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HomeMy WebLinkAbout11-7041MARO & MARO, P.C. By: Robert A. Maro, Esquire Attorney I.D. No.: 89585 1115 West Main Street Norristown, PA 19401 (610) 275-9600 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA RE: Joint Petition of J.G. Wentworth Originations, LLC and C. Keefer NO: 1(- 7041 0,-,v, r ram NOTICE OF HEARING ON PETITION TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS To: State Farm Life Insurance Company Attn. Madis Smith, Esq. One State Farm Plaza Bloomington, IL 61710 State Farm Mutual Automobile Insurance Company Attn. Madis Smit One State Farm Plaza Bloomington, IL 61710 J.G. Wentworth Originations, R,C a? --$ 201 King of Prussia Road `Q? s/11 rn- Radnor, PA 19087 ' V ?- -- CD ?r. N -i O - C% s ; : -rt C. Keefer C -- r. You are hereby given notice that J.G. Wentworth Originations, LLC has filed a petition to transfer structured settlement payment rights. A hearing in this matter has been scheduled on , 2011 at o'clock in courtroom no. courthouse, Cumberland County Court of Common Pleas, Pennsylvania. You are entitled to support, oppose or otherwise respond to the payee's petition, either in person or by counsel, by filing written comments with the court prior to the hearing or by attending the hearing. The Name, Address and Tax Identification number of the transferee is J.G. Wentworth Originations, LLC. 201 King of Prussia Road, Radnor, PA 19087, Tax I.D. No. 20-4728885_. BY: Date ,KoperLj?c iviarokr-squire Attorney for J.G. Wentworth Originations, LLC. 1115 W. Main Street Norristown, PA 19401 (610) 275-9600 (610) 275-9666(facsimile) 04.00 A0 AInq C1t 4(0(8 &c?&q 517 MARO & MARO, P.C. By: Robert A. Maro, Esquire Attorney I.D. No.: 89585 1115 West Main Street Norristown, PA 19401 (610) 275-9600 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA RE: Joint Petition of J.G. Wentworth NO: Originations, LLC and C. Keefer JOINT PETITION FOR PARTIAL TRANSFER OF STRUCTURED SETTLEMENT PURSUANT TO STRUCTURED SETTLEMENT PROTECTION ACT, 40 P.S. 4000, ET SEQ. TO THE HONORABLE. JUDGES OF SAID COURT: And now comes your petitioner, J.G. Wentworth Originations, LLC, by and through its attorneys, Maro & Maro, P.C., and joint petitioner, C. Keefer, and in accordance with the applicable rules of Pennsylvania Civil Procedure, hereby represents as follows: 1. Petitioner is J.G. Wentworth Originations, LLC. ("Buyer" or Transferee"), with an office address located at 201 King of Prussia Road, Radnor, PA 19087. 2. Joint Petitioner is, C. Keefer ("Payee"), an adult individual who resides in the County of Cumberland. For privacy concerns, any and all notices can be sent to 201 King of Prussia Road, Radnor, PA 19087. Petitioner will establish jurisdiction at the time of hearing. 3. This Joint Petition has been verified by the Transferee, J.G. Wentworth Originations, LLC. and the Petition includes all necessary information as prescribed by PA R.C.P. 229.2(d) et al and Section 3 of the Act, 40 P.S. §4001 et seq. 4. Pursuant to PA. R.C.P. No. 229.2(d)(3) there are four (4) attachments incorporated herein as follows: a. PA R.C.P. 229.2(d)(3)(i) Payee's Affidavit in Support of Petition. Please see Attachment/Exhibit "I"; and b. PA. R.C.P. 229.2(d)(3)(ii) An Initial Order of Court Scheduling Hearing; c. PA. R.C.P. 229.2(d)(3)(iii) A certification by Robert A. Maro, Esquire, attorney for transferee, J.G. Wentworth Originations, LLC.; and d. PA. R.C.P. 229.2(d)(3)(iv) A Final Order of Court Granting he Petition. 5. Joint Petitioner, C. Keefer, is the beneficiary of an annuity owned by State Farm Mutual Automobile Insurance Company and issued by State Farm Life Insurance Company. The structured settlement provides payment to the petitioner as described on Attachment/Exhibit "2". 6. Joint Petitioner, C. Keefer, after having the opportunity to have this matter reviewed by independent counsel of his own choosing including the implications of the transfer and any tax ramifications, expressly waived his right to independent counsel. A Copy of Joint petitioner's waiver is attached hereto, incorporated herein and marked Attachment/Exhibit "3". 7. Joint Petitioner, C. Keefer, proposes to enter into a purchase agreement with J.G. Wentworth Originations, LLC., its nominees, successors, or assigns, whose address is 201 King of Prussia Road, Radnor, PA 19087, who will purchase the following from Petitioner's structured settlement as follows: A) 1 payment of $45,525.22 on July 1, 2013 8. The structured settlement is currently owned by State Farm Mutual Automobile Insurance Company and issued by State Farm Life Insurance Company, and the net amount in return payable to C. Keefer is $30,000.00 from Buyer. A copy of the Purchase Agreement, Exhibit "A' to the Purchase Agreement and Disclosure Statement is attached hereto, made apart hereof, and designated Attachment/Exhibit "4". 9. The net amount payable to the payee after deduction of all commissions, fees, costs, expenses, and charges is $30,000.00. 10. Based on the net amount that the payee will receive from this transaction $30,000.00 and the amounts and timing of the structured settlement payments that would be assigned, the payee is, in effect, paying interest at a rate of 24.96% per year. 11. The Buyer furnished C. Keefer with a Disclosure Statement pursuant to 40 P. S. 4003 (See Attachment/Exhibit "4") at least ten (10) days prior to the date on which C. Keefer first incurred any obligation to the Buyer. 12. PA R.C.P. 229.2(b) requires the petition to be filed in the county in which the payee is domiciled (See also Section 4 of the Act 40 P.S. §4004). PA.R.C.P. 229.2(c) also requires both the Transferee and Payee to be parties to the Joint Petition. Both requirements have been fulfilled herein. 13. Written notice of the Transferee's Names, address and taxpayer identification number has been given to the Annuity Issuer and Structured Settlement Obligor. A copy of the Notice to the structured settlement obligor is attached hereto as Attachment/Exhibit "5". Joint Petitioners wills also serve written notice as required by 40 P.S. 4004 upon all interested parties. 14. The Joint Petitioner's best interest would be served by granting the relief requested herein for the following reasons. Joint Petitioner is widowed and has two (2) minor children. Joint petitioner has never transferred payment from the annuity in the past. Joint Petitioner is employed. Petitioner recently had back surgery and owes a great deal of money in medical bills, Further, Petitioner has two (2) minor children to care for and the money will be used to help support her family. All of the reasons for the transfer shall be expanded upon at the time of trial, however based upon the foregoing, it is clearly within the best interest of Petitioner and her minor children to approve the transfer at this time. WHEREFORE, Joint Petitioner's respectfully requests this Honorable Court to enter the Initial Order attached to this petition which shall schedule a hearing so that Transferee and Payee shall have the opportunity to discuss the purpose and reasons for the transfer and after hearing thereon, respectfully request that this Honorable Court enter a Final Order approving the Transfer of Structured Settlement Payments Rights as is mentioned herein. Maro & Maro, P.C. Respectfully Submitted: By: ,Kobert A. Maro, Esquire Attorney for Transferee "V'E?CATION I, Lori Borowski, Vice President of JG Wentworth Originations, LLC, have read the foregoing Petition to Transfer Structured Settlement Payment Rights between J.G. Wentworth Originations, .LLC and k -cc f tr- and hereby aver that the statements corrtained therein.are true and correct to the best of my knowledge, information and belief. This Veoficatian is made subject to the penalties of 18 Pa.C.S.A. Section 4904 relating to the unworn falsification to authorities. (?.L . . " LG,? Lori Borowski, VP Date CERTIFICATION OF ATTORNEY FOR TRANSFEREE I, Robert A. Maro, Esquire, attorney for Transferee, J.G. Wentworth Originations, LLC, hereby certify to the best of my knowledge, information and belief, formed after reasonable inquiry, that the Transfer will comply with the requirements of the Act (40 P.S. § 4000 et seq.) and will not contravene any other applicable federal or state statute or regulation or the order of any court or administrative authority. I, Robert A. Maro, Esquire, attorney for Transferee, J.G. Wentworth Originations, LLC, hereby verify that the facts and statements set forth herein are true and correct to the best of my knowledge, information and belief. I understand that false statements made herein are subject to the penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn falsification of authorities. ?I Date I?,6bert A. Maro, Esquire /Attorney for Transferee, J.G. Wentworth Originations, LLC MARO & MARO, P.C. By: Robert A. Maro, Esquire Attorney I.D. No.: 89585 1115 West Main Street Norristown, PA 19401 (610) 275-9600 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA RE: Joint Petition of J.G. Wentworth Originations, LLC and C. Keefer NO: CERTIFICATE OF SERVICE 1, Robert A. Maro, Esquire, hereby certify that a true and correct copy of the Petition for Transfer of Partial Structured Settlement has been served upon the following entities via first class mail and/or certified return receipt requested and/or email on : To: State Farm Life Insurance Company J.G. Wentworth Originations, LLC Attn. Madis Smith, Esq. 201 King of Prussia Road One State Farm Plaza Radnor, PA 19087 Bloomington, IL 61710 State Farm Mutual Automobile Insurance Company C. Keefer Attn. Madis Smit One State Farm Plaza Bloomington, IL 61710 Date: / -1.9_{ By: tbtomey bert A. Maro, Esquire for J.G. Wentworth Originations, LLC MARO & MARO, P.C. By: Robert A. Maro, Esquire Attorney I.D. No.: 89585 1115 West Main Street Norristown, PA 19401 (610) 275-9600 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA RE: Joint Petition of JG Wentworth NO: Originations, LLC and C. Keefer . Entry of Appearance TO THE PROTHONOTARY/CLERK OF SAID COURT Enter my appearance on behalf of: JG Wentworth Originations, LLC. Papers may be served at the address set forth below. By: Respectfully Submitted: Maro & Maro, P.C. bertaro, Esquire Attorney I.D. No 89585 Maro & Maro, P.C. 1115 W. Main Street Norristown, PA 19401 (610) 275-9600(office) (610) 275-9666(Fax) ATTACHMENT/EXHIBIT 6619! Payee's Affidavit in Support of Petition to Transfer Structured Settlement Rights I, G?IlKeefex, the payee, verify that the statements below are trae and carrect: Payee's name, address and age: (311NEeefer, 1. Marital Status: X - Widowed; Married; Separated; Divorced 2 Minor Children and other dependents: 1.) AJ=Keefer, ageZresides with me 2.) PUM Sample, age 6, resides with me 3. Income: I azn currently a Nurse Assistant/Activities Coordinator at My currerit montlily income is $1,500. 4. Child support, alimony or alimony pendente lite: Obligation to pay: Yes -X No _S. Previous transfers: Have you previously filed a petition to transfer payment rinhts under the structured settlement that is the subject of this petition'? Yes ...--X --.-No 6. Reasons for transfer: I recently had a back surgery, August 8, 201 1, which I will need to pay off as soon as possible. I also have 2 minor children that I need to support, which is very difficult to properly accomplish in my current situation, as I have a very small monthly income. In addition to providing adequate support for my family. I also have numerous medical bills that have accumulated which 1 would like to 6 t'd 099999LL 6L Aepno edoH EEV:90 t L 6Z Onb' catch up on. Lastly, I need a means to pay my-rent, so that my family has a place to live. This transaction would be greatly beneficial for nue to complete, and would allow me not only to pay off medical bills, but to provide a stable financial future for my family, 7. 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 Verification 1 verify that the statements made in this affidavit are true and correct. 1 understand that Use statements herein are made subject to the penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authorities. DATED: 07,,d ON999LL LL. C1r Ccefer Aellno edoH 9£V-90 L L 6Z BnV ATTACHMENT/EXHIBIT 442" 08-19-'11 12:58 FROM-footlocker g/1 I Owner FU?.I NAME 2 Payee T-965 P025/015 F-860 3 Beneficiary rUll NAME 00 $a PANOW & u4sm Miller same address as payee 140/3$ Parents ! I I 4 $27,143.66 due 7-1--2005 $71,876.03 due 7-1-2009 $45,52$.2R dw 7-1-M13 Dal >ooZnjaruarv 8 1997 _ _ at I . I (?. , SI k4vfimm Life - APPLICATION FOR SINGLE PREMIUM ANNUITY CERTAIN ATTACHMENVEXHIBIT "3" Account @: 2$9307 Please complete and sign. STATr.MFNT OF YROFESSIOl*IAL iZEPRES .N?A7'ION Please Choose Either Box A.O Box .Q Below. After you have made your choice, SIGN AND DATE the appropriate box signature tine. YOU SBOULD SIGN ONLY ONE 130X- THE BOX YOU HAVE CHOSEN, A. I HAVE BEEN ADVISED BY J.G. WENTWORTH ORIGINATIONS, L C ('JGW") THAT I SHOULD OBTAIN INDEPENDENT PROFESSIONAL REPRESEN'T'ATION CONCERNING TIIE: LEGAL, TAX ANDIOR FINANCIAL IMPLICA71ONS OF THIS TRANSACTION. I FULLY UNDERSTAND THE PURCHASE AGREEMENT AND THE IMPLICATIONS OF THE TRANSFER, INCLUDING THE TAX RAMIFICATIONS OF THE TRANSFER AND I D NOT WISH TO SEED OUT SUCH INDEPENDENT PROFESSIONAL REPRESENTATION. c Date B. I HAVE OBTAINED INDEPENDENT REPRESENTATION AND I FULLY UNDERSTAND THE LEGAL, TAX ANDIOR FINANCIAL IMPLICATIONS OF THE TRANSACTION, THE PURCHASE AGREEMENT AND THE RELATED DOCUMENTS. I WAS NOT REFERRED TO MY PROFESSIONAL ADVISOR BY JGW, THE NAME OF MY PROFESSIONAL ADVISOR IS SET FORTH BELOW: cii KEW90 Date To Be Compleded By CertNed Profemional Advisor Only ifyou have signed Box B Above Name of Professional: Phone Number. L? Address: Attorney ID # I have provided independent professional advice to _ contemplated thereby. Christina Keefer wes referred to me by the Professional's Signature in respect of the Purchase Contract with JG W and the transaction Date SSC.Comractl41 (' Wentt+r1111 !7rtin:uiuns_.J" b l'd 099999LL LL Aelln;D edoH aZtr:80 L L 6Z Bny ATTACHMENT/EXHIBIT 6(4" Account TD 289307 PURCHASE CONTRACT This is a Purchase Contract ("Contract") for the sale of structured settlement payments between (Keefer (You, Your), with legal residence at and I.G. Wentworth Originations, LLC (We, Us, Our) 3993 Howard Hughes Parkway, Suite 250, Las Vegas, NV 89169-6754. BACKGROUND A. In connection with the resolution of a personal injury claim, You or somconc acting for You, signed a Sertlement Agreement that entitles You to receive certain future payments ("Settlement Payments"), according to a set schedule. B. Those Settlement Payments are being paid to You from an annuity policy ("Annuity Policy") purchased by the person responsible for rrmking the Settlement Payments to you ("Obligor"). C. Rather than wait for the Settlement Payments to be made to You in the future, You want to sell all or some of those Settlement Payments ("Purchased Payments") to Us now for a lump scan. DEFINED WORDS Certain words used in this Contract have specific meanings, shown below. Annuity Policy The policy purchased by the Obligor to ensure that the Settlement Payments are made to You as required by the Settlement Agreement. Closing Documents Any documents necessary to carry out the purchase of the Purchased Payments, other than the "Contract or Contract .Documents" as defined below. Contract or Contract Documents Collectively, only this Contract and the Disclosure Statement. Contract Date The date Your signature at the end of this Contract is notarized. However, if You happen to sign this Contract before the number of days stated at the end of Your Disclosure Statement for waiting has passed, You will have no obligation under Your Contract until that time has passed. Court Order A legally binding ruling issued by a judge or properly etnpowered administrative officer, approving the sale of the Purchased Payments to Us ("Court Approval"). Disclosure Statement The document which identifies for You, the Purchased Payments, expenses, Purchase Price and various other disclosures. Encumbrance Any claim, right, lien, policy loan, or restriction. In addition, this includes any limits on rights of ownership (such as the use, voting, transfer, receipt of income; etc.). Fending Date The date We pay You the Net Purchase Price. Issuer "The insurance company that issued the Annuity Policy. Obligor The Person who is obligated to make payments to You under the Settlement Agreement. L'd 098999LL 6Z Ae11n0 edoH BL£*90 b 6 6Z Ony Accountl0: 289307 Party Onc of You or Us. Parties means both You and Us. Person Any natural person or legal entity. Purchased Payments Only those certain payments that We are purchasing from You under this Contract. Purchase Price: Gross Purchase Price The amount shown as the "gross amount payable to the seller (You)" on the Disclosure Statement. This is the Sum We have agreed to pay You before any deductions as set forth in the Contract Documents. Net Purchase Price Tho amount shown as the "net amount payable to the seller (You)" on the Disclosure Statement, This is the sum We have agreed to pay You after any deductions as set forth in the Contract Documents. Settlement Agreement The agreement that You and the Obligor signed to resolve Your personal injury claim. Settlement Payments All of the payments that the Obligor has agreed to make to You in the Settlement Agreement. We, Our, or Us J.G, Wentworth Originations, LLC, along with any of its successors, assigns, and designees. Some of the Contract Documents or Closing Documents may refer to Us as the purchaser. You or Your The Person named on this Contract's firstpage. Some ofthe Contract Documents or Closing Documents may refer to You as the seller. You and We agree as follows: 1. SALE C .F TI-Jg PURCHAS_qD PAYMENTS A. Upon the signing of this Contract and subject to certain conditions including Court Approval, You sell, transfer and assign to Us the right to receive the Purchased Payments specifically identified in the Disclosure Statement. B. We will pay You the Net Purchase price as agreed to in the Contract Documents, subject to certain conditions. including meeting Our underwriting requireinents, Court Approval and satisfactory completion of the Closing Documents. We will do this in exchange for You: • Selling the Purchased Payments to Us; • changing the beneficiary of the Annuity Policy to Your estate and not changing it again until. We have been paid all of the Purchased Payments; • having any current beneficiaries waive their rights to the Purchased Payments; and • fulfilling Your promises under this Contract.. 2, PURCHASE PRICE A. The Gross and Net Purchase Prices are shown on the Disclosure Statement and are fair and acceptable to You and Us. B. We will pay You The Net Purchase Price in the manner You designate for Us. C. Before we pay You, You agree that We will adjust for the foltowing amounts, if applicable! 9-d 09999OLL 6L Aepno ed0H egg:90 L t 6Z 6ny Account ID: 289307 • Purchased Payments Owed to Us- The Issuer may have already paid You some of the Purchased Payments before We have paid You for them. If that happens, We will deduct the amount of those Purchased Payments. • Holdbacks - Due to possible delays in the Issuer beginning to make the Purchased Payments to Us instead of You, We will hold back an amount equal to any Purchased Payments that the Issuer owes You within 90 days of the Funding Date. If We subsequently receive those particular Purchased Payments directly, We will return (lie amount of any related holdback to You. • Payment of Debts Owed - If You owe any past due child support, bankruptcy payoffs or taxes, or have any judgments or liens against You or Your amets, NVe may pay those amounts and deduct them from the amount We pay You. We will first confirm those amounts with You. D. If any Pin-chased Payments are mistakenly sent to You after we have paid You for them, You will immediately contact Us. If we then determine that any deductions or holdbacks as set forth above are not enough to reimburse Us, We will advise You of the amount You owe Us. You agree to immediately send that amount to Us by bank or certified check. 3. YOUR R>EPRESENTAT AIMS- AND WARRANTIES You represent and warrant to Us the following: A. You understand that THIS I5 A SALE AND NOT A LOAN. B. The Annuity Policy is in full force, You are the sole and undisputed recipient of the right to the Purchased Payments and have the right to sell them, free and clear of any Encumbrances. C. You understand that Court Approval is required for this purchase; and You agree to fully cooperate with Us to obtain that approval. D. You gave Us all requested information and signed originals of all documents necessary to complete the purchase. Every statement made by You in the Contract Documents and Closing Documents is true and complete. E. No law, divorce decree or other legal obstacle • requires You to keep the Purchased. Payments for the benefit of a current or former spouse, dependent children, or other person; or • legally prevents You from contracting with Us, selling the Purchased Payments or changing the Annuity Policy's beneficiary. F. Either: • You have never filed for bankruptcy, will not do so before the Funding Date and there are no lawsuits or efforts by any of Your creditors to put You into bankruptcy or take any of the Purchased Payments; or • If You filed for bankruptcy, the Purchased Payments were not subject to the claims of Your creditors. You will give Us a copy of any of Your bankruptcy documents that We request including evidence of a final bankruptcy payoff, if such is the case. G. We can rely on Your representations, warranties, and promises in this Contract. These representations, warranties, and promises are for Our benefit and the benefit of any future owners of the Purcliaaed Payments. You understand that any violation of Your representations or warranties may he an actor fraud by You under applicable state taw, which could result in You being held responsible for damages in favor of Us, with money to be paid by You to Us. 1-1. You had enough time to consider the'sale of the Purchased Payments, understand the terms of the Contract Documents and Closing Documents, are of legal contracting age and sound mind, not under the influence of drugs or alcohol, and freely and voluntarily, enter into this Contract and agree to all of its terms. 6,d 098999LL 1,L A911no edoH E6E'80 L L 6Z Ony Account ID; 294307 t. You were advised by Us to obtain independent legal advice and professional tax advice about the sale of the Purchased Payments and to have those advisors review the terms and legal, tax and other effects of this Contract with You prior to Your execution of this Contract You have also explored all appropriate financial options before entering into this transaction. J. We did not provide tax, financial, or legal advice to You about this Contract and have advised You that We may not refer You to any specific attorney for such purpose. K. IfY"ou are married, Your spouse understands all of the terms and conditions of this Contract including, but not limited to that You and Your spouse will not receive the same amount of money as You would receive under the Annuity Policy payments- Your spouse gives up any property rights he or she may have in the Purchased Payments. L. We may soil, transfer, or assign Our right to the Purchased Payments in a sale, securitization, or other Financing transaction (resale). Any resale would involve disclosing certain information about You (including Your personal information) to the parties to a resale. M. Any future owner of the right to die Purchased Payments will have all of the same rights We have and duties You owe Us under this Contract. This includes the right to make a claim against You for violating any of the representations, warranties, or promises You made im this Contract. 4. YPi3BY OMISF __,S To U Before and after the Rondim Date: A. You will tell us right away if Your address or telephone number changes and do everything necessary, including completing and signing all documents to: • sell the right to the Purchased Payments to Us and change the beneficiary as required by this Contract; and • correct any documentation errors in the Contract Documents or Closing Documents. S. You will also tell Us if any of the 'following occurs: • a violation of this Contract; or • anything that could negatively affect the Annuity Policy, the Purchased Payments, or this Contract. C. You will not: • agree to sell the Purchased Payments to any Person other than Us; • change the Annuity Policy's beneficiary to any Person other than Your estate until We have collected all of the Purchased Payments; or • withdraw cash from, borrow against, or change the Annuity Policy. D. You will give Us information necessary to update Your representations, warranties, and promises in this Contract. You will also update any documents and information so they will be true and complete on the Funding Date. E. We are now, and will continue in the future, to rely on the representations and warranties You have given Us. We will confirm the accuracy of Your representations and warranties. You must cooperate with this confirmation and provide complete access to any information We believe necessary. F. You agree that updating representations, warranties, promises, documents and other information will not cure a breach of any representation or warranty made by You that was not true and complete. G. You agree that Our liability to You under this Contract is strictly limited to the requirement to pay You what We owe ,. .,., , I 0 1'd 098999LL i,L iie1lnC edoH e60:90 l l 6Z dny Accotu t la.. 289307 You under the terms of this Contract, after receipt and approval of the Closing Documents, final underwriting approval and Court Approval. Under no circumstances will We be liable for any consequential damages. 5. CANCI&LLATI!QN _US -, BY We may cancel this Contract before the Funding Date if: A. You breach any representation, warranty, or promise in any Contract Documents or Closing Documents. B. The petition for the Court Order is contested, opposed, or not app7oved. C. We are sued or threatened with a lawsuit about this Contract or the Annuity Policy. D. There is any threatened, pending, or final action, or change in law or rule challenging the legality of, or negatively affecting this transaction. E. You file for, or are forced into bankruptcy. You die. G. Final approval has not been givers by Our underwriting department. H. The Purchase Contract is not signed by You and received back by Us by October 03, 2011. A major rating agency downgrades the Issuer's credit rating. The Issuer is, or becomes insolvent, orunder regulatory supervision. 6. .C?'ANQL9LLATION RY. YO(; A. (1) YOU MAY CANCEL THIS CONTRACT WITHOUT PENALTY OR FURTHER OBLIGATION AT ANY TIME WITHIN FIVE (5) BUSINESS DAYS AFTER THE DATE YOU RECEIVE PAYMENT HEREUNDER FROM US. IN ORDER FOR THE CANCELLATION TO 13E EFFECTIVE, YOU MUST SEND A NOTICE POSTMARKED AT ANY TIME WITHIN FIVE BUSINESS DAYS AFTER YOU RECEIVE PAYMENT HEREUNDER FROM US (This Is the rescission period). (2) YOUR NOTICE IS TO BE SENT EITHER BY CERTIFIED OR REGISTERED MAIL (RE-rU1LY RECEIPT REQUESTED) OR FEDEX OR ANOTHER MAJOR OVERNIGHT DELIVERY SERVICE. THE NO'l'1CE MUST INCLUDE A BANK OR CERTIFIED CHECK MADE PAYABLE TO CIS, IN THE FULL AMOUNT RECEIVED BY YOU. YOUR NOTICE MUST BE SENT TO: J.G. Wentworth Originations, LLC Attention., Manager of Operations 3993 Howard Hughes Parkway, Suite 250 Las Vegas, Nevada 89169-6753 - !ii: " I : : tl . 1 1 t 6 l'd 098999LL U Aepno ed0H e0t:90 ? 6 6Z bny Account ID, 289307 41. GEORGIA RESIDENTS: YOU IMAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO 5:00 P.M. OF THE TWENTY-FIRST DAY FOLLOWING RECEIPT OF THE ENCLOSED "NOTICE OF CANCELLATION RIGHTS" FORM, OR AT THE HEARING ON THE APPLICATION FOR AUTHORIZATION OF A TRANSFER OF STRUCTURED SETTLEMENT PAYMENT RIGHTS, OR AT ANY TIME WITHIN FIVE (5) BUSINESS DAYS AF'T'ER YOU RECEIVE PAYMENT HEREUNDER FROM US, WHICHEVER EVENT OCCURS LAST (This Is the Georgia rescission period). IN ORDER FOR THE CANCELLATION TO BE EFFECTIVE, YOU MUST SIGN THE ENCLOSED "NOTICE OF CANCELLATION RIGHTS" FORM AND MAIL OR DELIVER rl' T'O US AS SPECIFIED IN THAT NOTICE. C. WFST YIRQINLA.RESIDEIVTS; IN ORDER FOR YOUR CANCELLATION TO BE EFFECTIVE, YOUR NOTICE CAN BE SUBMITTED VIA PHONR, MAIL, OR FACSIMILE. ANY AMOUNTS ADVANCED BY US IN CONTEMPLATION OF THE TRANSFER SHALL BE IMMEDIATELX REFUNDED TO US. IF YOU DISMISS YOUR ACTION AVI'ER APPOINTMENT OF A GUARDIAN AD LITEM, OR RESCIND YOUR TRANSFER AGREEMENT (PURCHASE CON'T'RACT) WITHIN THE RESCISSION PERIOD IN 7(A) (1) ABOVE, YOU SHALL RE RESPONSIBLE FOR THE FILING FEE AND ANY GUARDIAN AD LITEM FEES. 7. NOTICES A. All notices about this Contract must be in writing. B. All notices must be sent either by: (1) certified or registered mail (return receipt requested); or (2) FedEx or another major overnight delivery service and are considered given when delivered as follows: If to You: to Your address listed on the first page of this Contract- If to Us: to the address listed in Section 7(A) (2) of this Contract. 8. EVENTS OF DEFAULT You will be in default if You: A. fail to comply with any terms or conditions of this Contract; or B. breach any of Your representations, warranties and promises in this Contract. If You are in default, We have the right to sue You in court to make You perform Your promises or to get money from You. 9. MISCELLANEOUS A. We can do background checks on You, including from the credit bureaus, in order to verify your legal residence and other contact information. B. 'litis Contract is the entire agreement between You and Us. C. If there is more than one of Us or You, this Contract applies to all of those people together, and to each of them on their own. D. Both Parties must agree in writing to any change to this Contract or waiver of its terms. E. If a court undoes any part of this Contract, the rest of the Contract remains valid. You cannot voluntarily or involuntarily sell, assign, or transfer this Contract, or any of Your rights or duties under this Contract, G. The law of the state of Your domicile (where You regularly reside on the Contract Date) will govern ibis Contract. The Parties must litigate any dispute arising under this Contract in that state's courts and the Parties agree to the jurisdiction of that state's courts. Z6'd 090999LL 6L Aeilno 9d0H 8W90 6 L 6Z 6ny AccountrD: 289307 H, This Contract also holds responsible Your heirs, and executors. This Contract benefits only You and Us, and no one else. However, if permitted to be, and if properly assigned, this Contract will bind and benefit the respective successors and assigns of the Parties. 1. Failure to enforce any provision of this Contract is not a waiver of that provision. J. The Parties may sign this Contract in one or more counterparts. Each counterpart will be considered an original. All counterparts will form one Contract. K. We have investigated the proposed transfer of the purchased Payments and, in light of information available to Us, have identified no violation of any applicable state or federal law. L. You will Twt receive an IRS Form 1099 from Us. M. Titles and headings in this Contract are for convenience only. Do not use them to interpret this Contract, N. Except as otherwise set forth in this Contract, You and We will pay our respective costs and expenses in carrying out this Contract You and We, intending to be legally bound, have signed this Contract as of the Contract Date below, and agree to all of its terms and conditions. By signing below, You also acknowledge that You were advised by Us in writing, that You should obtain independent legal advice and professional tax advice about the sale of the Purchased Payments and to have those advisors review with You, the terms and legal, tax and other effects of this Contract. Sworn to and subscribed SELLER: before me this :,2 9 day of , )yb , 201 ("Contract U Uate'? Nota Sworn to and subscribed SELLER'S SPOUSE (if applicable) before me this day of , 20_ Notary .? Spouse ..?.mWmdo...... ENNSYLVANIA al COM=?VC tary Public erl" Count)' Up Feb, 29 2013 Me er. PeAssodat?r? til Notaries US: J.G. Wentworth Originations, LLC BY: Sam Gottesman, Underwriting Manager +' 2(111 J.6. 4ti'enl.:oril, v)rigiamr,"5. 1. LC £ l 'd 098999LL LL ,(ellno edoH aLt:go L L 6Z 6n.y 08-19-'11 12;59 FROM-footlocker g/1 T-965 P002/015 F-860 A=Dmt ID: 13MI August 18, 2011 PENNSYLVANIA DISCLOSURE STATE EN We will purchase the following payments (Purchased Payments) from You: A)1 payment of $45,525.22 on July 1, 2013 (The remainder of the page Intentionally left blank) •1- `?nw.1 1. P, . nik%• M 111141r 1161!:, .-I .. 111 08-19-'11 12.55 FROM-footlocker g/1 T-965 P003/015 F-860 ACCOUnt IV' XIMU/ August 18, 2011 The aggregate amount of the Purchased Payments is $45,525.22. The discounted present value of the aggregate Purchase Payments at the federal interest rate of 2.20% is $43,708.18. The discounted present value is the calculation of the current value of the transferred structured settlement payments (Purchased Payments) under federal standards for valuing annuities. The gross amount payable to seller (You) is $309000.00. The net amount payable to the seller (You) is $30,000.00. Legal fees (this is an estimate of what Your attorn-ey will charge You if You choose not to waive representation): $500.00 No other expenses are incurred by You. The net amount that You will receive from Us in exchange for Your future structured settlement payments represents 68.60% of the estimated current value of the payments based upon the discounted value using the applicable federal rate. Based on the net amount that You will receive in payment from Us and the amounts and timing of the structured settlement payments that You are selling to Us, this is the equivalent of interest payments to Us at a rate of 24.96% per year. PLEASE 140TE THAT THIS IS NOT A LOAN, BUT A SALE OF PAYMENT RIGHTS AND THE INTEREST FIGURE IS ONLY PROVIDED AS AN ILLUSTRATION OF THE ECONOMIC IMPACT OF THE SALE. Please be advised there are no penalties or liquidated damages payable by you in the event of any breach of the transfer agreement by you. By signing below, You are confirming receipt of this Disclosure Statement at least 10 days prior to You first incurring an obligation with respect to the transfer agreement (Purchase Contract). EFER ?"°"` sYarr xF.,x? -2- Y., mot) J.G. Wena orth 0 8inaltons.1.1,C IMPORT NS NOT You are strongly urned to consult with an attorney who can advise you of the potential tax consequences of this transaction. Tay: ?' -R--IL '---w REEFER Sworn to and subscriber! Befo 1s e this slv of , 21) Notary COMMONWEALTH OF PENNSVWANIA No oMbl Seel Hope L. Ctilky, NotON °u: • ,c Upper Allen 7wp., Cumnsn-••t, County M aortYMNNbn Iris Pel,. 28, 2013 Member. Pennevlv'ama Aemdatlon of Notaries .+. U011 I (cI R'uthKndi I A i tut:uitm;. I LC 9 ?'d 099999LL lL A911no ad0H 801"90 66 6Z and ATTACHMENT/EXHIBIT 6(5" zr) . September 7, 2011 State Farm Life Insurance Company One State Farm Plaza Bloomington, IL 61710 Attn: Legal Department/Structured Settlements State Farm Mutual Automobile Insurance Company One State Fan-n Plaza Bloomington, IL 61710 Attn: Legal Department/Structured Settlements RE: Notice of Sale/Assignment of Payment Rights Your Contract #: LF1514M Payee: G4Mk Keefer Dear Insurer: Please be advised that I.G. Wentworth Originations, LI,C and/or its successors and assigns, have entered into a transaction with the above-referenced annuitant who is seeking to transfer certain of his/her rights to the payments scheduled to be received under the above-referenced annuity policy. We are currently seeking court approval pursuant to the applicable structured settlement transfer statute. Pursuant to the statute, please note the following information about the Purchaser: J.G. Wentworth Originations, LLC 201 King of Prussia Road, Suite 200 Radnor, PA 19087 Tax ID # 20-4728885 PLEASE NOTE: No payments under this annuity should be held until the courts have entered a final order and we have forwarded this order to you. Very truly yours, J.G. Wentworth Originations, LLC J By: Lori Borowski, Vice President 201 KINEi OF PRUSSIA ROAD, SUITE 200 • RAsDNOR, PA 19087 PHONE: (600) 790-4016 • FAX: (215) 567-6096 Reserved for Court Use. EILEU-O 1' iCE L THE r ROTHnNOTi-N,,"; , 2011 SEP 14 Ali 9- r5 CUMBERLAND COUNT). PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA r?nI ?1 RE: Joint Petition of J.G. Wentworth NO: I 1 Originations, LLC and C. Keefer t INITIAL ORDER OF COURT On this ?`day of 2011, it is ordered that a hearing on this Petition to Transfer Structured Settlement Payment Rights will be held on ? 1? , 2011, in Courtroom c? at ,OV o'clock. - The payee shall bring income tax returns for the prior two (2) years to the hearing. Within seven (7) days, the transferee shall give notice of the hearing date to the payee, the structured settlement obligor, the annuity issuer, the payee's spouse and any person receiving child support, alimony, or alimony pendente lite. The transferee shall attach a certificate of service to the notice of hearing date. A copy of the notice with the certificate of service shall be filed with the court prior to the hearing. A rte, E? v BY THE COURT: