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HomeMy WebLinkAbout04-4026IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION PETITION OF DANIEL G. CHARNEY F/K/A DANIEL GARCIA TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS PETITION TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS Petitioner, Daniel G. Charney f/k/a Daniel Gareia, brings forth the following Petition to Transfer Structured Settlement Payment Rights pursuant to, and in compliance with, the Structured Settlement Protection Act, 40 P.S. §§ 4001-4009, and in support states as follows: The Petitioner is Daniel G. Charney f/kYa Daniel Garcia ("Chamey"), an adult individual whose date of birth is August 12, 1983, and who resides at 21 Beach Cliff Drive, Carlisle, Cumberland County, Pennsylvania, 17013. 2. This Court has venue pursuant to the Structured Settlement Protection Act, because the Petitioner is domiciled in Cttmberland County, Pennsylvania. 3. Sometime prior to 1987, the Petitioner suffered personal injuries as a result of an accident. Thereafter, the Petitioner, entered into a Settlement Agreement and Release with the tortfeasor's insurance company. The Agreement provided that the Petitioner would receive the following guaranteed lump sum payments: $60,000.00 on or about August 12, 2008; $95,000.00 due on or about August 12~ 2013; and $150,000.00 due on or about August 12, 2018, A true and correct copy of the Petitioner's Settlement Agreement Affidavit confirming that the Petitioner has requested but has not received a copy of the Settlement Agreement and Release from the Settlement Obligor is attached as Exhibit "A." 4. Erie Indemnity Company is the Structured "Settlement Obligor" as defined by 40 P.S. § 4002. Erie Indemnity Company is located at 100 Erie Insurance Place, Erie, PA 16530. 5. Erie Indemnity Company funded the obligation by purchasing an annuity (Annuity Contract Number 90-800-252) from Allstate Life Insurance Company, the "Annuity Issuer." Id. Allstate Life Insurance Company is located at Allstate Plaza West - M3B, 3100 Sanders Road, Northbrook, IL 60062. A tree and correct copy of the Annuity Policy Certificate confirming the annuity's ownership and the benefit schedule are attached collectively as Exhibit 6. On June 25, 2004, Petitioner executed an Absolute Assignment mid UCC Article 9 Security Agreement (the "Transfer Agreement"), a true and correct copy is attached and incorporated herein as Exhibit "C?' The Transfer Agreement provides for the assignment of Petitioner's right and interest in receiving lump sum payments as follows: $60,000.00 due on or about August 12, 2008; and $95,000.00 due on or about August 12, 2013 (the "Assigned Payments"), to Settlement Funding, LLC (the "Transferee"). Settlement Funding, LLC d/b/a Peachtree Settlement Funding ("Settlement Funding") is a Georgia Limited Liability Company with its principal place of business at 6501 Park of Commerce Blvd., Suite 140B, Boca Raton, Florida, 33487. 7. The Transfer Agreement was executed by the Transferee on June 28, 2004. 8. The Petitioner shall retain all right and interest in receiving the remaining balance not assigned of: the entire lump sum payment in the amount of $150,000.00 due on or about August 12, 2018 (the "non-assigned payment"). 9. Additionally, as set forth in further detail in his Affidavit dated June 25, 2004, attached and incorporated herein as Exhibit "D," Petitioner avers that: a. He desires to sell the Assigned Payments to Settlement Funding, LLC. b. He is single and has no dependents. c. He is currently residing with his parents, rent free, until he has established himself and is able to earn a living on his own. d. The transaction contemplated by the Transfer Agreen~ent is in his best interest, it will improve his standard of living, and he has thoroughly considered all of the ramifications of the transaction. e. He intends to use the proceeds from the transfer for start-up costs to start his own clothing store business, to be opened in downtown Harrisburg. He will use the funds for rental of storefront space, purchase of inventory, and other initial costs. f. He has been advised to obtain, and has in fact obtained independent professional advice from an attorney or other professional. 10. Petitioner has been provided, and has acknowledged receipt at least 10 days prior to receipt of the Transfer Agreement, of the "Transfer Disclosure" required by 40 P.S. § 4003 (a)(2) attached and incorporated as Exhibit "E." As set forth in greater detail in the Transfer Disclosure, the following terms have been disclosed to the Petitioner: a. The amom~ts and due dates of the structured settlement payments to be transferred are lump sum payments as follows: $60,000.00 due on or about August 12, 2008; and $95,000.00 due on or about August 12, 2013. b. The aggregate amount of the structured settlement payments to be transferred is $155,000.00. 3 The discounted present value of the payments transferred using the most recently published applicable federal rate for determining the value of an annuity is $I 12,685.50. d. The federal discount rate used to determine the discounted present value is the effective annual rate of 4.60% as of 06/14/04. e. The gross amount payable to Petitioner in exchange of the transferred payments is $52,205.69. f. The good faith itemized listing of all broker's commissions, service charges, legal fees, notary fees, costs etc. deductible from the gross amount otherwise payable to the Petitioner is: Legal Fees of $2,000.00 and processing fee of $200.00. g. The net amount payable to Petitioner after deduction of the above commissions, legal fees, etc., is $50,005.69 minus any advances made to Petitioner against the amount payable to Petitioner. h. The quotient is 44.38%. i. The amount of penalty and aggregate amount of any liquidated damages inclusive of panalties payable by the Petitioner in the event of any breach of the transfer agreement by the Petitioner is: NONE. l 1. Petitioner has been provided, and has acknowledged receipt, at least 10 days prior to receipt of the Transfer Agreement, of the written "Important Notice" in bold print 12-point type required by 40 P.S. § 4003 (b). A true and correct copy of Petitioner's acknowledgement of the receipt of the § 4003 (b) notice is attached as Exhibit "F." 12. Petitioner has been advised to obtain and has in fact obtained independent legal advice regarding the implications of the transfer, including tax ramifications of the transfer, as set forth in the acknowledgement and the Independent Professional Advice ("IPA") Confirmation letter from Bmner Financial Services, LLC attached collectively as Exhibit "G." 13. On January 24, 2002, "The Victims of Terrorism Tax Relief Act," PL 107-134, 115 Stat. 2427, was enacted, which in part, amands the Internal Revenue Code of 1986. The Act amends 26 U.S.C.A. § 5891 and now provides for favorable tax treatment of "structured 4 17. Petitioner has seriously contemplated this transaction, and due to his personal circumstances and needs, believes that this assignment is in his best interests, taking into account the welfare and support of Petitioner's dependents. 18. Petitioner acknowledges that counsel, Jones, Gregg, Creehan & Gerace, LLP has not been engaged to render professional advice with respect to the advisability, or the implications of the transfer, including the tax ramifications of the transfer. Counsel has been engaged solely to prepare and present the within Petition, based upon Petitioner's independent determination and/or professional advice obtained from others, with respect to the advisability and rmnifications of the transfer. WHEREFORE, Petitioner prays that this Honorable Court grant this Petition to Transfer Structured Settlement Payment Rights. Respectfully submitted, Jones, Gregg, Creehan & Gerace, LLP Robert L. Monks PA I.D.//52760 411 Seventh Avenue Suite 1200 Pittsburgh, PA 15219 412-261-6400 Counsel for Petitioner, Daniel G. Chamey f/k/a Daniel Garcia VERIFICATION I, Daniel G. Charney, have read the foregoing Petition to Transfer Structured Settlement Payment Rights and hereby aver that the statements contained therein are true and correct to the best of my knowledge, information and belief. This Verification is made subject to the penalties of 18 Pa.C.S.A. Section authorities. 4904 relating to the unsworn falsification to Daniel G. Charney ~/ SETTLEMENT AGREEMENT AFFIDAVIT I, Daniel G. Charney aka Daniel Garcla, being duly sworn according to law upon my oath depose and say: 1. My current address is: 121 Fairview Dr. Carlisle PA 17013. 2. My social security number is: 189-64-8623 The annuity policy number 90-800-252 which is owned by Erie Indemnity Company, and is issued by Allstate Life Insurance Company authorizes me to receive the following payments. Lump sum payments as follows: $00,000.00 due on August 12, 2008; $95,000.00 due on August 12, 2013; and $150,000.00 due on August 12, 2018. 4. I am assigning the following payments to Settlement Funding, LLC: Lump sum payments as follows: $60,000.00 due on or about August 12, 2008; and $95,000,00 due on or about August 12, 2013. I am entitled to these payments, under policy number 90-800.252, pursuant to a tort action and they are not a result of a Worker's Compensation claim. The owner, Erie Indemnity Company of the above referenced policy has not responded to my request for a copy of the Release and Settlement. 7. I am not in possession of a copy of the Release and Settlement Agreement. STATEOF: P~"~'I i~'V'~U~"~;O,.~ COUNTY OF: [ 'LL.~V)~'~Ci ~ I HEREBY CERTIFY THAT THE FOREGOING STATEMENTS MADE BY ME ARE TRUE. I AM AWARE THAT IF ANY OF THE FOREGOING STATEMENTS MADE BY ME ARE FALSE, I AM Daniel G. Charney aka Daniel Garcia .,// On this ~ day of ~_\cz .~2 ,2~00,~, before me the above signed personally appeared before and produced for ident~cetion ,~r;o~_r3L:~ OR personally known to me to be the person whose name is subscribed to the within instrument and acknowledged to me that he/she executed it. My Commission Expires Exhibit A I Cathy E. F~. Hot,fy Public I Allstate Life Insurance Co pany A Stock Company -- Home Office: Northbrook, Illinois POLICY CERTIFICATE SCHEDULE OF PAYMENTS Aug. 12, 2008 Aug. 12, 2013 Aug. 12, 2018 $60,000.00 95,000.00 150,000.00 NkHE SEX A~4UIT3~2: Daniel c~?cia Male FIRST P~: $ 60,000.00 on Aug. 12, 2008 IAST P~: $150,000.00c~Aug. 12, 2018 ~~= 90-800-252 C~I%~R: Erie IndemnityCo. ISSUE DATE: J~n. 11, 1987 DATE OF BIRI~ Aug. 12, 1983 Exhibit ABSOLUTE ASSIGNMENT AND UCC ARTICLE 9 SECURITY AGREEMENT (THE "AGREEMENT") June 25, 2005 I, Daniel G. Chamey aka Daniel Garcla, ("1", "Me" or "Assignor") residing at 121 Fairview Dr. Carlisle, PA 17013 am entitled to Lump sum payments as follows: $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 (the "Periodic Payments") on account of the sefflement of a certain personal injury claim, the settlement of which is memorialized in that certain settlement agreement (the "Settlement Agreement'). The Periodic Payments ars due to me from Erie Indemnity Company (the "Settlement Obligor") under the terms of the Settlement Agreement and are being funded by an annuity issued by Allstate Life Insurance Company (the "Annuity Issuer") bearing annuity contract number 90-800-252. A. I hereby sell, assign and convey to Settlement Funding, L.L.C. (the "Assignee") or its assigns all of my rights to and interest in and to the following payments due or to become due under the Settlement Agreement: Lump sum payments as follows: $60,000.00 due on or about August 12, 2008; and $95,000.00 due on or about August 12, 2013 (the "Assigned Payments"). In consideration for this assignment, Assignee shall pay to me the sum of: $52,205.69 (the "Assignment Price"). hereby make the following unconditional representations, warranties and promises: 1, No one other than me has any interest or claim of any kind or nature in, to or under the Assigned Payments I am assigning hereunder. 2. I am not indebted to anyone that would affect in any way either the assignment of the Assigned Payments referenced above or Assignee's absolute dghts to receive same. 3. I agree to conduct my affairs so as to ensure that Assignee obtains all of the benefits of the assignment contemplated hereby. C. I agree that the fallowing shall be considered an event of default by me under this Absolute Assignment Agreement: 1. The representations set forth in Paragraphs B 1 and B 2 above are at any time not true. 2. Failure by me to perform the premise set forth in Paragraph B 3 above. 3, Failure by the Settlement Obligor or the Annuity Issuer to make any one or more of the Assigned Payments as a result of any act by me, my estate or any of my heirs. 4. Failure by the Settlement Obligor or Annuity Issuer to forward one or more Assigned Payments to Assignee as a result of any act by me, my estate or any of my heirs. 5. Failure by me to forward promptly to Assignee any Assigned Payment received by me from the Settlement Obligor or the Annuity Issuer, 6. Failure by me to fulfill any other obligation of mine under this Agreement. The following are conditions precedent to Asaignee's obligation to pay me the Assignment Price: 1. Assignee shall be satisfied, in its sole discretion, that there are no claims or interests of any kind or nature whatsoever that do or may affect Assignee's rights to ar interest in the Assigned Payments and Assignee's ability actually to receive same on the dates and in the amounts set forth herein. 2. Assignee shall have received a final non-appealable court order, or a signed acknowledgment from Settlement Obligor and the Annuity Issuer satisfactory to Assignee in its sole discretion (such court order or acknowledgement together are hereinafter referred to as the "Order"), authorizing the transfer by assignment of the Assigned Payments (which may continue to be made out to my name) to Assignee, and directing that the Periodic Payments due on or after the day of the Order be forwarded, or authorizing the forwarding of the Periodic Payments, directly to Assignee. E, Under this Agreement and only to the extent permitted by law Assignee and I intend to create a secudty interest under Article 9 of the Uniform Commemial Code of the state designated in Paragraph F below, in my rights to and interest in payments due to me under the Settlement Agreement, which dghts have been assigned to Assignee as General Intangibles under Article 9 of the Uniform Commemial Code of the state designated in Paragraph F below. This Agreement shall also function as a security agreement. This security interest secures payment of the rights assigned and performance of my obligations under Paragraph B above. Assignee may direct any account debtor, obligor on an instrument, including, without limitation, the Settlement Obligor or Annuity Issuer, to make periodic payments directly to Assignee as contemplated by the Uniform Commercial Code. Assignee may file a UCC-1 financing statement to perfect its dghts hereunder. F. Except as otherwise required by applicable statutory law, this Agreement shall be governed by and interpreted in accordance with the law of the state of residence of the Assignor on the date of this Agreement. ARBITRATION Any and all controversies, claims, disputes, fights, interests, suits or causes of action arising out of or relating to this Agreement and the negotiations related thereto, or the breach thereof, shall be settled by binding arbitration administered by the Amedcan Arbitration Association, The demand for arbitration shall be filed in writing with the other party to this Agreement and with the Amedcan Arbitration Association offices in your state of residence. The arbitration shall be held in the largest city in your state of residence. The arbitration shall be held before a single arbitrator selected in accordance with the Commemiai Arbitration Rules of the Amedcan Arbitration Association in effect at the time that the demand for arbitration is filed. Discovery, specifically including interrogatories, production of documents and depositions shall be at the discretion of the arbitrator and to the extent permitted shall be conducted in accordance with, and governed by the Federal Rules of Civil Procedure. A demand for arbitration shall be made within a reasonable time after the claim, dispute or other matter in question has adsen. In no event, shall the demand for arbitration be made after the date when institution of legal or equitable proceedings based on such claim, dispute or other matter in question, would be barred by the applicable statute of limitations. No arbitration arising out of or relating to this Agreement shall include, by consolidation or joinder or in any other manner, an additional person or entity not a party to this Agreement, except by written consent of the parties hereto, containing a specific reference to this Agreement and signed by the entity sought to be joined. Consent to arbitration involving an additional person or entity shall not constitute consent to arbitration of any claim, dispute or other matter in question not described in the written consent or with a person or entity not named or described therein. The foregoing agreement to arbitrete and other agreements to arbitrate with an additional person or entity duly consented to by parties to this Agreement, shall be specifically enforceable in accordance with applicable law in any court having jurisdiction thereof. The award rendered by the arbitrator shall be final, and judgment may be entered upon it in accordance with applicable law in any court having jurisdiction thereof. Such arbitrator shall identify the substantially prevailing party and shall include legal fees and expenses for the substantially prevailing party. This provision does not apply to the extent inconsistent with applicable state law regarding the transfer of structured settlement payments. In such case any disputes between the parties will be governed in accordance with the laws of the domicile state of the payee and the domicile state of the payee is the proper venue to bring any cause of action arising out of a breach of the agreement. G. I hereby grant to Assignee an Irrevocable Power of Attorney with full powers of substitution to do all acts and things that I might do regarding the Assigned Payments and any and all rights I have under the Settlement Agreement, including, without limitation, the power to endorse checks, drafts or other instruments, the power to alter, edit and change payment instructions and/or beneficiary designations and any other act which, in the sole discretion of Assignee as my Attorney-in-Fact is necessary or expedient for it to obtain all of the benefits of the bargain contemplated by this transaction. This power of attorney is coupled with an interest and shall survive my death or disability. Ho In the event that prior to the consummation of the transaction contemplated hereby I receive any of the Assigned Payments, or any portion thereof, the Assignment Pdce shall be reduced in like amount and the terms of this Agreement regarding the payments to be assigned shall be deemed to be adjusted accordingly, in the event Assignee receives or otherwise comes into possession of any of the Periodic Payment(s) or portion(s) thereof which are not included in the payments being absolutely assigned to Assignee hereunder, Assignee shall forward such amount(s) to me at the address set forth above within seven (7) days of receipt of such amount(s). I. Assignee shall be entitled to discharge any adverse claims against Assignor or any of the Assigned Payments whether or not such adverse claims are disclosed. Assignee may, provided Assignee furnishes prior written notice to Assignor, pay any and all amounts necessary or, if the Assignment Price has been deposited into an escrow account, instruct the escrow agent to pay any and ail amounts necessary to discharge such liens or other adverse claims, and the Assignment Price shall be reduced by the amount of any such payment. Adverse claims may include disclosed amounts to be deducted by Assignee from the Assignment Price to pay Assignee, as servicer for Peachtree Finance Company, LLC, to enable Assignor to obtain Peachtree Finance Company, LLC's release of its encumbrance on a portion of the Assigned Payments, which portion of Assigned Payments relate to prior transfer transaction(s) consummated pdor to the effective date of the applicable transfer act(s) which encumbrance must be released for the transaction contemplated herein to be consummated. J. I know that it will take some time for the Settlement Obligor and the Annuity Issuer to receive and process the court order once it is granted. I would like to receive the Assignment Price or a portion thereof as soon as possible thereafter. Accordingly, I hereby request Assignee to pay me a portion of the Assignment Price as soon as possible after the court order is granted and authorize Assignee to hold in escrow an amount it deems necessary or advisable from the Assignment Price (the "Escrow Amount") until all conditions precedent have been satisfied, including, without limitation, the receipt by Assignee of the Settlement Obligor and the Annuity Issuer's acknowledgment of the terms of the court order in writing and their agreement to honor and comply with same. At such time or earlier as Assignee may determine, I understand that Assignee will send the Escrow Amount to me minus any Assigned Payments that the Annuity issuer and/or Settlement Obligor sent to me while the Settlement Obligor and the Annuity Issuer were processing the court order. K. This Agreement shall take effect on the date it is signed by me (the Assignor) or on such later date prescribed by applicable statutory law. herewith. In witness whereof I hereunto set my hand. STATEOr On this ~ ~ day of All disclosure statements are a matedal part of this Agreement and shall be read in pad mataria Daniel G. Chamey aka Daniel G~ia ,200_~the above person, known to me to be the My Commission expires on Accepted: person whose name is subscribed to this instrument, personally appeared before me and acknowledged to me that he/she has read this instrument and that the instrument has been executed by him/her. PLEASE DO NOT SIGN THIS '7-C~ O - ~, DOCUMENT UNTIL 06/25/2004 Settlement Ftln~ll, L~L.C. Dat;:~(.~ Notarial $~1 Cathy E. Fry, N~coenty t~,.,ull~ Mkhtl~c~a T~p., (~ml~'lsna __. Commission Expires July 30, 2006 Authorization For Deductions Pursuant to the terms of the Agreement, Assignee may deduct from the Pumhase Price the full amount due to any and all third party creditors, judgment holders, holders of child support obligations, the holder of any other outstanding lien or claim (collectively the 'Judgments/Claims") including life insurance policy payment(s) or any attorney fees in connection with the consummation of this transaction. If Assignee is able to satisfy in full the Judgments/Claims for less than the full amount due, Assignee shall be entitled to keep the difference between the amount deducted and the amount actually paid. Authorization to Conduct Credit and Criminal Backc~round Checks I, Daniel G. Charney aka Daniel Garcia residing at 121 Fairview Dr., Carlisle, PA '17013, hereby authorize Settlement Funding or any of its agents or designees, to conduct any and all criminal background reports, searches or checks and any and ali credit history reports, searches or checks which it in its sole discretion and judgment deems necessary or advisable. Authorization to Release Information I, Daniel G. Charney aka Daniel Garcia, hereby request and authorize Erie Indemnity Company, Allstate Life Insurance Company, or any of their successors, assigns, designees, agents or administrators, or my attorney to disclose, or any other parties that may possess any information deemed necessary by Settlement Funding, or any of its agents or designees to be disclosed, make available and furnish to Settlement Funding, or any of its agents or designees any and all information pertaining to my personal injury settlement as set forth in a certain Release or any other documents deemed necessary by Settlement F~Jnding, or any of its agents or designees. I specifically direct that Erie Indemnity Company, Allstate Life Insurance Company, or any of their successors, assigns, designees, agents or administrators or any other person or entity that this authorization is given to, cooperate with Settlement Funding or any of their agents or designees regarding disclosure of information pertaining or related to my settlement or other required documentation. Please provide copies via fax or otherwise of any and all documents requested by Settlement Funding or their agents or designees regarding my settlement. Daniel G. Charney aka Daniel Garcia U Sworn and Subscribed before me this ~ day of Notary Public My Commission Expires: . _ C~ E. FO,, Noah7 l~bJic ~ '-~ ~pims ~3~ 30, 2006 AFFIDAVIT I, Daniel G. Charney aka Daniel Gamia, of full age, being duly sworn according to law, upon my oath depose and say: 1. I currently reside at 121 Fairview Dr., Carlisle, PA 17013. 2, I am the recipient of certain guaranteed payments under a structured settlement dated June 11, 1987. The entity presently obligated to make the payments due under the structured settlement is Erie Indemnity Company. In order to fund its payment obligations under the structured settlement Erie Indemnity Company purchased an annuity contract 90-800~252 from Allstate Life Insurance Company. 3. I voluntarily entered into an Absolute Assignment and UCC Article 9 Security Agreement (the "Agreement") dated June 25, 2004 with Settlement Funding, LLC d/b/a Peachtree Settlement Funding ("Peachtree"). Under that Agreement, I agreed to sell and assign to Peachtree the following payments due to me under the structured settlement: Lump sum payments as follows: $60,000,00 due on or about August 12, 2008; and $95,000.00 due on or about August 12, 2013 (the "Assigned Payments"). 4. I understand I will forego receipt of the Assigned Payments under the Agreement. I understand that my beneficiaries/heirs and I will no longer receive any of the Assigned Payments or any portion of the Assigned Payments. I understand that all of the Assigned Payments will go to Peachtree or the assigns of Peachtree. 5. I also understand that this Affidavit is submitted for use in the court approval process initiated by Peachtree and myself to seek court approval of the transfer of payments to Peachtree. 6. I also received from Peachtree a Disclosure Statement detailing the terms of the Agreement, which I signed and returned to Peachtree. I carefully reviewed the Disclosure Statement and fully and completely understand all terms of the Disclosure Statement. 7. In the Disclosure Statement, Peachtree advised me to seek professional advice regarding the Agreement from an attorney, accountant or other professional of my choice. I have either received said advice or fully intend to receive independent professional advice regarding this transaction. 8. I am 20 years old and i have no mental or physical disabilities that would prevent me from working. I was recently laid off, however I hope to open my own clothing business soon. I am currentJy living with my parents rant-free and they are also supporting me with any of my financial needs until I am able to earn Exhibit a living on my own. Therefore, I have another source of income other than the future lump sum structured settlement payments that I wish to transfer and assign to Settlement Funding, 9. I have thoroughly considered this transaction, my alternatives and the use to which I will put the proceeds of this sale. I have considered the impact of this transaction on myself. I will be able to improve my present standard of living if I am permitted to transfer and assign my right to receive the Assigned Payments to Settlement Funding as described in this Affidavit. After considering these factors I believe that this transaction is in my best interest. 10. I intend to use the proceeds I receive from Peachtree under the Agreement to start my own clothing business. I would like to use the proceeds from this transaction, approximately $50,000.00, as operating capital to start my own clothing business. I have been looking at the local demand for another clothing store in the area and I feel that another clothing and shoe store will do well here. I feel that the local market can easily support another small clothing store and I would like to capitalize on this opportunity. I realize that owning and operating your own clothing store is a risky venture. However, I feel that my potential for return on this investment and the gratification that I will receive from it far outweighs the risk. In addition, if I do not pursue this dream now I may never have the opportunity. In order for my store to commence operations, I will need $3,500.00 to put a down payment on a store in downtown Harrisburg, Pennsylvania. I would like to use $6,000.00 to pre-pay the rent on the building for 6 months. I will need to use around $15,000,00 to paint the shop and put some carpet in the store and to purchase shelves. I will also need $20,000.00 to purchase inventory such as shirts, pants, shoes and decor for the shop. I will use the remaining $5,500.00 to pay for advertising and marketing, I plan on selling my inventory at a competitive price, which I believe will keep customers coming back for more. I believe that completing this transaction will afford me the opportunity to make a great difference in my life by allowing me to become a business owner. This investment will allow me the opportunity to utilize my money in an efficient and profitable manner, which will help me secure my financial future. I do not have the financial wherewithal to pay for the aforementioned from my current finances. Therefore, I have decided to pursue this transaction with this Peachtree to obtain the monies I need to open my own store. 11. I will not be using any portion of the proceeds from the Agreement for day-to-day expenses. I have never assigned, sold or pledged any of the structured settlement payments that I am receiving from the aforementioned structured settlement, to any party or entity, in addition, I have no dependents. I do not believe that approval of this transfer will negatively affect my standard of living or harm me in any way. Therefore, I have determined that the proceeds from the Agreement with Peachtree is my best interest and will improve my quality of life. Sworn and Subscribed before me this ~ '~' day of My Commission Expires: PLEASE DO NOT SIGN THIS DOCUMENT UNTIL 06/25/2004 My C ~,mi,~,~, ~h~ July 30, 2006 PENNSYLVANIA TRANSFER DISCLOSURE Payee: Daniel Charney; resident of: PA A. Amounts and due dates of the structured settlement payments to be transferred: Lump sum payments as follows: $60,000.00 due on or about August 12, 2008; and $95,000.00 due on or about August 12, 2013 B. Aggregate amount of such payments: $155,000.00 C. (1) Discounted present value of such payments: $.112,685.50 (2)The discount rate used in determining such discounted present value: 4.60 percent as of June 14, 2004 D. Gross amount payable to the Payee in exchange for such payments: $52,205.69 E. Itemized listing of all brokers' commissions, service charges, application or processing fees, closing costs, filing or administrative charges, legal fees, notary fees and other commissions, fees, costs, expenses and charges payable by the Payee or deductible from the gross amount otherwise payable to the Payee: Legal Fees: $2,000.00; Processing Fee: $200.00 F. Net amount payable to Payee after deduction of all commissions, fees, costs, expenses and charges described above: $50,005.69 minus any advances made to Payee against the amount payable to Payee G. The quotient, expressed as a percentage, obtained by dividing the net payment amount by the discounted present value of the payments: 44.38% H. Amount of any penalty and the aggregate amount of any liquidated damages, inclusive of penalties, payable by the Payee in the event of any breach of the transfer agreement by the Payee: NONE Exhibit E J Payee acknowledges receipt of, and acknowledges to have read and understood, the above disclosure statement and information required to be disc,19sed~by Payee's applicable state statute(s) Initials: ,~.,~. ~ By signing below you are confirming that you received a copy of this disclosure at least 10 days prior to receipt of this contract. Date ILLINOIS TRANSFER DISCLOSURE Payee: Daniel Charney; resident of: PA A. Amounts and due dates of the structured settlement payments to be transferred: Lump sum payments as follows: $60,000.00 due on or about August 12, 2008; and $95,000.00 due on or about August 12, 2013 B. Aggregate amount of such payments: $155,000.00 C. Discounted present value of the payments: $112,685.50; this is the calculation of current value of the transferred structured settlement payments under federal standards for valuing annuities and is determined by applying a (discount) rate of 4.60% as of June 14, 2004 D. Gross amount payable to the Payee in exchange for such payments: $52,205.69 E0 Itemized listing of all applicable transfer expenses, other than attorney's fees and related disbursements payable in connection with the transferee's application for approval of the transfer, and the transferee's best estimate of the amount of any of those fees and disbursements: Processing Fee $200.00 F. Estimate of the amount of attorney's feeS: $2,000.00 G. Net advance amount: $50,005.69 H. Amount of any penalty and the aggregate amount of any liquidated damages (inclusive of penalties) payable by the Payee in the event of any breach of the transfer agreement by the Payee: NONE I. You have the right to cancel the transfer agreement, without penalty or further obligation, not later than the third business day after the date the agreement is signed by you J. You are advised to seek independent professional advice regarding the transfer K. Payee acknowledges receipt of, and acknowledges to have read and understood, the above disclosure statement and information required to be i cio ed by Payee's applicable state statute(s) Initials: ~.~. ~ By signing below you are confirming receipt of this disclosure at least 3 days prior to receipt of this contract NOTICE (PA) Payee: Daniel Charney IMPORTANT NOTICE: You are strongly urged to consult with an attorney who can advise you of the potential tax consequences of this transaction. I acknowledge receipt of the above notice. By signing below you are confirming that you received a copy of this disclosure at least 10 days prior to receipt of this contract. Darnel Charney Exhibit F" I ACKNOWLEDGEMENT (PA} Payee: Daniel Charney I have received independent legal advice regarding the implications of the transfer, including considerations of the tax ramifications of the transfer. (Initials) Daniel Charney Exhibit G I ~UN-89-~004 09:58A FROM:BRUNER FINANCIAL SER 7175097755 T0:18005~?161 p:~ Peachtree Settlement Funding 6501 Park of Gommerce Blvd Ste 140B Boca Raton FL 33487 6-29-04 Dear Peachtree: This letter is to con_firm that on 6-28-04, I spoke with Daniel Charney regarding the structured settlement and annuity contract, which you are working on. We went over the Agreement and Disclosure. Specifically, tl~t according to the Agreement, Peachtree will give a net mnount of $$0,005.69 for the annuity payments. This amount is instead of the two lump sum annuity payments of $60000 on g-12.08, and $95000 on 8-12o13, all totaling $155,000. The client want to use this amount is to pay offdebt and start a business. He feels this settlement is the best route to accomplish this, and understands that this transaction cannot be reversed once it is completed. No legal advice was given, and I encouraged the consideration of all options before making a final decision. Should you have any questions, or ifI cam be of service in the future, please call me at 717-509-7744. Sincerely, Daniel Charney Robert W Bruner 2561 Lititz Pike, Lancasl~r PA 17601 · t~: (717) 609-7744. to, ~e: t-8~-4 BRUNER (866-427-8637) Se~uri~es ~ tl~ Wood'oury Financial S~vjcos. M~ NASI:~. BRUNER Finnncial Services. J. LC is Independa~ of Weodbmy Finnnefal Services. 26 USCA § 5891 Page 1 26U.S.C.A. § 5891 I.R.C. § 5891 UNITED STATES CODE ANNOTATED TITLE 26. INTERNAL REVENUE CODE SUBTITLE E--ALCOHOL, TOBACCO, AND CERTAIN OTHER EXCISE TAXES CHAPTER 55--STRUCTURED SETTLEMENT FACTORING TRANSACTIONS_ Copr. © West Group 2002. No claim to Orig, U.S. Govt. Works. Current through P.L. 107-136, approved 1-24-02 § 589l. Structured settlement factoring transactions (a) Imposition of tax.--There is hereby imposed on any person who acquires directly or indirectly structured settlement payment rights in a structured settlement factoring transaction a tax equal to 40 percent of the factoring discount as determined under subsection (c)(4) with respect to such factoring transaction. (b) Exception for certain approved transactions.-- (1) In general.--The tax under subsection (a) shall not apply in the case of a structured settlement factoring transaction in which the transfer of structured settlement payment rights is approved in advance in a qualified order. (2) Qualified order.--For purposes of this section, the term "qualified order" means a final order, judgment, or decree which-- (A) finds that the transfer described in paragraph (1)-- (i) does not contravene any Federal or State statute or the order of any court or responsible administrative anthonty, and (ii) is in the best interest of the payee, taking into account the welfare and support of the payee's dependents, and (B) is issued-- (i) under the authority of an applicable State statute by an applicable State court, or (ii) by the responsible administrative authority (if any) which has exclusive jurisdiction over the underlying action or proceeding which was resolved by means of the structured settlement. (3) Applicable State statute.--For purposes of this section, the term "applicable State statute" means a statute providing for the entry of an order, judgment, or decree described in paragraph (2)(A) which is enacted by-- (A) the State in which the payee of the structured settlement is doimciled, or (B) if there is no statute described in subparagraph (A), the State in which either the party to the structured settlement (including an assignee under a qualified assigunaent under section 130) or the person issuing the funding asset for the structured settlement is domiciled or has its principal place of business. (4) Applicable State court.--For purposes of this section-- (A) In general.--The term "applicable State court" means, with respect to any applicable State statute, a court of Copr. © West 2002 No Claim to Orig. U.S. Govt. Works Exhibit H ~ 26 USCA § 5891 Page 2 26 U.S.C.A. § 5891 the State which enacted such statute. (B) Special rule.--In the case of an applicable State statute described in paragraph (3)(B), such term also includes a court of the State in which the payee of the structured settlement is domiciled. (5) Qualified order dispositive.--A qualified order shall be treated as dispositive for purposes of the exception under this subsection. (c) Definitions.--For purposes of this section-- (1) Structured settlement.--The term "structured settlement" means an arrangement-- (A) which is established by-- (i) suit or agreement for the periodic payment of damages excludable from the gross income of the recipient under section 104(a)(2), or (ii) agreement for the periodic payment of compensation under any workers' compensation law excludable from the gross income of the recipient under section 104(a)( 1 ), and (B) under which the periodic payments are-- (i) of the character described in subparagraphs (A) and (B) of section 130(c)(2), and (ii) payable by a person who is a party to the suit or agreement or to the workers' compensation claim or by a person who has assumed the liability for such periodic payments under a qualified assignment in accordance with section 130. (2) Structured settlement payment rights.--The term "structured settlement payment rights" means rights to receive payments under a structured settlement. (3) Structured settlement factoring transaction.-- (A) In general.--The term "structured settlement factoring transaction" means a transfer of structured settlement payment rights (including portions of structured settlement payments) made for consideration by means of sale, assignment, pledge, or other form of encumbrance or alienation for consideration. (B) Exception.--Such term shall not include-- (i) the creation or perfection of a security interest in structured settlement payment rights under a blanket security agreement entered into with an insured depository institution in the absence of any action to redirect the structured settlement payments to such institution (or agent or successor thereof) or otherwise to enforce such blanket security interest as against the structured settlement payment rights, or (ii) a subsequent transfer of structured settlement payment rights acquired in a structured settlement factoring transaction. (4) Factoring discount.--The term "factoring discount" means an amount equal to the excess or-- (A) the aggregate undiscounted amount of structured settlement payments being acquired in the structured settlement factoring transaction, over (B) the total amount actually paid by the acquirer to the person from whom such structured settlement payments are acquired. (5) Responsible administrative authority.--The term "responsible administrative authority" means the Copt. © West 2002 No Claim to Orig. U.S. Govt. Works 26 USCA § 5891 Page 3 26 U.S.C.A. § 5891 administrative authority which had jurisdiction over the underlying action or proceeding which was resolved by means of the structured settlement. (6) State.--The term "State" includes the Commonwealth of Puerto Rico and any possession of the United States. (d) Coordination with other provisions.-- (1) In generaL--If theapplicable requirements of sections 72, 104(a)( 1 ), 104(a)(2), 130, and 461 (h) were satisfied at the time the structured settlement involving structured settlement payment rights was entered into, the subsequent occurrence of a structured settlement factoring transaction shall not affect the application of the provisions of such sections to the parties to the slructured settlement (including an assignee under a qualified assignment under section 130) in any taxable year. (2) No withholding of tax.--The provisions of section 3405 regarding withholding of tax shall not apply to the person making the payments in the event of a structured settlement factoring trunsaefion. CREDIT(S) 2002 Pocket Part (Added_Pub. L. 107-134, Title I, § 115(a), Jan. 23, 2002, 115 Stat. 2436.) <General Materials (GM) - References, Annotations, or Tables> HISTORICAL AND STATUTORY NOTES Revision Notes and Legislative Reports 2002 Acts. Statement of President, see 2001 U.S. Code Cong. and Attn. News, p. 1812. Effective and Applicability Provisions 2002 Acts. Pub. L. 107-134, Title L § 1 I5(c), Jan. 23, 2002, 115 Stat. 2438, provided that: "(1) In generaL--The amendments made by this section [enacting this chapter] (other than the provisions of section 5891(d) of the Internal Revenue Code of 1986; as added by this section [26 U.S.C.A. § 5891(d)]) shall apply to structured settlement factoring transactions (as defined in section 5891(c) of such Code (as so added) [26 U.S.C.A. § 5891(c)]) entered into on or after the 30th day following the date of the enactment of this Act [Jan. 23, 2002]. "(2) Clarification of existing law.--Section 5891(d) of such Code (as so added) [26 U.S.C.A. § 5891(d)] shall apply to structured settlement factoring transactions (as defined in section 5891(c) of such Code (as so added) [26 U.S.C.A. § 5891(c)]) entered into before, on, or after such 30th day. "(3) Transition rule.--In the case of a structured settlement factoring transaction entered into during the period beginning on the 30th day following the date of the enactment of this Act [Jan. 23, 2002J and ending on July 1, Copr. © West 2002 No Claim to Orig. U.S. Govt. Works 26 USCA § 5891 Page 4 26 U.S.C.A. § 5891 2002, no tax shall be imposed under section 5891(a) o?such Code [26 U.S.C.A. § 5891(a)] if-- "(A) The structured settlement payee is domiciled in a State (or possession of the United States) which has not enacted a statute providing that the structured settlement factoring transaction is ineffective unless the transaction has been approved by an order, judgment, or decree of a court (or where applicable, a responsible administrative authority) which finds that such transaction-- "(i) does not contravene any Federal or State statute or the order of any court (or responsible administrative authority); and "(ii) is in the best interest of the structured settlement payee or is appropriate in light of a hardship faced by the payee; and "(B) the person acquiring the structured settlement payment rights discloses to the structured settlement payee in advance of the structured settlement factoring transaction the amounts and due dates of the payments to be transferred, the aggregate amount to be transferred, the consideration to be received by the structured settlement payee for the transferred payments, the discounted present value of the transferred payments (including the present value as determined in the manner described in section 7520 of such Code [26 U.S.C.A. § 7520]), and the expenses required under the terms of the structured settlement factoring transaction to be paid by the structured settlement payee or deducted from the proceeds of such transaction." 26U.S.C.A. § 5891 26USCA § 5891 END OF DOCUMENT Copr. © West 2002 No Claim to Orig. U.S. Govt. Works IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION PETITION OF DANIEL G. CHARNEY F/K/A DANIEL GARCIA TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS No. FINAL ORDER OF COURT AND NOW, this __ day of ,2004, upon presentation of the Petition of Daniel G. Chamey f/k/a Daniel Garcia to Transfer Structured Settlement Payment Rights pursuant to the Structured Settlement Protection Act, 40 P.S. §§ 4001-4009, it appearing to this Court that proper notice of the filing and presentation of this Petition was given to the Settlement Obligor, Erie Indemnity Company, and to the Annuity Issuer, Allstate Life Insurance Company; and it further appearing that Erie Indemnity Company and Allstate Life Insurance Company have not answered or otherwise appeared; after due consideration, this Court finds as follows: I. This Court has subject matter and personal jurisdiction. 2. The transfer complies with the requirements of the Structured Settlement Protection Act, 40 P.S. §§ 4001-4009, and will not contravene other applicable Federal or State statutes or regulations or any applicable law limiting the transfer of workers' compensation claims. 3. Not less than ten (10) days prior to the date upon which the Petitioner first incurred any obligation with respect to the transfer, the Transferee, Settlement Funding, LLC provided the Petitioner a disclosure statement setting forth in boldface, minimum 12-point size type all of the following: a. The amounts and due dates of the structured settlement payments to be transferred. b. The aggregate amount of such payments. c. The discounted present value of such payments, together with the discount rate or rates used in determining such discounted present value. d. The gross amount payable to the Petitioner in exchange for such payments. e. An itemized listing of all brokers' commissions, service charges, application or processing fees, closing costs, filing or administrative charges, legal fees, notary fees and other commissions, fees, costs, expenses and charges payable by the Petitioner or deductible from the gross amount otherwise payable to the Petitioner. f. The net amount payable to the Petitioner after deduction of all commissions, fees, costs, expenses, and charges described above. g. The quotient, expressed as a percentage, obtained by dividing the net payment amount by the discounted present value of the payments. h. The amount of any penalty and the aggregate of any liquidated damages, inclusive of penalties, payable by the Petitioner in the event of any breach of the transfer agreement by the Petitioner. 4. The Petitioner has established that the transfer is in his best interests, taking into account the welfare and support of the Petitioner's dependents, if any, at time of entry of this Order of Court. 5. The Petitioner has obtained independent professional advice regarding the implications of the transfer, including consideration of the tax ramifications of the transfer. 2 6. The transfer has been expressly approved in writing by the Petitioner, and at the time the Petitioner and the Transferee proposed to enter into the Transfer Agreement, a favorable The approvals of the Annuity Issuer and Settlement Obligor are not tax result was in effect. required. 7. The Petitioner has given written notice pursuant to 40 P.S. § 4003 (a)(6) of the Transferee's name, address, and taxpayer identification number to the Annuity Issuer, and the Structured Settlement Obligor, and a copy of the written notice has been filed with the Court. 8. Prior to entering into the Transfer Agreement the Petitioner was provided with a written notice on a separate sheet that contains the following, in boldface, minimum 12-point size type required by 40 P.S. § 4003 (b): "IMPORTANT NOTICE: You are strongly urged to consult with an attorney who can advise you of the potential tax consequences of this transaction." 9. Not less than 20 days prior to the scheduled hearing on the petition for authorization of a transfer of structured settlement payment fights under 40 P.S. § 4003, the Petitioner flied with the court and served on the Transferee a notice of the proposed transfer and the application for its authorization, including in the notice a copy of the Petitioner's Petition to the Court, a copy of the transfer agreement, a copy of the disclosure statement required under 40 P.S. § 4003, notification that the Transferee, the structured settlement obligor or the annuity issuer is entitled to support, oppose or otherwise respond to the Petition, either in person or by counsel, by submitting written comments to the court or by participating in the heating and notification of the time and place of the heating and notification of the manner in which and the time by which written responses to the petition must be filed. 10. The Transfer Agreement does not authofize Transferee or any other party to confess judgment or consent to entry of judgment against Petitioner. 11. The Petitioner shall retain all right and interest in receiving the remaining balance not assigned of: the entire lump sum payment in the amount of $150,000.00 due on or about August 12, 2018 (the "non-assigned payment"). NOW THEREFORE, in consideration of the foregoing findings, it is hereby ORDERED, ADJUDGED and DECREED that the Petition to Transfer Structured Settlement Payment Rights pursuant to the Structured Settlement Protection Act, 40 P.S. §§ 4001-4009 be and is hereby GRANTED as follows: A. The transfer by Petitioner, Daniel G. Chamey f/k/a Daniel Garcia to Transferee, Settlement Funding, LLC of the Transferred Payments (consisting of lump sum payments as follows: $60,000.00 due on or about August 12, 2008; and $95,000.00 due on or about August 12, 2013) is hereby APPROVED. B. The Settlement Obligor, Erie Indemnity Company shall direct the Annuity Issuer, Allstate Life Insurance Company to send the Transferred Payments to Settlement Funding and its successors and/or assigns care of the following address: P.O. Box 116476 Atlanta, GA 30368-6476 or such other address as Settlement Funding and its successors and/or assigns may designate upon written notice to Settlement Obligor, Erie Indemnity Company and the Annuity Issuer, Allstate Life Insurance Company. Settlement Obligor, Erie Indemnity Company and the Annuity Issuer, Allstate Life Insurance Company shall not be required to change the address for the Transferred Payment absent payment of a reasonable administrative fee, which shall not be charged to or paid by the Payee. C. Settlement Funding, LLC and its successors and/or assigns shall defend, indemnify and hold harmless (collectively, the "Indemnity") the Settlement Obligor, Erie Indemnity Company and the Annuity Issuer, Allstate Life Insurance Company from any claims, liability or damages, including, but not limited to, reasonable costs and attorneys' fees, arising from or in connection with (a) any disclosures made in or related to this Order of Court; (b) compliance by the Settlement Obligor, Erie Indemnity Company and the Annuity Issuer, Allstate Life Insurance Company with this Order of Court; and/or (c) the Transferee's failure to comply with the Act. D. Settlement Funding and Petitioner Daniel G. Chamey f/k/a Daniel Garcia agree that the terms of this Order of Court are based exclusively upon the facts, representations and circumstances of this particular case. Nothing in this Order of Court shall preclude Settlement Obligor, Erie Indemnity Company and the Annuity Issuer, Allstate Life Insurance Company from contesting any other proposed transfer of structured settlement payment rights. This Order of Court is entered without prejudice to the rights of Settlement Obligor, Erie Indemnity Company and the Annuity Issuer, Allstate Life Insurance Company and the Court makes no findings regarding the enforceability of any non~assignment provision(s) contained in the structured settlement agreement or related documents; provided, however, that the transfer of the Transferred Payment, as provided in this Order of Court shall be valid and enforceable against Settlement Obligor, Erie Indemnity Company and the Annuity Issuer, Allstate Life Insurance Company in accordance with its terms. This Order of Court shall not serve as precedent in any way nor be cited in any matter. Nothing contained in this Order of Court shall be deemed to afford Petitioner Daniel G. Chamey f/k/a Daniel Garcia and Settlement Funding, LLC any rights of ownership or control of the annuity or shall otherwise affect the exclusive ownership and control of the annuity by Settlement Obligor, Erie Indemnity Company. E. The death of Petitioner Daniel G. Chamey f/k/a Daniel Garcia prior to the due date of the last Assigned Payment shall not affect the transfer of the Assigned Payments from Petitioner Daniel G. Charney f/k/a Daniel Garcia to Settlement Funding, and Petitioner Daniel G. Charney f/k/a Daniel Garcia understands he is giving up his rights, and the rights of his heirs, successors and/or beneficiaries, to the Assigned Payment. F. Pursuant to the Act, this Con~ ,~ ..... E. The death of Petitioner Daniel G. Chamey f/k/a Daniel Garcia prior to the due date of the last Assigned Payment shall not affect the transfer of the Assigned Payments from Petitioner Daniel G. Chamey f/k/a Daniel Garcia to Settlement Funding, and Petitioner Daniel G. Chamey f/k/a Daniel Garcia understands he is giving up his rights, and the rights of his heirs, successors and/or beneficiaries, to the Assigned Payment. F. Pursuant to the Act, this Court orders that Settlement Obligor, Erie Indemnity Company and the Annuity Issuer, Allstate Life Insurance Company are hereby discharged and immune from all liability to the Petitioner, anyone claiming through the Petitioner, or to any other person or entity (except Settlement Funding, LLC per the terms of this Order) for the Transferred Payment or for disclosures made in or related to this Order. G. Compliance with the requirements and fulfillment of the conditions set forth in the Act shall be solely the responsibility of the Transferee in the transfer of the Transferred Payment, and neither Settlement Obligor, Erie Indemnity Company nor the Annuity Issuer, Allstate Life Insurance Company shall bear any responsibility for, or any liability arising from, noncompliance with those requirements or failure to fulfill those conditions. H. All interested parties, including Petitioner, the Transferee, the Structured Settlement Obligor, and the Annuity Issuer shall abide by the terms of the Transfer Agreement in all respects. This Order shall be considered a "qualified order" for purposes of 26 U.S.C.A. § 5891. Notice of the entry of this Order shall be served by Petitioner on all parties and Proof of Service shall be filed with the Court. Jurisdiction shall remain with this Court. BY THE COURT: 6 AUG ' IN THE COURT OF COMMON PLEAS OF CUMBERLAND C~)UNTY PENNSYLVANIA CIVIL DIVISION AUG 0 4 7004 IN RE: PETITION OF DANIEL G. CHAP, NEY F/K/A DANIEL GARCIA TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS : Xo. 0q ORDER OF COURT SCHEDULING HEARING DATE AND NOW, this /t~. day of~ .... 2004, upon the filing and presentation of the Petition to Transfer Structured Settlement Payment Rights pursuant to the Structured Settlement Protection Act, 40 P.S. §§ 4001-4009, it is hereby ORDERED that a hearing thereon is set for the o~//~ day of ~/m'~/~/~ ~ ,2004 at ~: 6r'O t~.m. in Courtroom ¢ before this Court. Petitioner shall provide at least 20 days notice of the time and date set for hearing, a copy of the Petition filed, and the Transfer Disclosure, to the Settlement Obligor, and the Annuity Issuer, as set forth in the Petition, and shall in all other respects comply with the terms of the aforementioned statute. BY THE COURT: Jo IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION PETITION OF DANIEL G. CHARNEY F/K/A DANIEL GARCIA TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS No. 04 - 4026 Civil NOTICE OF PROPOSED TRANSFEI~[ OF STRUCTURED SETTLEMENT PAYMENT RIGHTS Erie Indemnity Company 100 Erie Insurance Place Erie, PA 16530 (Settlement Obligor) Settlement Funding, LLC 6501 Park of Commerce Boulevard Suite 140B Boca Raton, FL 33487 Atto: Jason Sutherland (Transferee) Allstate Life Insurance Company Allstate Plaza West - M3B 3100 Sanders Road Northbrook, IL 60062 (Annuity Issuer) Daniel G. Chamey f/k/a Daniel Garcia 21 Beach Cliff Drive Carlisle, PA 1'7013 (Payee) Please take notice that a Petition to Transfer Structured Settlement Payment Rights has been filed in the Court of Common Pleas of Cumberland County, Pennsylvania. An Order has been issued by the court requiring that responses or objections of the transferee, structured settlement obligor or the annuity issuer, be brought before the court either in writing or in person, or through counsel, at a heating set for September 24, 2004, at 3:00 p.m., before the Honorable Kevin A. Hess, in Courtroom 4 of the Cumberland County Court House. (A copy of the Scheduling Order dated August 19, 2004, is included with this notice). Provided with this notice is a copy of the Petition to Transfer Structured Settlement Payment Rights, including as attachments thereto a copy of the Transfer Agreement, and a copy of the Transfer Disclosure Statement required by 40 P.S. § 4003 (2). Pursuant to 40 P.S. § 4003 (6) notice of the transferee's name, address and taxpayer identification number are as follows: Settlement Funding, LLC 6501 Park of Commerce Boulevard Suite 140B Boca Raton, FL 33487 (TIN: 58-2292928) Respectfully submitted, Jones, Gregg, Creehan & Gerace, LLP Robert L. Monks PA I.D.# 52760 411 Seventh Avenue Suite 1200 Pittsburgh, PA 15219 412-261-6400 Attorney for Petitioner, Daniel G. Chamey f/k/a Daniel Garcia CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of this Notice of Proposed Transfer of Structured Settlement Payment Rights, the Petition to Transfer Structured Settlement Payment Rights and the Transfer Disclosure Statement, and the Scheduling Order setting a Hearing Date have been served via certified mail, return-receipt requested upon the persons and entities, and at the addresses listed above, this 25th day of August, 2004. Respectfully submitted, Jones, Gregg, Creehan & Gerace, LLP Robert L. Monks PA I.D.# 52760 411 Seventh Avenue Suite 1200 Pittsburgh, PA 15219 412-261-6400 Attorney for Petitioner, Daniel G. Chamey f/lc/a Daniel Garcia IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION IN RE: PETITION OF DANIEL G. CHARNEY F/K/A DANIEL GARCIA TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS No. 04-4026 Civil AFFIDAVIT OF SERVICE OF NOTICE OF FILING OF PETITION AND NOTICE OF HEARING Before me, the undersigned authority, personally appeared, Robert L. Monks, who, after being first duly sworn according to law, deposes and says that on August 25, 2004, he served true and correct copies of the Petition of Daniel G. Chamey f/k/a Daniel Garcia to Transfer Structured Settlement Payment Rights including a copy of the Transfer Disclosure, a copy of the Notice of Proposed Transfer of Structured Settlement Payment Rights, and a copy of the Order of Court scheduling the heating date for September 24, 2004, at 3:00 p.m., in Courtroom 4, via certified mail, return-receipt requested, upon the following: Erie Indemnity Company 100 Erie Insurance Place Erie, PA 16530 (Settlement Obligor) Allstate Life Insurance Company Allstate Plaza West - M3B 3100 Sanders Road Northbrook, IL 60062 (Annuity Issuer) and Settlement Funding, LLC 6501 Park of Commerce Boulevard Suite 140B Boca Raton, FL 33487 Attn: Jason Sutherland, Esquire (Transferee) Copies of the certified mail return-receipts are attached hereto as Exhibit "A." Respectfully submitted, Jones, Gregg, Creehan & Gerace, LLP Robert L. Monks PA ID No. 52760 411 Seventh Avenue, Suite 1200 Pittsburgh, PA 15219 412-261-6400 Counsel for Petitioner, Daniel G. Chamey f/k/a Daniel Garcia Swom t~lt.~nd subscribed before me this O~ day of~.lZl~__t TM , 2004. My Commission Expires: 2 · Complete items 1, 2, and 3. Also complete item 4 if Rsstficted Delivery is desired. · Pdnt your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article/~dressed to: Erie Indemnity Company 100 Erie Insurance Place Erie, PA 16530 A. Signature C. Date of Delivery D. Is delivery addressd~m~t fT°mitem 17 [] Yes If YES, enter daiivery address below: [] No I Certified Mail ['~ Express Mail [] Registered ~lllReturn RecelptitIlIIIlI·~ [] Insured Mall ['1 C.O.D. 2. ,a~flcle Numb 7004 0750 0003 5685 6255 (Transfer fron PS Form 3811, February 2004 Domestic Return Receipt · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. · print your name and address on the reveres so that we can returo the card to you. · Attach this card to the back of the mailplece, or on the front if space permits. 1. Article Addressed to: Allstate Life Insurance Company Allstate Plaza West - M3B 3100 Sanders Road Northbrook, IL 60062 A. SignaturCHRIS SHIELOS, AGT. FOR_ . X ALLSTATE INS. CO. ~-3 '~nr~ssee " B. Received by ( P~nted Name) C. Date of Delive~ Aur! -. address different flom ~ 1 ? [] Yes If YES, enter daiivery add below: [] No [] Registered ~Raturn Receipt ~ [] Insured Mail [] C.O.D. 4. Restricted Daiivery? (ExUa Fee) [] yes 0003 5685 6262 2. Art~cleNumbE -~nrq. 0750 PSFo~m381] , _ ary · : · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Settlement Funding, LLC 6501 Park of Commerce Boulevard Suite 140B Boca Raton, FL 33487 Arm: Jason Sutherland [] Agent D. Is deliver) Ilffemnt from item 1 ? [] Yes If YES, enter delivery address below: [] No Service Type ~ertlfled Mail [] Express Mail Rscaipt [] Registered ¢=~'Return [] Insured Mail [] C.O.D. 4. Restricted Delive,ry? (Extra Fee) [] Yes 2. Article Number (Transfer from service 7004 0750 0003 5685 7'054 ~ PS Form 381 1, February 2004 Domestic Return Receipt IN RE: PETITION OF DANIEL : G. CHARNEY f/k/a : DANIEL GARCIA TO : TRANSFER STRUCTURED: SETTLEMENT PAYMENT: RIGHTS : IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 0~-4026 CIVIL ORDER AND NOW, this l~° day of September, 2004, upon the filing and presentation of the Petition to Transfer Structured Settlement Payment Rights pursuant to the Structured Settlement Protection Act, 40 P.S. §§ 4001-4009, and upon request of Petitioner's counsel, it is hereby ordered that the hearing thereon previously set for the 24th day of September, 2004, at 3:00 p.m. shall now be held at 11:00 a.m. in Courtroom 4 before the Honorable Kevin A. Hess. Petitioner shall provide notice of the rescheduled time :for hearing, and sh , in all,~other. respects comply with the terms of the aforementioned statute. KevTA. Hess, J. Robert L. Monks, Esquire . ~.~ ~'.~,~d For the Petitioner ~ :rim ~, IN THE COLrRT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION PETITION OF DANIEL G. CHARNEY F/I<JA DANIEL GAl{CIA TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS No. 04-4026 Civil ORDER AND NOW, this ,~ '/' day of ,~r~d~.r, 2004, upon consideration of the unopposed petition of Daniel Chamey, aka Daniel Serafin Garcia ("Mr. Chamey'') and the Order attached as Exhibit "A" approving the underlying structured settlement, it is hereby ORDERED, ADJUDGED, and DECREED, as follows: 1. This Court has jurisdiction over this matter pursuant to the Pennsylvania Structured Settlement Protection Act, 40 P.S. §§ 4001 et seq. 2. The transfer of structured settlement proceeds (the "Assigned Payments") by Mr. Chamey to Settlement Funding, L.L.C. ("Settlement Funding") as described in the petition in this matter (the "Proposed Transfer"): (i) does not contravene any federal or state statute or regulations, the order of any court or responsible governmental or administrative authority, or any applicable law limiting the transfer of workers' compensation claims, and (ii) is in the best interest of Mr. Chamey, taking into account the welfare and support of Mr. Chamey's dependents, if any. 3. The Proposed Transfer complies with the requirements of the Structured Settlement Protection Act, 40 P.S. §§ 4001 et seq. and 21 Ii,CS 153/1 et seq. BE\327869~2 4. Not less than ten (10) days prior to the date on which Mr. Charney first incurred any obligation with respect to the Proposed Transfer, Settlement Funding provided to Mr. Chamey a disclosure statement in full compliance with 40 P.S. § 4003(2). 5. Mr. Chamey has received independent legal advice regarding the implications of the Proposed Transfer, including consideration of the tax ramifications of the Proposed Transfer. 6. Mr. Charney has given written notice of Settlement Funding's name, address, and taxpayer identification number to Erie Indemnity Company ("Erie") and Allstate Life Insurance Company ("Allstate Life") and has filed a copy of such notice with the Court. 7. Mr. Chamey has timely filed and served on all interested parties, including Allstate Life Insurance Company ("Allstate Life") and The Member Companies of the Erie Insurance Group ("Erie"), a notice of the Proposed Transfer and the application for its authorization in compliance with the requirements of 40 P.S. § 4004. 8. Pursuant to 40 P.S. § 4003, the Proposed Transfer is approved. During the period the structured settlement payment rights are being assigned or encumbered pursuant to the transaction at issue, the designated contingent beneficiary under the Annuity shall be the Estate of Mr. Chamey. Mr. Chamey shall submit to Allstate a written request to change the designated contingent beneficiary under the Annuity to his Estate. However, it is the intention of the parties that the Assigned Payments shall be made to Settlement Funding even in the event of Mr. Chamey's death. 9. Allstate Life shall forward the Assigned Payments, within 7 days of the date due, by check made payable to Settlement Funding, LLC, at P.O. Box 116476, Atlanta, GA 30368- 6476, as follows: $60,000.00 due on August 12, 2008; and $95,000.00 due on August 12, 2013. BE\327869~2 -2 - 10. In the event Settlement Funding further assigns the Assigned Payments (or any portions of them) to any person or entity, Allstate Life will not itself be obligated to redirect the Assigned Payments (or any portions of them) to any person or entity other than Settlement Funding. 11. Settlement Funding shall defend, indemnify, and hold harmless Erie and Allstate Life, and their successors and assigns, from and against any and all liability, including reasonable attorney's fees and costs, for all claims arising out of, related to, or in connection with the Purchase Agreement, the Assigned Paymentss the Proposed Transfer, or any stipulation executed in connection with this matter, except with respect to claims to enforce such a stipulation. 12. Allstate Life's or Erie's lack of opposition to this matter, or its stipulation hereto or compliance herewith, shall not constitute evidence in this or any other matter, and is not intended to constitute evidence in this or any other matter that: a. payments under a structured settlement contract or annuity or related contracts can be assigned or that "anti-assignment" or "anti-encumbrance" provisions in structured settlement contracts or annuities or related contracts are not valid tu~d enforceable; or b. other transactions entered into by Settlement Funding and its customers constitute valid sales and/or loans; or c. Allstate Life or Erie has waived any fight in connection with any other litigation or claims; or d. Settlement Funding has waived any right in connection with any other litigation or claims. 13. Settlement Funding and Mr. Chamey, for themselves and for their respective successors, assigns, heirs, or administrators, or individuals or entities that may claim through them (the "Releasors"), hereby remise, release and forever discharge Allstate and Erie, and their BE~27869~ - 3 - directors, shareholders, officers, agents, employees, servants, successors, executors, administrators, and assigns, and any parent, subsidiary, or affiliate thereof, and their directors, shareholders, officers, agents, employees, servants, successors, executors, administrators, and assigns, past and present (the "Releasees"), of and from any and all manner of actions and causes of action, suits, debts, dues, accounts, bonds, covenants, contracts, agreements, judgments, settlements, damages, claims, and demands whatsoever, in law or in equity, in connection with, related to, or arising out of, any claim or allegation that was or could have been asserted in connection with, related to, or arising out of, the Purchase Agreement, the Assigned Payments, the Proposed Transfer, or any stipulation executed in connection with this matter, which against each other or the Releasees, the Releasors can, shall or may have, except for claims to enforce any party's rights under such a stipulation. DONE 1N OPEN COURT this ~ ~'° day of .f~t~<,- , 2004. BE\327869~2 - 4 - EXHIBIT A BE\327869X2 ELFI~N ~al~IA, SR. , ADMINISTI~T~ OF T~ ~STAT~ OF SEIb%F~N ~IA, II, Plainei£~ WAY, Defendants IN THE COURT OF COMMON PLEAS OF CUMBE~tLA/~D COUNTYt PENNsYLVANiA NO. 3439 1986 CIVIL A~TION - LAW W~ONGFUL DEATH AND SURVIVAL ACTION ORDEIt A~PR0%'ING COMP~0MiS~ AND NOW this /l~aay of Jun~, 1987, upon of Pl=~n~ff in ~e ~ove-captionad proc~ding~ and by therm~o of Le~ Allen and peq~ G~cia, it appearing ~hat ail parties, ~ents, ~ard~ans and ~y pe=son wieh ~y h~ein on b~lf of Plaintiff hav~g join=d in ~ re,est for relief IS ~BY O~D ~ D~C~ED ~ F0~WS: ~. Peg~ G~cia of S86 Lewisberr~ Roan, New C~erlan~, Dennsylv~ia 17070 a~ Pennsylvania National B~k and T~u~ C~p~y =e hereby appointed the lawful co-~ardian= of ~u estate of Daniel Scraf~n ~aruia born 8/12/83. 2. Le~ Allen of 5245 Winding Way, Aperients, Harrisburg, Pe~sylvania 171~9 and National Bank ~d T~se C~pan~ ar~ hereby appoint~ the lawf~l co-guardians of =he estate of S~raf~ Garcia, Jr. born 3. The said ¢o-quardians ~hall zurve without bond and shall have such pOwer~ a~d ~eaponsibilities as are 4. Plains:iff is auth0=ized to eh=er into a full and cu~mle~ ~aeral =elea~e with th~ a~ve-n~ed Defendan~ in ~c~ for ~e ~ of $I0~,000.00 to ~ disbursed a~ herei~ ~et forth. 5. Plaintlff i~ aU~riz~ ~o enter into a full herei~ter Bet fo~ an~ fo~ satlsfacto~ ~araneee of 6. The Plalntlff shall, upon receipt of =he a~ve ~em=rib~ present cash paints of ~s,000.00, disburse ~ar¢i&, II, action. la) $20,000.00 to the estate of Serafin in full and complete settlement of the survival (h) $30,000.00 to Peggy Garcia and Pennsylvania National Bank an~ Trust Company as co-qnardians of the estate of Daniel ierafin garcia.. (c) $30,000.00 %0 Leah Allen an~ Pennsylvanla National Bank ~nd Trust Company am ¢o-~uardlan~ of th9 estate of gerafin Gax¢ia, Jr. (d) $30~000.00 to Elfren Garcia, Sr. and Pennsylvania National ~a~k and Trust Company as =o-guardians of the estaee of Miguel Juan Garcia. - 2 (e) $15,000.00 tO ~lfren Ga~cia, Sr. and Pennsylyaruta National Bank ~nd Trust COmpany as co-guardians of the estate of Dio~isio Se~a£in Ga~cia. (f) $30,000 %o John c. H0wett, Jr., Esquire, as part/al payment of counsel fees, which sum-may be paid by Erie directly to ea~d attorney. 7. The future payments %o be payabl~ by Erie Insurance Company referr~ to generally hereinabove are approved as follows~ (a) To Daniel $~rafin Garcia (DOB 9/12/83), the s~m of $60,000.00 'On his 25t/% birthday (8/12/05); the sum of $95,000.00 on his. 30~h birthday (8/12/13); the sum of $150,000.00 on his 35th birthda~ (~) TO Serafin ~ar¢ia, Jr. (DOB S/~/79), the sum of $45,000.00 on.his ~5%h birthday (8/$/04); the sum of $70,000.0~ on hi= 30th birthday (8/8/09); ~he =u~ of $105,000.00 on his 35~h birthday (¢) TO Migllel J~=n Garcia (DOS 10/~?/75), the ~u~ of $32,500.00 On his 25~h birthday (10/27/00}; the sUm of ~50,000.00 on his 30th birthday (8/27/04}; the sum* of $75,000.00 on his 35%h bir=hO&y (10/27/10). (4) TO Dio~isiO Serafin Gar¢ia (DOB 8/27/74); the sum of $45,000.00 on his 25th birthday (~/~7/99); the sum Of $~5,D00.00 on his 30th birthday (8/27/04); the stun of $105,000,00 on his 35th birthday (8/27/09). - 3 ~ (=) To Jehn C. ~owett, Jr., Esquire, as and for the balance Of.legaX fees, costs and expenses the sum of $§0,000.00 on J~uluary 15, 1989 aha the sum of $54,790.00 en Jan~&ry 15, 1989. BY TRE COiI~T: TRUE COPY FRO~,~ RECORD 0 - 4 - IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA CIVIL DIVISION PETITION OF DANIEL G. CHAR-NEY F/K/A DANIEL GARCIA TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS : No. 04-4026 Civil AFFIDAVIT OF SERVICE. OF FINAL ORDER OF COURT APPROVING PETITION Before me, the undersigned authority, personally appeared, Robert L. Monks, who, after being first duly sworn according to law, deposes and says that on September 24, 2004, he served a true and correct copy of the Final Order of Court entered September 24, 2004, approving the Petition of Daniel G. Charney f/k/a Daniel Garcia to Transfer Structured Settlement Payment Rights via regular U.S. mail, postage prepaid, upon the following: Erie Indenmity Company 100 Erie Insurance Place Erie, PA 16530 (Settlement Obligor) Allstate Life Insurance Company Allstate Plaza West - M3B 3100 Sanders Road Northbrook, IL 60062 (Annuity Issuer) Settlement Funding, LLC 6501 Park of Commerce Boulevard Suite 140B Boca Raton, FL 33487 Attn: Jason Sutherland (Transferee) and Daniel G. Charney 21 Beech Cliff Drive Carlisle, PA 17013 (Payee) Respectfully submitted, Jones, Gregg, Creehan & Gerace, LLP Robert L. Monks PA ID No. 52760 411 Seventh Avenue, Suite 1200 Pittsburgh, PA 15219 412-261-6400 Counsel for Petitioner, Daniel O. Chamey f/k/a Daniel Garcia Swom to ~/~d subscribed before me this ~ day of &~~, 2004. N't3TARY My Commission Expires: 2