percentage) obtained by dividing the net payment amount by the discounted present value of the payments is 31.09% (#6 divided by #3). 00164718 PA 8. Effective Annual Interest Rate. Based on the net amount that you will receive from us and the amounts and timing of the structured settlement payments that you are turning over to us, you will, in effect, be paying interest to us at a rate of 18.90% per year. 9. Breach of Contract. The 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 shall be: None. 10.Cancellation. You have the right to cancel the transfer agreement, without penalty or further obligation, not later than the third day after you sign the agreement. 11.Effectiye Date. Stone Street's commitment or obligation to enter into this transaction is conditional and contingent upon the execution and your return of this Disclosure Statement and execution of a Purchase, Transfer and Assignment Agreement and related documents by all parties. The effective date of the Purchase, Transfer and Assignment Agreement shall be the date on which the transaction is closed and funded to you, which date shall not, under any circumstances, be less than ten (10) days after the date of this Disclosure. By signing this Disclosure Statement where provided below, you acknowledge and agree that you have read and fully understand the foregoing Disclosure Statement, that you have been advised by Stone Street to discuss the Disclosure Statement and the details of the proposed transaction with your financial advisors and attorneys and have been provided an opportunity to do so. RECEIVED, AGREED AND ACKNOWLEDGED: Daniel Charney Date 0016411 A VA I ) IMPORTANT NOTICE: You are strongly urged to consult with an attorney who can advise you of the potential tax consequences of this transaction. 001647 i8 Yn l )0 '- STATEMENT ON INDEPENDENT PROFESSIONAL ADVICE Stone Street Capital, UC is required by law to advise you of your right to consult with an independent professional advisor regarding the legal, tax and financial implications of the transfer of your structured settlement payment rights. gin-lesdgc?#-1ent I, Daniel Chamey understand than 1 may consult with an independent professional advisor and acknowledge that Stone Street has informed me of that right. Choose one: ? I have received independent professional advice from _ (an Attorney, Licensed Financial Planner or CPA) whose office is located at phone number ( ) regarding the legal, trot and financial implications of the transfer of my structured settlement payment rights. -OR- 1 have knowingly and voluntarily chosen not to consult with an independent professional advisor and hereby expressly waive the right to du so. I ant aware of the legal, tax and financial implications of the proposed transfer and t desire to have the court approve the transfer of structured settlement payment rights as described in the Purchase, Transfer and Assignment Agreement. aniel Charney 00164)16 b' ,', -1 fo IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION IN RE: PETITION OF STONE STREET CAPITAL, LLC TO TRANSFER No. STRUCTURED SETTLEMENT PAYMENT RIGHTS (PAYEE, DANIEL G. CHARNEY) CERTIFICATION OF COUNSEL Ronald E. Reitz:, attorney for Stone Street Capital, LLC, hereby sets forth the following: 1. I, Ronald E. Reitz, am counsel of record in this matter for Stone Street Capita., LLC. 2. Based on materials provided to me by Stone Street Capital, LLC, and upon reasonable investigation and inquiry, the transfer set forth in the within Petition complies with all requirements of the Structured Settlement Protection Act, 40 P.S. § 4001-4009, and does not contravene any applicable Federal or State statute or regulation, or order of any court or administrative authority. 3. This Certification is made to the best of my knowledge, information and belief pursuant to New Pa.R.C.P. ?29.2. MAR 12 2010 U }N PHE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION TN RE: PETITION OF' STONE STREET CAPITAL, LLC TO TRANSFER STRUCTURED SETTLEMENT PA`r'MEN'E RIGHTS (PAYEE, DANIEL G. CHARNEY) No. I l 7 ?-c iv INITIAL ORDER OF COURT On tills JS? day of 2010, it is ordered tY:at a hearing on this Petition to Transfer Structured S(-,-t : emaent: Payment Rights will be held on Iq q,010 r C<;urtr_oom 5 at 30 A.M. a' clock. The payee sh;;'_' t,r _r-g _ncome tax returns for the prior two (2) years t.c, r near irig r _ i._!n ! n seven (?) days, the fans Pere- shal__ g! Ve 0( ;.CE' O d?at_e !.o .he payee, tre s,-uctured set:t emert C> ; : aJj , :r'.e anr,u. ty l ssuer , t rle payee's spouse -and ai pE rso, r-e-:p1v].rc? :rl?1d sLtF.pGrt., alilClUn'y, or a:iP.-cony xJ2I1de,te - 1te r SF:erEJe SYia!.i_ attacr; a certificate C° service t," thE' 110t1ci' of near-inci date. A copy of Lne notice the certif cate of a sE> cE: sha . _ be f..i__i.ed with the coact prior to r.he hear' -ig. c7 ` BY TH' COURT C- -- 0 i QQJJ / I f -t ? ???? ) '?• /vl ?l l PY N ?l?L1Jv