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HomeMy WebLinkAbout12-4580 MARO & MARO, P.C. By: Robert A. Maro, Esquire Attorney I.D. No.: 89585 1115 West Main Street Norristown, PA 19401 (610) 275-9600 ao ?? ?uL 2 3 19,1" rN ? P/Cc?na? "" ?n J Lem IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA RE: Joint Petition of J.G. Wentworth NO: ? - q bjo " - ?l L Originations, LLC and Branden Hippensteel ?rVII) 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, Branden Hippensteel, 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, Branden Hippensteel ("Payee"), an adult individual who resides in the County of Cumberland, 126 Beech Street, Carlisle, PA 17013-3161. 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. C# 5,9 22 6 PP-J'- ;_'7,29 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, Branden Hippensteel, is the beneficiary of an annuity owned by American General Assignment Corporation and issued by Western National Life Insurance Company. The structured settlement provides payment to the petitioner as described on Attachment/Exhibit "2". 6. Joint Petitioner, Branden Hippensteel, 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, Branden Hippensteel, 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 $130,000.00 on March 11, 2014; and B) 1 payment of $6,500.00 on March 11, 2019; and C) 1 payment of $4,500.00 on March 11, 2024; and D) 1 payment of $36,584.90 on March 11, 2029. 8. The structured settlement is currently owned by American General Assignment Corporation and issued by Western National Life Insurance Company, and the net amount in return payable to Branden Hippensteel is $110,000.00 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 $110,000.00. 10. Based on the net amount that the payee will receive from this transaction $110,000.00 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 15.08% per year. 11. The Buyer fiimished Branden Hippensteel 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 Branden Hippensteel 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 single and has one (1) minor child. Joint Petitioner is transferring a partial amount of the structured settlement. The purpose of this transfer is to assist Petitioner and family with purchasing a home, free and clear. Petitioner wants to have a stable environment for himself and his family and believes with the state of the real estate market, he can obtain a great deal that will provide his family with a stable environment for the rest of their lives. Petitioner has thought about this decision thoroughly and believes that this is in his best interest and that of his family's to proceed with this transaction. Based upon the foregoing which shall be expanded upon at the time of trial, the transfer is clearly within the best interest of Petitioner and family. 15. In accordance with Cumberland County Local Rule 208.3(a)(2), no other petitions or similar matters have been filed regarding his case. 16. This is a Joint Petition and notice of the petition has been sent to all interested parties in accordance with the applicable rules of civil procedure. As of date, no objection has been filed or received by joint Petitioners. 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. S By: 06errlt(A. 1 o, Esquire Attorney for Transferee • r 5 VERIFICATION T, Lori Borowski, Vice President of J.G. Wentworth Originations, LLC, have read the foregoing Petition to Joint Petition to Transfer Structured Settlement Payment Rights and hereby aver that the statements contained therein are true and correct to the best of my knowledge, information and belief. This Verification is made subject to the penalties of 18 Pa.C.S.A. Section 4904 relating to the unsworn falsification to authorities. L or' Borowski, Vice President ? - I `I 2') 12 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 unworn falsification of authorities. T; Date I36bert 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 NO: Originations, LLC and Branden Hippensteel CERTIFICATE OF SERVICE I, Robert A. Maro, Esquire, hereby certify that a true and correct copy of the Petition for Transfer of Partial Structured Settlement has been served upon the following entities via first class mail and/or certified return receipt requested and/or email on : To: Western National Life Insurance Company J.G. Wentworth Originations, LLC Attn. Legal Dept./structured Settlements 201 King of Prussia Road 205 E. 10th Street Radnor, PA 19087 Amarillo, TX 79101 Attn: Legal Dept/Structured settlement American General Assignment Corporation Branden Hippensteel Attn. Legal Dept/structured Settlements 205 East 10th Avenue Amarillo, TX 79101 Date: 74 q-1 By: A. Maro, Esquire -y 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 Brandon Hippensteel 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. Respectfully Submitted: Maro & Maro, P, By: btrt A. Maro, 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 "I" 1 Jul 17 12 01 ?03p Hope Colley 7177666860 p.10 I i Payee's Aflidavit in Support of Petition to 't'ransfer Structured Settlement Rights 1, -Brendan H ippersteel, the paycc. verity that the statements below are true arjd ;,arreci: Payee's name, address and age: Brendan I lippensteel. 126 Beech St, I Carlisle, PA 17013-311 61. 21 1. Marital Status: X Never Married; Married; Separated; I Divorced I i'married or separated, narne of spouse; N/A 2 Vlinor Children and other dependents: Blake Hippensteel, age 4, 1 26 Beech St Carlisle, PA 17013 3. Income: Payee's monthly income and sources: I am currently unemployed, but I seeking new job opportunities. 4_ Citild support, srlintony or• alinx>n,y pendente lite: Obligation to pay: Yes Rio , If yes, state the arnount of the obligation, to whom payable, and whether there are I ttrrearages: none 5. Previous transfers: Complete the below for competition deals only. If prior transfers were %vith JGNN, then just hjpe See Exhibit "A". Have you previously filed a petition to transfer payment rights uncles the structured settlement that is the subject of this petition'? Yes --X---.No Ifves, for each petition that you filed, I (a) Ift.he transfer was submitted for cows approval, list the i court. the case caption and case nurnlber- and state wljether the I i Jul 11 12 01 04p Hope Gulley 7177666860 p.20 court approved or disapproved the transfer: if the transfer was approved. (b) State the name of the transferee and identify ((listing due dates and payment amount(s)) the payments involve in the transfer: II State the amount of money and the manner in which I the money was used: I (c) Have you ever transferred payments withouti court approval'? I I' so, pleare oxplain: No j b. Reasons for transfer: Describe in detail your reasons for the proposed transfer, including an i explanation as to why a sale of a lesser amount of the structured se{tlement amount will better serve vour interests: I want to use the money from this transfer i to buy a house, and to put the remainder into a high yield savings a I ccount. 7. Payment of debts: j I I you seek the transfer in order to pay debts. list each debt, including the name of i the creditor anal the amount presently owed: Debt Creditor Amount 0i ed .Jul 17 12 01:04p Hope Culley 7177666860 p.21 I Verification I verify that the statements made in this affidavit are true and Corr t. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authorities. DATED: 3", l y i i } aCJO Branden Hip pensteel ATTACHMENT/EXHIBIT "2" 2 AMERICi?kN CM) ,,.I . /J •77?? ? a r GI uruice call?iir{ I c tl trLS i ` 4'n 1 , 1 )Ior i on it n i? I I I i :_1 lfl _ l) +'•i 0 s1VIENT .70 . F".1 c u , ANNUITYhlN illl V API>LICK(ION i, fv;unc. l sl Firl Middle ANNIAI'AN'i l N"W: p)?enstecl Keith PAYEE; T? i.dclr- ?, tret?l YR State n Lip C 6 . 2. PAYEE: Sexi try f I 1111 Atli' ?brr *imp -woone Primary Beneficiary >SU Relationship Secondary Beneficiary SSN Relationship Name: Last First Middle Address Sex 5trect City State Zip Code Doto of IJrih Social Security Number DaYtimo laisphone: Primary Beneficiary S•N Relationship Secondary F3.;ne il,i<3rl 5SN (Zei .t.onstiip 3. `Name last _. First _ Mu'd'F? JOINT _._ _.._____..._-..-. ANNUITANT I ;Address: Slrool City State 2ip Code PAYEE, IF ANY: Sex Date of Gil III Social Security Number Daytime'felephone: TReceivin'. Benefits Jointly with Annuitant No., 4 Namh-merican General Assignment Corporation Taxl0,-1723,21 )WNER OF Address: ANNUITY: 205 Ea The Owner PLAN APPLIED FOR AND OtY> Ave LE OF PA Cl 11 The sum of $500.00 monthly beginning March 11, 2007 for 10 years, certain, 7 he lump sum payment of $146,650 payable on March 11, 2011, The lump sum payment of $146,650 on March 11, 2014, The lump sum payment of $146,650 on March 11, 2019, The lump surn payment of $146,650 on March 11, 2024, and The lump sum payment of $146,684.90 on March 11, 2029. Amount paid with this application $1 0 Valuable Consideration ? Check if additional sheet is attached I Will the annuity applied for replace or be exchanged for any existing life insurance er Annuity in this or any other Company? ? Yes Ig No Any person who, with intent to defraud or knowing ;hat helshe is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement, commits insurance fraud which is a crime and may subject the person to criminal and civil penalties, I have read the above statements or they have been read to me. I represent that the above statements are true and complete to the best of my knowledge and belief. I agree that this application shall be part of the annuity contract(s) issued by the Company. Application is made with the knowledge and consent I of the proposed annuitant(s). I agree that any annuity contract issued upon this application shall be a contract of the state in which the Owner resides at the time of application. AMARILLO, t" tit '` l l 1, ? 1 r 1 ()G) Signed at ^-Q?„--- ti )?r,, ly. State American Genety ral Assignment Corp. Sl a Date r ?> by X M. Owner , Signature of Owner OR AGt?i` O ?Y t r f'°!? ? .e In o anon given on this apotrcatan ")and?ofnpiete to the bes? otXa04 -I,?vledge;and fief, 5igrvOu're of Agent Agent or Compan Name Rio /o J y'?-G11'a- Agent or Ccmpany No. Telephone No. `.S AA-98 A City State Zip Code Ainar.:i1,1. TX 79101 ATTACHMENVEXHIBIT "3" Jul 17 12 01:11 p Hope Culley 7 77666$60 p.36 Account II)! 36X584 Please complefe atrflsign- STATEMENT OF P...... FESSIONAL RE, PRESENTAT ON e ise ChooseEither Ro?c A OR Bz,it3_ $elow, i After you have made your choice. SI('N AND D:aTE the appropriate box signarure tine. YOU SI IOL LIB SIGN ONLY ONE' OX - TI lE BOX YOU I-iAVEIC-IOSE.N. A. I HAVE BEEN ADVISED BY J.G. WENTWORTH ORIGINATIONS, ("JGW") THAT I SHOULD OBTAIN INDEPENDENT PROFESSIOP REPRESENTATION CONCERNING THE LEGAL., TAX AND/OR F { IiVTI?LICATIONS OF TI11S TRANSACTION. I FULLY UNDERsTAr AGREEMENT AND THE IMPLICATIONS OF THE TRANSFER, IN RAMLFTCATIONS OI+ TH1-i 'T'RANSFER AND 1 DO NOT WISH TO INDEPENDF..NT PROFESSIONAL, REPRESENTATION. a BitANDLN WIPFNSI EEL. Date L 1 THE PURCHASE LUDING THE TAX AKs OUT SUCH B. I HAVE OBTAINED INDEPI:I\'1)I%NT IIEPRESENT.A'I"ION AND I FULLY UNDERSTAND THE. LEGAL, TAX AND/OR FINANCIAL IMPLICATIONS OF THE TRANSACTION, THE PURCHASE A(;RF.,Frw1EN7' AND THE RELATED DOCUMENT $. I WAS NOT REFERRED TO MY PROFESSIONAL. ADVISOR BY , CN11. THE N.Ai1ZE OF AI PROFESSIONAL.. ADVISOR IS SET FORTH BELOW: BE2A1\'UI;\ Iil1'1'I.VSTF:FI Date To ,tae Completed Aj; C'crrifred Protessionvi t dtv.ror Oniy if Corr !rave signer! Box B if bane { Name of Professional: Attorney ID #? Phone Numbcr: L___) Addr?,s: I havc pusonnlly met with and pro' id;d indcNirident professional cdviCZ to in respect ofthe Purchase Contract with JGW and the transaction conte-ntplated thcrcb,. 13r:utdcn Hippec5a:0 wits referred lu ate by the I I Prolesatonal'a Sigraturc t}hk: "Sc C:ontrt YI ATTACHMENVEXHIBIT 4(4" `1 Jul 17 12 01 C5p Hope Culley 7177666860 p.26 Aecoi.ur M, 3,SUSa PURCHASE CONTRACT i This it> a 'urchasc Contract ("Contract') For the sale of' structured settlement payments bet•.aeeli Brandon I lipptnsteci (You, Your), with legal residence at 126 6ccch St, C'arlide, PA )7013 3161 ? i and J.G. Wentworth Originations, LLC (We, Us, Our) 3993 Howard Hughes Parkway, Suitc 250, Las Vegas, NV 3916 -6754. BACKGROUND A. In connection with the resolution of a pcrsona) injury clairtl, Y'ou or :)orne<inc actin for You, sighed a Settlement Agr .ernent that entitles You to receiv g e. certain future payments ("Settteulen : YOU, si nod according to a set schedule - 13. '('host Settlement Payments are being paid to You from an annuity policy ("Annuity Policy") purchased by the Person responsible for makim, the Settlement Pavtrtants to You ("Obligor"). C. Rather than wait for [lie Settlement Payments to be made to You in the future, You want tb sell all or some of those Settlement Payments ("Purchased Payments") to Us now for a lump sum. j D. THIS CONTRACT CONTAINS AN ARBITRATION PROVISION WHICH YOU SHOT: LD READ CAREFULLY, AS IT WILL HAVE A SUBSTANTIAL IMPACT ON IIOW DISPUiTES BETWEEN YOU AND US ARE RESOLVED. DEFINI°.D WORDS Ccnain !nords used in this Contract have specific meanings, Shown below. Annuity Policy The policy purchased by the Obligor to ensure that the Settlement Payments are rnade to Yo_I as xquirckii by the 5cttLioicnt itl;f:"iantJt[. Closing Docunreuts Any documents necessar;y to carry out the purchase of the Purchased Payments. other han the "Contract or Contract Documents" as denied below. Contract or Contract Documents Collectively, only this Contract and the ?disclosure Statement. Contract Date The dale )'our signaui% at the end of this Contract is notarized. I iotveve, il' T ou happen 'o sign this Ccwr'u t befa;e the number of days stated at the end of Your Disclosure tatemcat for waitinc Plan passed, You v ;ill have no ohli?a[ion under Your Contract until :hat tame has passed. Court Order A legall} binding ruling issued by a judge er properly empowered t:dministrative officer, ;approving the sale of the Purchased Payments to L.s ("Court Approval") Disclosure Statement The document which idem.ifies For You, the Purchased Payments, expenses, Purchase Price at:d various other disclu,,:res. Encumbrance Any ciaim, right, lien, policy loan, or restriction In addition. this incaude;l Lin" limits on rights of o•snership (.such a'> flin rr>e, voting, transfer, receipt o income, Punding 0:1te The date We pay You the Nel C'ur,;hasc Prig. Jul 17 12 01:06p Hcpe Culley 717 7665860 p.27 A CC<un l If,: 3(3$594 Issuer The insurance company that issued the Annuity Policy Obligor 'T he Person who is obligated to snake paYn7c11t5 to You under he Settlement Agreement. Party Ortc of You or Us. Panics means both You and Us, Person Any natural person or legal entity. Purchased Payments Only those certain payments that We are purchasing from You under this Contract. Purchase Price: Gross Purchase Price The amount shown as the "gross amount payable to the seller'l You)" on the Disclosure Statement. This is the sum We have agreed to pay You befora any deductions as set forth in the Contract Documents. Net Purchase Price The amount shown as the "net amount payable to the seller (You)" on the Disclosure Statement. This is the sum We have agreed to pay You after any deductions as set forth in the Contract Documents. Settlement Agreement The agreement that You and the Obligor signed to resolve Yo1rr per>onal injury claim. Scttlernent Payments All of the payments that the Obligor has agreed to make to You in the Settlement Agreement. We, Our, or Us J.G. Wentworth Originations, LLC, along with any of its successors, assigns, and designees. Some of the Contract Documents or Closing Documents may refer to Us as the purchaser. You or Your The person named on this Contract's first page. Some of the Contract Documents or Closing Documents may refer to You as the seller. You and We agree as fog"ow;: 1. SALE OF THE PURCHASED PAYMENTS A. Upon the signing of this Contract and subject to certain conditions including Court Approval, You sell, transfer and assign to Us the right to receive the Purchased Payments specifically identified in the Disclosure Statement. B. We will pay You the Net Purchase Price as agreed to in the Contract Docutrnents, subject to certain conditions, including meeting Our underwriting requirements. Court Approval and srcrisfamo,,. completion ref the Closing Cocumems, Wo will do this in exchange to,- You: sellins 0W purcilascii Payments to U$ ; charging the henefic;an of the Annuity policy to Your estate and not changing it again until We have beers paid all of the Purchased Payments: • havin any current benefliciaries wane their rights to the Purchased Payments; and • f.dnlling Your promises under this Contract. C. If We arw buying only a portion of Your payments, this will have no effect upon Your rights in the unsold portion. You will continue to receive the unsold portion unless You have already sold or encumbered that portion. However, sometimes the Issuer, the Obligor or the court may require Us to receive the entire amount of Your payment. 11'so. We will then forward the portion of-the payment still due to You and You hereby agree to this payment servicing arrangement. Jul171201:07p Hope Culley 7177666860 p.28 A.;cOurl 1J. 30858:: 2 PURCHASE: PRICE, :1. ['lie Gross and Net Purchase Prices are shown on the Disclosure Statement and aro fair and acceptable to `r'ou and'' 13 We will oay You the Net Purchase Price, in the nanner You designate for Us C. Before we pay You, Vol, agree that We will ndjust for the following amoi rats, if applicable: • Purchased Payments Owed to Us -The Issuer may have already paid You some of the Purchased Yavnients before We have paid You for them. If that happens, 1VP will deduct the amnunt 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 Us post Court Approval, that are due within 90 days of tlic Funding Date. If We subsequently receive those particular Purchased Payments directly, We will return the amount or tiny 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 assets, We may pay those amounts and deduct them from the amount We pay You, and You hereby provide Us with specific authority totake such action. We will provide You with notice of the amounts that We are going to pay, prior to actual payment. D. If any Purchased Payments are mistakenly sent to You after We have paid You for them,iYou will immediately contact Us_ IrWe then determine that any deductions or holdbacks as set forth above are not enough to mimbursc U's, We will advise You ofthe amount You owe Us. You agree to immediately send that amount to Us by bank or certified check. 3. YOUR RFPItESE.NI'ATIONS AND WARRANTIES You represent and warrant to Us the following: A. You understand that "fIIIS IS A, SAI.F AND NOT A LOAN. F3. The Annuity Policy is in full force, You are the sole and undisputed recipient of the righ0to the Purchased Payments, have the right to sell them free and clear of any Encumbrances and have not previously sold any of the Purchased Payments to any other Person. C. You understand that Court Approval is required for this purchase; and You agree to fiully cooperate with Us to obtain that approval. D. You gave Us all requested information and signed all documents necessary to complete tha purchase. Every statement made by You in the Contract Documents and Closing Documents is true nd complete. E. No law, divorce decree or other legal obstacle; + requires You to keep the Purchased Payments for the benefit of a cur rent or formor spause, dependent children, or other person: or • le ;ally 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 l'ourcreditors to put You into bankruptcy or take any of the Purchased Paytents; or • If You filed for bankruptcy, the Purchased Payments wurc not subject to the claims of Your c. editors. You will give Us a copy of any of Your bankruptcy documents that We request including evidence ofa final bankruptcy payoff or case closing, if any. .. , i ?? .,;; , Jul 17 1' 01 07p Hope CulleY 7177CE368C3O p 29 Account ID 36$38&1 U. We rrn rely on Your representations, warranties, and promises in this Conirtct. 't'hese representations, twarranlies, and promises are for Ot,r benefit and the benefit of any future owners of the Purchased Payments. You understand that Our reliance on any intcntiona misrepresentation by You may rcrull in Our enlorcing our -ights against YoL in court. H. You had enough time to consider the sale of the Purchased Payments, understand the terns of the Contract Documents and Closing Documents (including the arbitration provision), are of legal contracting age and sound mind, not under the influence of drugs or alcohol, and fl•eely and voluntarily, enter into this Contract and agree to all of its terms. 1. 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. If You are married, Your spouse understands all of the terms and conditions of this Contract including, but not limited to the fact that, after the Funding Date, You (and Your spouse) will not receive the same amount of money on the same payment schedule as You would have received under the Annuity Policy. Your spouse has been provided with all information relating to the transaction and has had every opportunity to review the terms of the transaction and to seek any advice relating thereto. Your Spouse also understands that lie or she will be giving up any property or contract rigf is that he or she may have in the Purchased Payments. L. Wu nla.y sell, trat:sft:r, or assign Our right to tic Purchased Paymcnts in a sale, sccuritixation, or other financing transaction i; resale). Any resale -would involve dis,rlo rout certain information about You including 1`uur personal inftrmaton) to the parties to a resale. M. Any future owner of the right to the Purchased Payments will have all of the same rights We have, including the right to the duties You owe Us under this Contract. This includes the right to make a claim againtst You for violating any of the representations, warranties, or promises You made in this Contract 4. YOUR PROMISES TO US Before and after the Fundin- Date: A. You will tell us right away if Your address or telephone nurnber chc,nges and .de eYery,thing necessary, including completing and signing all documents to: - sell the right to the Purchased Payments to Us; • change the beneficiary as required by this Contract; and ¦ correct any documentation errors in the Contract Documents or Closing Documents. You wilt atso tell Ut; if auy of the followings occur,: • a violation of this Contract; or anything that could neC,atively affect the Annuity Policy, the Purchasod Payment, or this Contract. C. You will not: • agree to sell the Purchased faynteuts to any Person ether Ihan l:s change th !annuity 'nlicv's beneficiary lu any Person other ;han Your -hate until tb'e have: collected all of the Purchased Payments; or • withdraw cash from. burrow against, or change the Annuity Policy. Jul 17 12 01:07p Hope Gulley 7177666860 p.30 Acanun ID, 3!,9584 1 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 D .dc 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 t is 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 obligation to You under this Contract is strictly limited to the requirement to pay You what We owe 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 he liable for any consexlueutial dajnanes. H. You hereby appoint Us and any of Our designees, with full power of substitution as yourlAttomey in Fact, to act in Your name and place for the purpose of assigning and transferring ownership of any, and all right, title and interest that You have in the Purchased Payments and for Us to obtain all benefits contemplated by dtis transaction. You also give Us full authority to act in any way proper and necessary to exercise this Attorney in Fact ,appointment including, but not limited to. (1) negotiating, endorsing and executing checks, drafts and other instruments in Your name: and (2) instituting. maintaining, compromising, settling and terminating any litigation or otheir proceedings related to the Purchased Payments. This power ofattornev is coupled with an interest and shall surviyc;death or disability. CANCELLATION BY US i 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 CoW Order is contested, opposed, or not approved. j i C. We are sued or threatened :with a lawsuit or an arbitration about this Contract or the Annuity Policy. D. There is any threatened, lrendir.g, or fnnl action:, or change in lave, or rule ch:•tllengirrt' the Ic?siity of, or negatively a fccting this transaction. E. You file for, or are forced into bankruptuy. F. You die. I G. Final approval has riot been given by Our underwriting department. 11. The Purctnrse Conaact is not signed by You and received back by Us by Augusta 1, ^_012. 1. A jnaje;r rating agency downgrades the Issute'5 credit reiirt . J. I'he issuer Is, or becomes insolvent, or under -cgulatcrv supervision. K. With respect to A through J above, to the extent permitted by applicable law, the arbitration provision in Section 9 of this Contract shall survive the termination, cancellation or rescission of this Contract j CANCELLATION RY YOU A. (1) YOU MAY CANCFL'fHES CONTRACT WITHOUT I'ENALTY OR FURTEl1?R OBLIGATION AT AN-V TIME WITHIN FIVE (S) BUSINESS DAYS AFTER THE DATE YOU RECLIVE1 PAIVNIEN'I 11ERE UNI)I'R FRO.%,l IN ORDER FOR 'I NL; <::AAC'LLLATION TO BE EFrECTIVE, YOU MUST SFND A NOTICE: POSTN1ARKE:D AT AV1' I [Mk 1111THIN FIVE BLSINl SS D 1I. S AVI'F;IZ VOIt RECEIVE FAYYiENT HEREUNDER ricam US (This is the rescission period). i Jul 17 12 01:08p Hope Gulley 7177666860 p31 Aa oom II): W4584 (2) YOUR NOTICE IS TO BE SENT ErrIIR.R BY CER'I IFIED OR REGISTERED NIAIL (RETURN RECE[PT REQUESTED) OR FEDEX OR ANOTHER MA,1011 OVERNIGHI I)E).IVtRV SERVICE. THE NOTICE MUST INCLUDE A BANK OR CERTIFIED CHECK MADE PAYABLt TO US, IN THE FULL AMOUNT RECEIVED UY YOU. YOUR NO'l ICl: i41USI BE SF„N°I TO: j J.G. Wentworth Originations, LLC Attention: Manager of Operations 3993 Howard Hughes Parkway, Suite 250 Las Vegas, NV 89169-6154 i B. CEOItG1A RESIDENTS: YOU MAY CANCEL TII IS TRANSACTION AT ANY (TIME PRIOR TO 5:00 P.M. OF THE TWENTY-FIRST DAY FOLLOW ING R.ECEIP'I' OF TH1 ENCI..OSED "NOTICE. OF CANCELLATION RIGHTS" FORM, OR AT THEll CARING O\ THE APPLlC:,1TION FOR AUTHORIZATION OF A TRANSFER OF STRUCTURED SE171.FNIEN'T PAYMENT RIGHTS. OR AT ANY TIME WITHIN FIVE (5) BUSINESS DAYS .AFTER YOU REC:EVVE PAYME\ 1' 111?Rx UNDER FROM US, WHICHEVER EVENT OCCURS [,,AS']'( I'his is the Georgia rescission period). IN ORDER FOR THE CANCELLATION TO BE EFFECTIVE, YOU MUSTSIGN T'IIE ENCLOSED "i,''OTICE 011' CANCELLATION RIGHTS" FORM AND MAIL OR DELIVER IT TO US AS SPECIFIED IN THAT VOTICE AND YOU MUST RETURN ALI.. AMOUNTS (PURCHASE PRICE 012 OTHERWISE) RF,CF,IVF.D BY YOU ACCORDING TO THE REQUIREMENTS OF 6 (A) (2) ABOVE. C. WEST VIRGINIA RESIDENTS: IN ORDER FOR YOUR C'ANCLLi.,AT ION TOIBE EFF'EC'ITVE, YOUR NOTICF CAN BE SUBY1iTTED VIA PHONE.., MAIL OR F'ACSIMIL& ANY ANA OUNTS ADVANCED BY US IN CONTEMPLAI ION OF TILE T'IL\NSFBR SIiALL BE IMMEDIATELY REFUNDED TO US. IF YOU DISMISS YOUR ACTION AFTER APPOINT MF,ItT OF A GUARDIAN AD L1 'E' , OR RESCIND YOUR TRANSFER AGIK.EEMENT (PURCHASE CONTRAC t') W l THIN 'THE RESCISS ON PERIOD IN 6(A) (1) ABOVE, YOU SHALL BL RESPONSIBLE FOR THE FILING FEE AND ANY GUARDIAN AD LITEM FELS. I D. With respect to A through C above, to the extent permitted by applicable law, the arbitration provision in Section 9 of this Contract shall survive the termination, cancellation or rescission of this Contract. 7. NO"l'1C'-'S A. All notices about this Ccntract must be in writing. B. All notices must be sent either by: (1) certified or registered mail (return receipt rvgvesled); for (2) FedEx or another major overnight delivery service with a delivery tracking system and are considered given when delivered as follows: Ifto You: to the most recent address for You listed in Our files. if to Us; to the address listed in Section 6(A) ('_) of this Contract. 3. EVENTS OF DEFAULT' You cNiil be in default if You; i A" fail to comply with any terms or conditions ofthis Contract; or i B. breach any of Your representations, warranties and promises in 1,,is C'onuHcl. If You are in default, even if You have not rejected the arbitration provision (see Section Y of this Contract), We have the right to enforce Our rights against You in court to make You perform Your promises or to get money from You. If we sue You in court in connection with a Claim That is subject to arbitration under the arbitration provision in Section 9 of this Contract, and You have not rejected the arbitration provision, You will have the option ofremaining in court or seeking tot ompel arbitration of that Claim under the teens of the arbitration provision. Jul 17 12 01:09p Hope CUlley 7177666860 p.32 Account If?. 36894 9. AI,6lTR.NI ON. PROVISION To the extort permitted by applicable lawn, You and We agree to the fbilowing athitration provision. YOU HAVI; THE RIGHT T(3 REJECT'll HIS ARBITRATION PROVISION AS SET F'ORTFI 13Ei.OW. If You do not reject this arbitration provision and a Clain is arbitrated, You will not have the right to: (1) haven court or a ju ry decide the Claim; (2) engage in. inrormation gathering (discovery) to the sane extent as ill court; (3) participate in I class action in court Ur in arbitration; or (4) join or consolidate a Claire with claims of any other person. "fhe right to appeal is more limited in arbitration than in court and other rights in court may be unavailable or limited in arbitration. Claims Subject to Arbitration. A `Claim" sulhJM1 to arbitration is any claim. dispute or controversy Between You and Us (other than an Excluded Claim or Proceeding as set forth below), whether prezxisting, present or future, which aFk CS out of, or relates to the Contract, the negotiations related thereto, the breach t}tereof or any other transaction conducted with usI in connection with the Contract "Claim" has the broadest possible meaning and includes initial claims, counterclaims, cross-claims, third-party claims and federal, state, Iocsl and administrative Claims. It ircludcs di,.putcs based upon contract, tort, consuMerl rights, fraud and outer intentional torts, constitution, statute, regulation, ordinance, cnmrnon law and equity and includes clair;is for money damages and injunctive or declaratory relief. Upor the demand of You or Us, Claim(s) will be resoh•ed by individual (not crass or class-twice) binding arbitration in accordance with the terms specified in this arbitration provision. Special Definitions. Solely for purposes of this arbitration provision, in addition to the meanings set forth in this Contract: (I)'"We," "Us" and "Our" also (a) refer to Our employees, officers, directors, parents, controlling persons, subsidiaries and affiliates and (b) apply to third parties ifYou assert a Claim against such third parties in oar:.nection with a Claim you assert opinst Us; and +2) "You" or "Your" also refer to Your current or former spouse(s), children. heirs, estate, executors, successors, assigns, representatives and beneficiaries. Excluded Claim or Proceeding. Notwithsemrdin- the fore<<eing. "Claim" does not include any dispute or controversy about tae validity, enforceability, coverage or scope of this arbitration provision er any part thereof (including. Without 111litaticrra, the "Class Action Waiver" set forili below andlor this sentence); all such disputes or controversies are sor a court and not an arbitratorto decide. However, any dispute or controversy that concerns the validity or enforceability of the- Contract as a whole is for the arbitrator, not a coi,xi, ice decide- In addition, We will not require You to arbitrate any individuai action brought by Yoit in small claims court or Your state's equivalent court, unless such action is transferred, removed, or appealed to a different court, Federal Arbitration Act. Nohvithstanding any other p-ovisicm in this Contract, You and We agree that this Contract evidences a transaction involving interstate commerce and that We federal Arbitration Act (Titl: [I of the United Seste5 Code) ("FAA") shalt govern its interpretation and enforcement and prose ;trims p:.n stair thereto. To fire extent state IaW is applicable under the FAA, the law Ofthe state of Your domicile (where You regularly reside on the Contract Datej shall apply. Class Action Waiver. Notwithstanding any other provision ofthis ('ontrccr, if a Claire is arbitrated, neither You nor We will have the right: (a) to participate in a class action, private attorney general action or other represIentalive action in court or in arbit"tion, either as a class representative or class member, or (b) to joist or consolidate Claitnslwith claims of any other Persons. No arbitrator shall have authority to conduct any arbitration in violation of this provis?on (provided, however, that the Class Action Waiver does not apply to any tavrosuit or administrative proceeding riled against) us by a state or federal goveronaent agency even when such a=gency is seeking relief on behalf of a class of borrowers including Yon. This means that We will not have the right to compel nrhitrallon of any claim brought Vy such an agency). The Class. Action Waiver is nonseverable from this arbitration provision. If the Class %etion Waiver, iti limited, voided or found unenforceable, then Otis arbitration provision (except tier this sentence) shall be null and void with respect to such procceiding, subject to Cite right to app Gil the limitation or invalidation of the Class Action Waiver. Arbitration Procedures. If Yen or Wes seek to arbitrate a Claire, the Party seeking arbitration must notiN the. other Party in writing. This notice can be l=iven after the begiruting of`a lawsuit and can be given in papers fitcd in the lawsuit„ such as a nwtion to compel arbitration. Otherwise, Your notice must lie sent to Us at the address specified in Seclion 6 (A) (2) of This Contrw;t and Out notice must be sent to the most recent address for You in our files. Ary arbitration hcmin• that You attend wilt take place in a venue of lour domicile. if a Party files it lawsuit in courtasserting Claim(s) that are subject in arbitration, and the other Party files a motion to cornpet atbitnition with the court, Wikh is granted, it will be die tc°,ponsibi:ity of the Party prosecuting the Maim(s) to select an arbitration administrator in accordance with the paragraph be'Qw and rnnnuence the arbitration proceeding in accordance with the -dminktrrtor's -ales and p tocedures. ,it L Jul 17 12 01 09p Hope Culley 7177E66860 p 33 Account tt)? 3W )W, The arbitration will be administered by the American Arbitration Association ("AAA"), 1633 Broudway, 10h Floor, New York, NY 10019, wwwadr.org, 1-800-778-7879 or JAMS, 1920 Main Street, Suite 300, Irvine, CA 9261 1, www..)jamsadr.com, 1-800-352-5267. The rules and forms of the AAA and JAMS may be obtained by writing to these organizations at the adtlresses listed above. If the AAA and JAMS are unable or unwilling to serve as administrator, the Parties may agree upon another administrator or, if they are unable to agree, a court shalt determine the administrator. No company may serve as administrator, without the consent of all Parties, if it adopts or has in place any formal or informal policy that is inconsistent with and purports to override the terms of this arbitration provision. In the event of a conflict between the provisions of this arbitration provision, on the one har Id, and other provisions of this Contract or any applicable rules of the AAA or JAMS or other administrator used, on the other hand, the provisions of this arbitration provision shall control. 1 A single arbitrator will be appointed by the administrator and must be a practicing attorney with ten or more years of experience or a retired judge. The arbitrator will not be bound by judicial rules of procedure and evidence that would +Ply in acourt, or by state or local laws that relate to arbitration proceedings. The arbitrator will honor statutes oflimitation and claims of privilege recognized under applicable law. In determining liability or awarding damages or other relief, the arbitrator will fallow this Contract and the applicable substantive law, consistent with the FAA and this Contract, that would apply ifthe matter had been brought in court. At Your written request, we will pay all filing, hearing andlor other fees charged by the administrator and arbitrator to You for Claim(s) asserted by You in arbitration after You have paid an amount equivalent to the fee, ifany, for filing such Claim(s) in state or federal court (whichever is less) in the judicial district in which You reside. (If You have already paid a filing ee for asserting the Claim(s) in court, You will not be required to pay that amount again). In addition, the administrator may have a procedure whereby You can seek a waiver of fees charged to You by the administrator and arbitrator. We will always pay any fees or expenses that We are required to pay by law or the administrator's rules or that We are required to pay for this arbitration provision to be enforced. The arbitrator will have the authority to award attorneys' and expert witness fees and costs to the extent permitted by this ?ontract, the administrator's rules or applicable Iavv. The arbitrator will always award You reasonable attorneys' and expert witness) fees and costs (a) if and to the extent You prevail on Claims you assert against Us in an arbitration commenced by You and (b) to the extent required under applicable law for this arbitration provision to be enforced. "rhe arbitrator shall w•Tite a brief explanation of the grounds for the decision. A judgment on the award maybe entered by any court having jurisdiction. Severability and Survival. If any part of this arbitration provision, other than the Class Action Waiver, is deemed or found to be unenforceable for any reason, the remainder shall be enforceable. To the extent permitted by applicable law, this arbitration provision shall survive the termination, cancellation or rescission of this Contract Effect of Arbitration .Award. The arbitrator's award shall be final and binding on all Parties, except fur any right of appeal provided by the FA.A. However, if the amount of the Claim exceeds $50.000 or involves a request for injunctive or declaratory reliefthat could foreseeably involve a cost or benefit to either Party exceeding 550,000, any Party can, within 30 days alfter the entry of the award by the arbitrator, appeal the award to a three-arbitrator panel administered by the ndministrator. The panel (shall reconsider anew any aspect of the initial award requested by the appealing Party, The decision ofthe panel shall be by mafgrityvote, Referertcc in this arbitration provision to "the arbitrator" steal: mean the panel if an appeal of the arbitrator's decision has' been taken. The costs of such an appeal will be borne in accordance .vidi the above paragraph titled "Arbitration Procedures." Any final decision ofthe appeal panel is subject to judicial review only as provided under the FAA. Right to Reject Arbitration Provision. You may reject this arbitration provision by sending Us written notice of Your decision so that We receive it at the address listed below within forty-five (4i) days of the Contract Date. Such nonce must be sent by certified or registered mail (return receipt requested) or by FedEx or another major overnight delivery service within delivery tracking system; must include a statement that You wish to reject the arbitration provision along with Your name, address, Account LD. number and Your signature; and must be delivered to Us at the address specified in Section 6 (A) (2) of this Contract. This is the sole and only method by which You can reject this arbitration provision. Upon receipt of a rejection notice, We will reimburse You for the standard cost of a certified or registered letter or overnight delivery. Rejection of this arbitration provision will not affect any other terms of this Contract and will not result in any adverse consequence to You. You agree that Our business records will be final and conclusive with respect to whether You rejected this arbitration provision in a timely ind proper fashion. This arbitration provision will apply to Van and Us unless you reject it by providing proper and timely notice as stated herein. t • ,Jul 17'201:11p Hcpe Culley 717766686C p.34 Amouul ;[) 36MI 10. MISCELLANEOUS ' A. You give Us pennission to conduct backpround checks on You, including obtaining info (nation born the credit bureaus, in order to verify Your legal residence, contact information, anti arty other information W4 deem necessary flir this transaction. We can also search records for UCC filings, bankr uprcy faings, jud'ments, iii ns and child support obligations against YYou. B. This Contract is the entire a°re-.rr.ent bet-weer, Yrr,i and Us C. If there is more than one of Us or You, this Contract applies to all ofthose people together, and to each of them on their own. D. Both Parties must agree in writing to any change to `his Contract or waiver of its terms. E. F..xcept as set. forth in the arbitration provision in Section 9 of this Contract, if a court uri s any part of this Contract, the rest of the Contract remains valid. E. You cannot voluntarily or involuntarily sell, assign. or transfer this Contract, or any of Yggqur rights or duties under this Contract. Any such action taken by You in violation of this section shall be void and of rip affect. G. Except as otherwise required by applicable law, the law ofthe state of Your domicile (where You regu'.arly reside on the Contract Date) will govern this Contract and disputes under this Contract shall be determined in Your domicile State (where You regularly reside on the Contract Date). H. This Contract also holds responsible Your hens. and executors. This Contract benefits on?y You and Us, turd no one else. However, if properly assigned by Us, this Contract will bind and benefit Our successors and assigns. I. Failure to enforce any provision of this Contract is not a waiver ofthat 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 Contact. A facsimile, pdf or other electronic copy of the sign d Contract or any counterpart will be considered an original and treated as such in any court [or arbitration) proceeding K. We have investigated the proposed transfer of the Purchased Payments and, in light of in Iorntation available to Ls, have identified no violation of any applicable state or federal law. L. You will not 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 other%visc sct forth in this Contract (including the arbitration provision in Secti In 9 oft'ais Contract), You and We will pay our respective costs and expenses in carrying out this Contract. You rind We, intending to be legally bound, have signed this Contract as of the Contract Date below, and ssgree to all. of its terms and conditions, including the arbitration provision. I Jul 171201:1lp Hope Culley 717 7666860 p.35 I .ACcoum ID' .168584 I 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 salt of the Purchased Payments and to have those advisors review will) You, the terms and legal tax and other effects of this Contract. I Sworn to xncl .nhscribed fore ure this jZday or514 20/'?'(`°t_'ontr:rrl Date") Nolarv SELLER: Branden Hippensteel SIGN HERE A Acknowledged and Agreed; Sworn to and.subscrihed before nie this _ __ day or _ , ?t) INOLary SIsI-LER'S SPOUSE (if apl Spouse ++? - US: J.G. Wentworth Originations, l.,t,G r- i;OMalUNwtA L l ly 01--r'tNNSYLVAN:A Notarial Seal i ?lol? L. wI1CY, ?140u rp public ,- , UUUE,'r`lk+n Twp., C u W-, rxl County MY Commlesion Expires fttb, 28, 2013 BY- ` w grnon&Notarles Sam Gottesman. Undcnniti?tg Vianager l.. 1 Jul 1 / 12 01:01 p Hope Culley 1177666860 p.8 Amain:. ID: 363581 July 16; 2012 PENNSYLVANIA DISCLOSURE STATEMENT We will purchase the following payments (Purchased Payments) from You: A) 1 payment of $130,000.00 on March 11, 2014 8) 1 payment of $6,500.00 on March 11, 2019 Q 1 payment of $4,500.00 on March 11, 2024 D) 1 payment of,06,584.90 on March 11, 2029 (The remainder of the page intentionally left blank) I I Jul 17 12 01;01 p Hope Culley 7177666860 P9 A ccocm t ID, 3C. r,84 July 16, 2012 The aggregate amount of the Purchased Payments is $177,584.90. The discounted present value of the aggregate Purchase Payments at he federal interest rate of 1.20% is $167,372.50. The discounted present value is the calculation of the current value of the transferred structured settlement payments (Put -chased Payments) under federal standards for valuing annuities. The gross amount payable to seller (You) is $1.10,000.00. The net amount payable to the seller (You) is $11.0,000.00. Legal fees (this is an estimate of what Your attorney will charge You if You choose not to waive representation): $500.00 1 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 65.70% of the estimated current value of the payments based upon the discounted value using the applicable federal rate. i Based on the net amount that You will receive in payment from Us acid the amounts and timing of the structured settlement payments that You are selling to ills, this is the equivalent of interest payments to ITS at a rate of 1.5.08% per year. PLEASE NOTE THAT THIS IS NOT A LOAN, BUT A SALE OF PAYMENT RIGHTS AND THE INTEREST FIGURE IS ONLY PROVIDED AS AN ILLI`?STR:kTl- N OF'I'I]E 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. I 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) BRAN:DEN HIPPENS'I'., ,:L stcrl r>?[i.> 2- Jul 17 12 01:01 p Hope Culley 7177666860 p.10 j Account ID: 36858.1 July 16, 2012 'T'EXAS DISCI. OSURt STATE.MEN T We will purchase the following payments (Purchased Payments) from You: A) 1 payment of $130,000.00 on March 11, 2014 B) I payment of $6,5b0.00 on March 11, 2019 C) 1 payment of $4,500.00 on March 11, 2024 D) I payment of $36,584.90 on March 11, 2029 (The remainder of the page intentionally left hla .Jul 17 12 01:01 p Hope Culley 7177666860 p,11 i Account ID: 368584 July 16, 2012 The aggregate amount of the Purchased Payments is $177,5584.90. The discounted present value of the aggregate Purchased Payments at the federal interest rate of 1.20% is $1.67,372.50. The discounted present value is the calc6lation 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 $110,000.00. No other expenses are incurred by You. The net amount payable to the seller (You) is $110,000.00. Based on the net amount that You will receive in payment from Us a d the amounts and timing of the structured settlement payments that You are selling to i s, this is the equivalent of interest payments to Us at a rate of 15.08% per year. PLEASE NOTE THAT THIS IS NOT A LOAN, BUT A SALE OF PAYMENT RIGHTS AND THE INTEREST FIGURE IS ONLY PROVIDED AS AN ILLUSTRATIO? OF THE ECONOMIC IMPACT OF THE SALF- Notice of Cancellation Rights: You may cancel without penalty or further obligation, not later than the fifth business day after Your receipt of payment from Us under the transfer agreement IWurchase Contract). Please be advised there are no penalties or liquidated damages payable by You in the event of any breach of the transfer agreement (Purchase Contract) by You. By signing below, You are confirming receipt of this Disclosure Stat prior to You executing the transfer agreement (Purchase Contract)- ?._... ?. ? ? _ SIGN F1EI2E BW'tN sLN Hl1 l'k N;S EF'L at least 3 days Jul 17 12 01:12p Hope Colley 7177666860 p 38 IMPORTANT NOTICE You are strongly urged to consult with an attorney who can advise you of the potential tali consequences of this transaction. i i ??yy By: 7. c$R ?NDEN AIPPFNSTEEL Sworn to and subscribed re rue this?/ ' 7 ti T/y) ?(I 1 2 Notary ° r _CJf?1h1JN`.V?t? ? H (1F PkNNSYWAhEIA Notartal ?eaf 1i lup i. Cullen, NotarPubli" II;7 Upper Alen Tv, p , Currberla,OCcAjmy _MY rCommissio^4xplro;Teb.23;20!3 rie ntcr. (?Eriliyv:v:+?ii s sociat'on Of V0`1Tk-; I i rA r ATTACHMENT/EXHIBIT 665" 5--? 11 A, a J.G.WINIAVOWUH, July 19, 2012 Western National Life Insurance Company 205 E. 1 Oth Ave Amarillo, TX 79101 Attn: Legal Department/Structured Settlements American General Assignment Corporation 205 East 10th Avenue Amarillo, TX 79101 Attn: Legal Department/Structured Settlements RE: Notice of Sale/Assignment of Payment Rights Your Contract #: Payee: Branden Hippensteel Dear Insurer: Please be advised that J.G. Wentworth Originations, LLC and/or its successors and assigns, have entered into a transaction with the above-referenced annuitant who is seeking to transfer certain of his/her rights to the payments scheduled to be received under the above-referenced annuity policy. We are currently seeking court approval pursuant to the applicable structured settlement transfer statute Pursuant to the statute, please note the following information about the Purchaser: 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 leave entered a final order and we have forwarded this rirder to you. Very truly yours, J.G. Wentworth Originations. LLC By: Lori Borowski, Vice President 201 KING OF PRUSSIA ROAD, SUITE 200 • R ADNOV, i'rk 19087 PHONE: (800) 790-4016 • FAX: (215) 567 C3096 I Reserved for Court Use. LJ { 4? JUL 31 AM ? 2 f-UMBERIAHIU ENNSYUARI" IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA RE: Joint Petition of J.G. Wentworth NO: Originations, LLC and Branden Hippensteel / ???? INITIAL ORDER OF COURT ?, On this 2Lfday of 2012, it is ordered that a hearing on this Petition to Transfer Structured Settlement Payment Rights will be held on 5 , 2012, in Courtroom ! at /O 30 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. BY THE COURT: J. 4ed A C-s 6Py ma,'l-ed 71 /-CL 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: a'? ?Sd Originations, LLC and Branden Hippensteel NOTICE OF HEARING ON PETITION TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS To: Western National Life Insurance Company J.G. Wentworth Originations, LLC Attn. Legal Dept./structured Settlements 201 King of Prussia Road 205 E. 10`h Street Radnor, PA 19087 Amarillo, TX 79101 Attn: Legal Dept/Structured settlement American General Assignment Corporation Branden Hippensteel Attn. Legal Dept/structured Settlements 205 East I01h Avenue Amarillo, TX 79101 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 2012 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 i J.G. Wentworth Originations, LLC. 201 King of Prussia Road, Radnor, A 1(187, a D. No. 20-4728885. Date BY: $r-flL Mho, Esquire Attorney for J.G. Wentworth Originations, LLC. 1115 W. Main Street Norristown, PA 19401 (610) 275-9600 (610) 275-9666(facsimile) Vi( IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA RE: Joint Petition of J.G. Wentworth NO: Originations, LLC and Branden Hippensteel FINAL ORDER OF COURT On this Day of , 2012, it is ordered that the Petition to Transfer of Structured Settlement Payment Rights is granted. The court specifically finds that: (1) the payee has established that the transfer is in the best interests of the payee or the payee's dependents; (2) based on the certification by an attorney for the transferee, and the court having not been made aware of any statute, regulation or order that would be incompatible with the proposed transfer, the transfer will not contravene any applicable federal or state statue or regulation, or the order of any court or administrative authority; (3) the transfer complies with the remaining requirements of the Structured Settlement Protection Act, including Sections 3(a)(2), 3(a)(4), 3(a)(5) and 3(a)(6); (4) the payments that are to be transferred are designated as follows: A) 1 payment of $130,000.00 on March 11, 2014; and B) 1 payment of $6,500.00 on March 11, 2019; and C) 1 payment of $4,500.00 on March 11, 2024; and D) 1 payment of $36,584.90 on March 11, 2029. (5) the terms of this order shall survive the death of the payee and shall be binding on the payee's heirs, beneficiaries and assigns; (6) the payee shall receive from the transferee, within ten (10) days from the date of this Order, the amount of $110,000.00, from which no funds are owed for counsel fees, administrative fees, or other costs, fees or expenses. BY THE COURT: J. Maro & Maro, P.C. By: Robert A. Maro, Esquire Attorney I.D. No.: 89585 1115 W. Main Street Norristown, PA 19401 (610) 275-9600 Attorney for JG Wentworth Origination, LLC IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: Joint Petition of JG Wentworth NO: 20124580 Civil Originations, LLC and Branden Hippensteel CERTIFICATE OF SERVICE 1, Robert A. Maro, Esquire, hereby certify that a true and correct copy of the Notice of Hearing was served upon the Payee, The Structured Settlement Obligor, The Annuity Issuer, the Payee's Spouse and any person receiving child support, alimony; or ,..,_, alimony pendente lite. r " A copy of the Notice is attached hereto. w Date: August 7, 2012 By ""? = Robert A. Maro, Esquire Attorney for JG Wentworth Originations, LLC MARO & MARO, P.C. By: Robert A. Maro, Esquire Attorney I.D. No.: 89585 1115 West Main Street Norristown, PA 19401 (610) 275-9600 7.`1tPRO HO ICE y 0 TARy G LE ?f??$ ?tslD l.VCOUNTY NiIN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA (n? v RE: Joint Petition of J.G. Wentworth NO: Originations, LLC and Branden Hippensteel NOTICE OF HEARING ON PETITION TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS To: Western National Life Insurance Company J.G. Wentworth Originations, LLC Attn. Legal Dept./structured Settlements 201 King of Prussia Road 205 E. 10'h Street Radnor, PA 19087 Amarillo, TX 79101 Attn: Legal Dept/Structured settlement American General Assignment Corporation Branden Hippensteel Attn. Legal Dept/structured Settlements 205 East 10 h Avenue Amarillo, TX 79101 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 2012 at d • 3 d 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 i 'y J.G. Wentworth Originations, LLC. 201 King of Prussia Road, Radnor, A J78 No. 20-4728885. // Zr. Date 7- 1q-1 1.. BY: R,4*k-X MWo; Esquire ttorney for J.G. Wentworth Originations, LLC. 1115 W. Main Street Norristown, PA 19401 (610) 275-9600 (610) 275-9666(facsimile) MARO & MARO, P.C. By: Robert A. Maro, Esquire Attorney I.D. No.: 89585 1115 West Main Street Norristown, PA 19401 (610) 275-9600 ~~`- Ts~ ! ~~ OFF'{^~ ~i1 f ' t 't ,...~ ,: F:,r ~ia~~ ~~ ~ C~?~.'tdr ~ r ~~, s ,~ rF a - ~5:3~r IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA RE: Joint Petition of J.G. Wentworth NO: 12-4580-Civil Originations, LLC and Branden Hippensteel AMENDED JOINT PETITION FOR PARTIAL TRANSFER OF STRUCTURED SETTLEMENT PURSUANT TO STRUCTURED SETTLEMENT PROTECTION ACT, 40 P.S. 4000. ET SEO. 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, Branden Hippensteel, 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, Branden Hippensteel ("Payee"), an adult individual who resides in the County of Cumberland, 126 Beech Street, Carlisle, PA 17013-3161. 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 "1 "; 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) Acertification by Robert A. Maro, Esquire, attorney for transferee, J.G. Wentworth Originations, LLC.; and d. PA. R.C.P. 229.2(d)(3)(iv) AFinal Order of Court Granting he Petition. 5. Joint Petitioner, Branden Hippensteel, is the beneficiary of an annuity owned by American General Assignment Corporation and issued by Western National Life Insurance Company. The structured settlement provides payment to the petitioner as described on Attachment/Exhibit " 2". 6. Joint Petitioner, Branden Hippensteel, 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, Branden Hippensteel, 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 $130,000.00 on March 11, 2014; and 8. The structured settlement is currently owned by American General Assignment Corporation and issued by Western National Life Insurance Company, and the net amount in return payable to Branden Hippensteel is $100,000.00 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, ezpenses, and charges is $100,000.00. 10. Based on the net amount that the payee will receive from this transaction $100,000.00 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 18.63% per year. 11. The Buyer furnished Branden Hippensteel 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 Branden Hippensteel 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 asAttachment/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 single and has one (1) minor child. Joint Petitioner is transferring a partial amount of the structured settlement. The purpose of this transfer is to assist Petitioner and family with purchasing a home, free and clear. Petitioner wants to have a stable environment for himself and his family and believes with the state of the real estate market, he can obtain a great deal that will provide his family with a stable environment for the rest of their lives. Petitioner has thought about this decision thoroughly and believes that this is in his best interest and that of his family's to proceed with this transaction. Based upon the foregoing which shall be expanded upon at the time of trial, the transfer is clearly within the best interest of Petitioner and family. 15. In accordance with Cumberland County Local Rule 208.3(a)(2), no other petitions or similar matters have been filed regarding his case. 16. This is a Joint Petition and notice of the petition has been sent to all interested parties in accordance with the applicable rules of civil procedure. As of date, no objection has been filed or received by joint Petitioners. WHEREFORE, Joint Petitioner's respectfully requests this Honorable Court to enter the Initial Order attached to this petition which shall schedule a hearing so that Transferee and Payee shall have the opportunity to discuss the purpose and reasons for the transfer and after hearing thereon, respectfully request that this Honorable Court enter a Final Order approving the Transfer of Structured Settlement Payments Rights as is mentioned herein. Maro & Maro, P.C. By: for Transferee Respectfully Submitted: VERIFICATION I, Lori Borowski, Vice President of J.G. Wentworth Originations, LLC, have read tkie foregoing Petition to Joint Petition to Transfer Structured Settlement Payment Eights and hereby aver that the statements contained therein aze true and correct to the best of my knowledge, information and belief. This Verification is made subject to the penalties of 18 Pa.C.S.A. Section 4904 relating to the unsworn falsification to authorities. or' orowski, Vice President ~--31- IZ 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. ~ ~ °}1-11. Date eft A. Maro, Esquire ttorney for Transferee, J.G. Wentworth Originations, LLC MARO & MARO, P.C. By: Robert A. Maro, Esquire Attorney I.D. No.: 895$5 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: 12-4580-Civil Originations, LLC and Branden Hippensteel CERTIFICATE OF SERVICE I, Robert A. Maro, Esquire, hereby certify that a true and correct copy of the Petition for Transfer of Partial Structured Settlement has been served upon the following entities via first class mail and/or certified return receipt requested and/or email on To: Western National Life Insurance Company Attn. Legal Dept.lstructured Settlements 205 E. 10~' Street Amarillo, TX 79101 Attn: Legal DeptlStructured settlement American General Assignment Corporation Attn. Legal Dept/structured Settlements 205 East 10~' Avenue Amarillo, TX 79101 Date: 13J-i ~ By: J.G. Wentworth Originations, LLC 201 King of Prussia Road Radnor, PA 19087 Branden Hippensteel for J.G. Wentworth Originations, LLC Aug 2912 09:23p Hope Culley 7177666860 p.23 Payee's Affidavit in Support of Petition to Transfer Structured Settlea~en~t Rights I, Branden Hippensteel, the payee, verify that the statements below are true and correct: Payee's name, address and age: Brarulen Hippensteel, 12b Beech St, Carlisle, PA 17013-3161, 23 1. Marital Status: X ~ Never Married; Married; Separated; _______ Iaivarced if married or separated, name of spouse: N!A 2 Minor Children anal other dependents: Blake I-Iippensteel, age 4, 12613eech. St Carlisle, PA 17013 3. Income: Payee's monthly income and sources: 1 am currently unemployed, but seeking new job opportunities. 4. Child support, alimony or alimony pendente liter Obligation to pay: Yes X No If yes, state the amount of the obligation, to whom payable, and. whether there are arrearages: none S. Previous transfers: Complete the below for competition deals only. If prior transfers were with JGW then jnst type See Exhibit "A". Have you previously filed a petition. to transfer payment right.5 under the structured settlement that is the subject of this petition? Yes X No If yes, for each pefitron that you filed, {a) If the transfer was submitted for court approval, list tl~e court, the case caption and case number, and state whether the Aug 29 12 09:23p Hope Gulley 7177666$60 p.24 court approved or disapproved the transfer: I f the transfer was approved, (b) State the name of the transferee and identify (listing due dates and payment amounts}} the payments involved in the transfer. State the amount of money and the manner in which the money was used: (c) 1~Iave you ezrer transfern~d payments without court approval°? if so, please explain: No 6. Reasons for transfer:. Describe in detail your reasons for the proposed transfer, including an explanation. as to why a sale of a lesser amount of the structured settlement amount will better serve your interests: I want to use the rnaney from this transfer to buy a house, and to put the remainder into a high yield savings account. 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 Aug 29 12 09:23p Hope Cuiley 7177666860 p.25 Verification I verif}r that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §490, relating to unsworn falsification to authorities. DATED: -~~Q ~,G- ~ ~ ..~ Brandon Hippensteel i ,. /~3.1~/Y~.~2.~.6._`f1~~.i1~~1 i A 7 :can ~acrna;,t ianmity ~,lr_,..1V.tt:,Jl.~.h7~1. fllr5mrtrfnmpanytti;iilY ' IINNIJI7'Y Amari&r,,'rr>as 79!n1 t9ro) az~. ~~:,,, fZ~,~~^I 4J~~~';61 t~1~~ ! ~,.~n1YIFw1'~~~ i, Name° lest First Middtu ANNUI'fAN1' 1. ~` ;i ~~: .rie,.a: ICe i t~h :. ., PAYEE: 44~~: Itidgr: ~t:a.~i~nL Car:l:i.s L~~~ State Ply 2ip1'1U~13 M x ~ ...M. ~ ~ ben Daytime'felephone: _ ___. _ .~._ Primary Beneficiary ~ __.. SSN' ~~ ~ ~ RalaGonsfiip Socondary Beneficiary _ 5SN Relationship ~.~_~~ ^ ~.~__~~~~ 2. Name: Last First Mtiddle PAYEE: ___.._._ _..._ ._ _...._ .__ . . __. Address: Street Cily Stale Zip Code ~_.__...._ _.... ____. .~___-._ ___w_. _~._. _._. ..._._._.__._._..__...~ _... .__. _.~ _..__-- Sox Date of ttirth y ___ .I 5aaal Security Number Daytime'fe`aphano. -- I ~(... , . _l.... Primary 6enefiriary S8N Relationship Secondary Beneficiary SSN 12elat~onship _ 3. _ .. __ .. _..__._.._ _. __ .._ ._... ..._ ....._____.__... _.._ _..___ .. ___ _.._......___ ..__._. _ F___.. _ .__ _._.._,_,..__... _.~_ . Name-. Last First Midiie JOINT ANNUITANT I _ Address: Strout City ~ ___. State .:ltp Code PAYEE, IF ANY: __--~--..--.n.__._-~.-.--.. _. __....___._.-__._-- .._.._......__._.___._.._.___~ ._____ .~_.__.__.__.__.~ Sex i Date of Biifh 1 Social Security Number Daytime "telephone: „_._,..._..~...~ Recei ' Benefts Jointly with Annuitant No.: , . . ~ A. ._._ ... _.. , ......_.. „ .. ~_ .._ ...,. . _. _~.,rv.__~.. ,.. r ..... _. ~ _.. Nan~~~can .General AsSignrnent Corporation Tax ID35.1723521 )WNER OF _ ANNU{TY: Address: Street _ City State Zip Code 205 East 10tYi Ave ~1mar. i17.ra TX 79101 _ _ _ The Owner is: D Individual Ll Partnership ~ ~ Corporation , ~ ~... O Trustee_ _~ _ _~„__ _,.._..__ PLAN APPLIEt] fOR AND 5C}iEl)ULE OF PAYMENTS: The sum of $500,00 monthly beginning March 11, 2007 for '10 years, certain, ° 7~he lump sum payment of $146,650 payable on March 11, 2011, ~t~tt;p~msclt.of $ 3 413,650 an March 11, 2Q 14, ~ 146,650 or March i 1, 2019, ~ , y ~ . ., YI ~ =~ ,§ f :.., Amount paid with this application: __ ~ i,:o o Valuable Consideration I ^ Check if additional sheet Is attached. Will the annuity applied for replace or be exchanged for any existing life insurance or Annuity in this or any other Company? ~p Yes fB No __._.._.__....___~_ .._.... ......w.._ . .., . __ ....... .. ..._...-..._.._.._..~.~_ _..._.._...._._.._..~-~.~., Any person who, wish intent to defraud or knowing that he/she is faalitating a fraud against an insurer, submits an application or files a claim containing a false or dec~egive statement, commits insurance fraud: whsch is a crime and may sub act the arson to criminal and Civil penalties.. w I have read the above statements or they have been read to me. I reprzsenf that the above statements are true and complete to the best o my knowledge and belief. t agree that this application shall be part of the annuity contract(s) Issued by ttte Company. AppBcalion is made with the knowledge and consent of the proposed annuitant(s). I agree that any annuity contract issued upon this application shall be a contract of the state in which the Owner rrsodes at the tirne of application. ~tr\RiLLO, EX~ ~ ^ " ,~~ ~ ~ ~~ '1 ~ .. -~ Signed at ~- ~ h t!~' ~~ ~ - _ ...... w..~~~.. ..__ _. , ~ .~ ..r..._~ . ale...: ~~~ ~~~3: A~s~grnment Corn b X ~.~ .._. _ __. .._.. _ _ _.~ Y ,. ~ .........~ .._... .._........~ ~ Owner Signature of Owner . OR A ONLY r eseh a Info 'ton given on this ap~c~lJg {i ~S~r i~fanC ~o~np`etit to lhe~be~s~~ot~~4lc~owledgeand iteJief J ~ R~ .. ._ . .._. __......._.. _ __.__............._._ .. .. of A t ° A N ure gen gent or Comp ame -~1o Sal?-Ul !'a- __._..._._...__ ...... _......_. _.._. .~.. , _...r... .. .. T ~-___ ._ ___..__. _..__..._.._ .__ , . ~. _ ._ . _ __ _.._..... _... _..... __ ...._..,.._.. _..~___. __ Agent a CcmpanyNo. jetephone No. SSAA-913 A Ju1171201;11p HopeCultey 717766686 p,3fi Please r_omple~te arul sign. WP)ease Choase Either I3ox A. {~R. Bc~~ el w. After you have made your choice, .SIGN .1.ND DATE the appropriate boy YC)U~ Sl-IOILU S1(~N f)NLY f):Vl's BOX. - TI31 BOX ~'OU HAVE) i I A. I HAVE BEEI~i ADVISED BY J.G. WENTWOR:['H ORIGINATIONS, ] {`°,IG~V"} THAT I SHOULD OBTAIN INDEPENDENT PROFESSION REPRESENTATION CONCT,RNING TI•IE LEGAL, TAX AND/4R 1H~ [11~II'.L'ICATIO~iS OTC THIS TRAi~1SACTION. I S+ULI,Y UNI)I,IZSTAN~ AGREEMENT AND THE IMPLICATIONS OF TIIE 'TRANST'ER, IT~Q RAMIFICATIONS ()N THI: 'I'RA~NSFIaR AIY)D I ~( NOT WISF3 'I.O~; 1NDEPENDENT PROFESSIONAL REPRESENTATION. .~....~____ ~_.. ~~e__....____ AhiDGA HIPPEWSI'EEi.. Date ~ B. I HAVE OBTAINED Il1DEPENDF,NT }2EI'RESEItiTA1'ION ANI) ! JkT[ TAE, I..EGAL, TA.X ANTI7tOR Flrl'ANC7AL IMPLICATIONS OF THE 'THE PURCHASE AGRF.,i!,MENT ~~'D THE R>~I.,.ATT;D DOCL'N1EN7 REFERRED TU MY FROFESSIONAI. ADVISOR BY JGW. THE N.~ PROFESSIONAI, ADVISOR IS SET Ft)RTH BELOW: BRAIti:DEN t{IFYI?VSTEEI, ~_~...~~..- llafe Accztunt iU: 36x5&t signaeure line. CI-IOSE:N. ANCIAL THE PI7RCHASE ~Unl~lG TINE Tax EK pUT SUCH X tiNDERSTAND I WAS NOT OF MX To !3e Computed Bp Cerfif[ed Prnfesrinnal Adues»r Orly ijyntr />'avesi~ned Bus B.-i6avY Name of Professional: __ , .,,.___,__,__,~~ Attorney Ii #_,___.- __.....___._...__.__ _. Phone T(umbor: (__) __._ , _..__ - A ddress: ___..w.w.v._._.__.. ._ _ .. _ ............. 1 htrve persatnJly met with and prop idtxi ictdcp~.nchhtt profi~siunal edvio~ to ... _ ............. .......---.._.__.. -... in rrspcG of the Pta•chase Canttyut with JG1V and the transactiat contoniplat~~J [hercb~•. 1'ir~ndcn Hippcnsux;l wus referral to me by [he_,_ i Profnxyional's Signnttac Daic SSC.Cuntrna[ I Aug 29 12 09:17p Hope Culley 7177666860 PURCHASE CONTRACT p,12 :4ctAUnt1D; 368,584 This is a Purchase Contract (`'Contract") for the sale of structured settlement payments between Breeden Hippensteel (You. Your), with legal residence at l2fi t3eech St, Carlise, PA 17013- 5161 sad J.G. Wentworth Originations, LLG (We, Us, Oer) 3993 Howard 1~(ughes Parkway, Suite 250, l.as Vegas, NV 84169-6754. BACKGROUND A. In connection with the resolution of a personal injury claim, You or someone acting for You, signed a Setttement Agreement that entitles You to receive certain future payments ("Settlement Payments"), according to a set schedule. B. Thom Settlement Payments are being paid to You from an annuity policy {"Annuity Policy") purchased by the Person responsible for malting 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 {"Pwchased Payments") to Us now for a lump sum. D. THIS CONTRACT CONTAINS AN ARBITRATION PROVISION WHICH YOU SHOULD READ CAREFULLY, AS IT WILL HAVE A SUBSTA':VTIAL IMPACT Oh HOW DISPUTES BETWEEN YOU AND US AIItE RfeSOLVED. DEFIPtED WORDS Certain wards used in this Contract have specific meanings, shown below. Aonuitp Policy The policy purc;ttased by the Obligor to ensure that the Settlement Paymerns 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 err 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 nilir~ issued. by a judge ar properly empowered administrative officer, apptoving the sale of the Purchased Payments to Us {"Court Approval"). Disclosure Statement Trie document which identifies far You, the Purchased Payments, expenses, Purchase Price and various other disclosures. Eeeumbrsrraee 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, exc.).. Fending Date The date We pay You the Net Purchase Price. Aug 2912 09:17p Hope Culley 7177666860 p.13 AccouatlD: 3685$4 Issuer The insurance company that issued. the Annuity Policy. Obligor The Person who is obligated to make payments to You under the Settlement Agreement. Party One of You or Us. Parties means both You and Us. Persoa Any natural person or legal entity. Purchased Payments Only those certain payments that We are purchasing from You under this Contract. Purchase Price: Gross Parehase Price The amount shown as the "gross amount payable to the setter (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 The amount shown as the "net amount payable to the seller (You)" on the Disclosure Statement. This is the sum W e 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. Settlenatat Payments ALI 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 first page. Some of the Contract Documents or Closing Documents may refer to You as the setter. You and We agree as follows: f. SALE OF THE PI:RC'HASED PAY11~);,N1'S A. Lpon 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. 4Ye will pay You the Net Purchase Price as agreed to in the Contract Documents, subject ro certain conditions, including meeting Our undetvvriring requirements, 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 Yaur estate and not changing it again until We have bean paid a[l of the Purchased Payments; • having any current beneficiaries waive their rights to tfie Purchased Payments; and • fulfilling Your promises under this Contract. C. If We are buying only a portion of Your payments, this will have no effect upon. Your rights in the unsold portion. You wiU continue to receive the unsaid portion unless You have already sold or encumbered that portion:, However, sometimes the Issuer, the (~ligor or the court may require Us to receive the entire amount of Your payment. if so, We will then forward the portion of the payment still due to Yau and You hereby agree to this payment servicing arrangement. Aug 2912 09:18p Hope Culley 7177666860 p.14 AccaunttD: 368S8A 2. PURCHASE PRICE A. The Gross and Net Purchase Prices are shown on the Disclosure Statement and are fair and accttable to You and Us. B. 11We will pay You the Net Purchase Price in the manner You designate for tJs. C. Before wve pay You, You agree that We will adjust for the following amounts, if appticarbte: • Purchased Payments C?wed bo IJs-The Issuer may have already paid You same ofthe Purchased Payme~s before We have paid You for them. Tf that happens, We wdl deduct the sa~ount of those Purchased Payments. • Iioidbaeks - D®t to possible delays iY the Issuer betlinaing to make the Purchased Payments io Us instead of Yau, We >!rtll hold bade an anwnnt egaal to any Purchased Payments that the Cssuer owes Us post Court Approvarl, that are due within 90 days of the Funding Datt. If We subsequently receive those particular Purchased Payments directly, We will return the amount of any related holdback to Yoa. • Payment of Debts Owed - IfYoa owe any past due child support, bankruptcy payoffs or taxes, or have any judgments or Inns against You or Your assets, We raay pay those amounts and deduct theot from the arnaunt We pay Yon, and You hereby provide Us with specific authority to take such aetioA. We mill provide You with notice of the amounts that We are going to pay, prior to acteal paynre~nt. D. lfany Purchased Payments are mistakenly sent to You aB~er We have paid You far them, You will immediately contact Us. If We then determine that any deductions ar holdbacks as set Earth above are not enough to reimburse Us, ti4~e will advise You of the amount You owe Us. You agree to immediately send that amount to t;`s by bank or certified check:. 3. YOUR REPRESENTS?IONS AND WA~RRAN?il;S Yau represent and warrant to Us tine following. A. You undcrstand that THIS IS A SALE AND NOT A LOAN. B. The Annuity Policy is in full farce, You are the sole and undisputed recipient of die right to the Purchased Payments, have the right to sel! diem free and clear of any .Encumbrances and have rrot previously sold any of the Purchased Paymetas to any other Person_ C_ You understand that Court Appr~val-s required for this purchase: and You agree to fully cooperate with Us to obtain that approval. i~. You gave is ail regtusted information and signed 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 larv, 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 arry ofthe Purchased Payments; or • If You filed for bankruptcy, die Purchased Payrrtents were not subject to the claims of Your creditors. You will give Us a copy of any of Your bankruptcy d~utnents that We request including evidence of a final bankruptcy payoff or case closing, if airy. Aug 2912 09:18p Hope Gulley 7177666860 p.15 Accamr tn: 36358a G. We can rely on Your representations, warranties, and promises in this Contract. These representations, warranties, and promises are far Our benefit and the benefit of any future owners of the Purchased Payments. You understand that Chu reliance on any intentional misrepresentation by You may result in Our enforcing Our rights against You in court. H. You had enough time rA consider the sate of the Purchased Payments, understand the terms of the Contract Documents and Closing Documerns (including the arbitration provision), are of legal contracting age and sound mind, not under the influence of drugs qr alcohol, and freely and voluntarily, enter into this Contract and agree to alt of its terms. 1. You were advised by Us to obtain independent legal advice and professional tax :advice about the sate of the Purchased Paymems and to have those advisors review the terms and legal, tax and other effects of this Contract with You prior to Your exewtion of this Contrast. 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 arty specific attorney far ~h purpose. K. if You are married, Pout spouse understands all of the terms and conditions of this C,ontr~t including, but rwt limited to the fact that, after the Funding Date, You (and Your spouse) wi{I not receive the same amount of money on the same payment schedule as You would have received under the Annuity Policy. Your spouse has been provided with: all information relating to the transaction and has had every opportunity to review the terms of the transaction and to seek any advice relating thereto. Your Spouse also understands than he m she will be giving up any property or contract rights that he ar she may have in the Purchased Payments. L. We may sell, transfer, or assign Our right w the Purchased Payments in a sale, securiti~tion, or other financing transaction (resale). Arty 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 the Purchased Payments will have al l of the same rights We have, including the right to the duties You owe Us under this Contract. ?his includes the right to make a claim against You for violating alny of the repmsentations, warranties, or promises You made in this Contract. A. YOUR PROMlSF.S TO tilS Before and at>Der 1t~ Funding Date: A. You will tell us right away if Your address ar telephone number changes and da everything necessary, including completing and signing alt documerrts to: • sell the right to the Purchased Paymenks to Us; • change the beneficiary as required by this Contract; and • eornect any documentation errors in the Contract Documents ar Closing Documents. B. You will also tell Us if any of the fallowing occtus: • a violation of this Contract; or • atrything that could negatively affect the Annuity Policy, the Purdtased Payments, or this Contract. C. You will not: • agree to sell the Purchased Payments to any Person other than IJs; • charge the Annuity Policy's beneficiary to any Person other than Your estate until We have collected all of the Purchased Payments; ar • withdraw cash from, barrow against, or change the Anrtuiry Policy. Aug 2912 09:19p Hope Culley 7177666860 p.16 Accouru [D: 368584 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 wip be true and complete on the Funding Date. E. We ate 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 warranrties. You must cxtoperate 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 ogee that Our obligation to You under this Contract is strictly limited to the regturem~at. to pay You what We owe You under the terms of dais Contrnct„ after receipt saxl approval of the Closing Documents, final undenvr7ting approval and Court Approval. Undec no circumstances will We be liable for any consequential damages. H, 'You hereby appoint Us and any of Our designees, with full power of st>bstitut ion as your Attorney in Fact, to act in Your name and place for the purpose of assigning and transferring ownership of any and all right, title and interest that You have in the Purchased Payments and for Us to obtain all benefits contemplated by this transaction. You also,give Us full authority to act in atry way proper and necessary to exercise this Attorney in Fact appointment ineludmg, but not limited to: (1}negotiating, endorsing and executing checks, drafts and other instruments in Your name; and (2) instituting, maintaining, compromising, settling and terminating airy litigation. or other proceeElings related to fire Purchased Pa}Tnents. This power of attorney is coupled with an interest and shall survive death or disability. 5. CANCELLATION I;~S We may cancel this Contract before the Funding Date if A. You breach any representation, warranty, or promise in any Conract Documents or Closing Documents. B. The petition for the Court. Order is contested, opposed, or not approved. C. We at+e sued or tlB+eatened with a lawsuit or an arbitration about this Contract or the Anmrity Policy.. D. There is any threatened, pending, or fmal action, or change in law or rule challenging the legality of or negatively affecting this transaction, E. You file for, or are forced into banlwptcy. F. You die. G. Final approval has not been given by Our underwriting department. H. 'The Purchase Contrail is not signed lay You and received back by Us by CJctober i 4, 2U 12. I. A major rating agency dawragrades the Issuer's credit rating. J. The Issuer is, or becomes insolvent, or under regulatory supervision. K. Wirth respect to A through d above, to the eactent permitted by applicable law, the arbitration provision in Section 9 of this Contract shall survive the termination, cancellation or rescission ofthis Carnrail. ti. CANCELLATION BY_YOU A. (i) YOU MAY CANCEL THIS CONTRACT WTI'HOUT PENALTY OR FURTHER OBLIGATION AT ANY TIME WITHIN FIVE (S} BU5iNE55 DAYS AFTER THE DATE YOU RECEIVE PAYMENT }IREUNDER FROM US. IN ORDER FOR THE CANCELLATION TO BE EFFECTIVE, YOU MUST SEND A KOTYCE POSTMARKED AT ANY TIME WITIN FIVE BUSINESS DAY5 AFTER YOU RECEIVE PAYMENT HEREUNDER FROM US (This is the rescission period). Aug 2912 09:ZOp Hope Culley 7177666860 p,17 Ac~t:ID: 3b85&4 {Z) YOUR NOTICE IS TO BE SENT EITHER BY CERTIFIED OR RECL5TERED MAIL {RET'LTRN RECEIPT REQUESTED) OR FEDEX OR ANOTHER MAJOR OVERNIGHT DELIVERY SERVICE. THE NOTICE MUST INCLUDE A BANK OR CERTIFIED CHECK MADE PAYABLE TO US, IN THE FULL AMOUNT RECEIVED BY YOU. YOUR NOTTCE MC:ST BE SENT TO: J.G. Weitwort6 Originations, LLC Attention: IViaeager of Operations 3993 Howard Hughes Parkway, Sine 250 Las Vegas, NV 89Ib9-ti754 B. GF.OR~IA RESIjQ,~NTS: YOU MAY CANCEL THIS TRANSACTTON AT ANY TIME PRIOR TO 5:~ P.M.. OF THE TWENTY FIRST DAY FOLLOWING RECEIPT OF THE ENCLOSED "NOTICE OF CA.'rICELLATION RIGHT'S" FORM, Olt AT THE .HEARING ON THE APPLICATION FOR AUTHORIZATION OF A TRANSFER OF STRUCTURED SETTLEMENT PAYMENT RIGHTS, OR AT ANY TEME WITHIN FIVE (5~ BUSINESS DAYS AFTER YOU RECEIVE PAYMENT HEREUNDER FROIvi US, WHICHEVER EVENT OCCURS LAST (This is the Georgia rescission period). IN ORDER FOR THE CANCELLATION TO BE EFFECTIVE, YOU MUST S[GN THE ENCLOSED "NOTICE OF CANCELLATION RTGH'['S" FORIW AND MAIL OR DELIVER IT TO US AS SPECIFIED IN THAT NOTICE AND YOU MUST .RETURN ALL AMOUNTS (PURCHASE PRICE OR OTHERWISE) RECEIVED BY YOU ACCORDING TO THE REQUIREMENTS OF b (A) (2} ABOVE. C. ,~t+EST VIRGINIA RESIDENT: IN ORDER FOR YOUR CANCELLATION TO BE EFFECTIVE, YOUR NOTICE CAN BE SUBMITTED VIA PHONE, MAIL, OR FACSIMILE. ANY AMOUNTS ADVANCED BY U5 IN CONTEMPLATION OF THE TRANSFER SHALL BE IMMEDIATELY RF.FtiNDED TO US. 'tF YOU DISMISS YOUR ACTION AFTER APPOINT.I~IENT OF A GUARDIAN AD LITEM, OR RESCIND YOUR TRANSFER AGREEMENT (PURCHASE CONTRACT) WITHIN THE RESCISSION PERIOD IN ti(A) (I) ABOVE, YOU SHALL BE RESPONSIBLE FOR THE FILC~IG FEE AND ANY GUARDIAN AD GITEM FEES. D. With respect to A through C above, to the extent permitted by appliaeable law, the arbitration provision in Section 9 of this Contract shall survive the termination, caaeeNatioa or rescission of this Contract. 7. NQ,~,FS A. All notices about this Contract must be in writing. B. Ail notices must be sent either by: (I) certified or registered mail (return receipt requested}; or (2} FedEx or another major overnight detivery service with a delivery tracking system and are cxmsidered given when delivered as follows: If to You: to the most recent address for You listed in Our files. Cf to Us: to the address listed in Section 6(A} (2) of this Contract. S. EVENTS OF DEFAULT You will be in default if You: fail to comply with arty terms or conditions of this Contract; or B. breads any of Yaurrepresentations, warranties and promises in this Contract. if You are in default, even i f You have not rejected the arbitration provision (see Section 9 of this Contract), We have the right to enforce Our rights against Yon ~ court to make You perform Your promises or to get money from You. If We site You in court in connection with a Claim that is subject to arbitration under the arbitration provision in Section 9 of this Contract, and You have not tsjeded the arbitration provisia», You will have the option of remaining in court or seeking to compel arbitration of that Claim under the terms of the arbitration provision. Aug 2912 09:20p Hope Gulley 7177666860 p.18 AcoounttD: 368584 9. ARBJTRATIOI+I PROVISION To the extent permitted by applicable law, You and We agree to the following arbitration provision. YOU HAVE THE RIGHT TO RF iECT TH1S ARBITRATION PROV€SIO~v AS Sl;T FORTH BELOW. Tf Yon do not reject Ibis arbitration provision and a Claim is arb#txted, Yau will not have the right to: (1) Rave a cattrt ar a jury decide the Claitrr (2) engage in information Gathering {discovery) to the saute a:tent as in court; (3) participate in a ehtss action in coact or in arbitration; or (4} join or coasoliithrte a Claim witk claims of any other person. The right to appeal is wore graited in arbitratign than in court oral ether rights io ooatrt may be unavailable or limited in arbitration. Claims Subject to Arbitration. A "Claim" subjt7ct to arbitration is any claim, dispute ar controversy between. You and Us (other than an Excluded Claim or Prataeeding ~ set forth below), whether prcexisting, present or future, which arises out o~ or relates to the Contract, the negatiati~s rested thereto, the breach thereof or arty other transaction conducted with us in cortnectron with tine Contract. "Claim" has the broadest possible meaning and includes initial claims, ctxmterclaims, cross-claims, third-party claims and federal. state, local and administrative claims. [t includes disputes based upon cattEract, tort, consumer rights, fraud and other intentional torts, constitution, statute, rtgtrlation, ordirtartce, common law and equity and includes claims for money damages and injunctive or declaratory relief. Upon the demand of You or Us, Claim(s) will be resolved. by individual (not class or class-wide} binding arbitration in accordance with die terms specified in this arbitration provision. Spec~€1?efinitioas. Solely for purposes of this arbitration provision, in addition to lire meanuxgs set forth in this Contract: (l) "We," "Us' and "Our" also {a) refer to Our employees, officers, directors, paretns, controlling parsons, subsidiaries and affiliates and {b) apply to third parties if You assert a Glaim against such third parties m carmecxion with a Claim you assert against Us; and (2) "You" ar "Your" also refer to Your current or farmer spouse{s), children, heirs, estate, executors, successors, assigns, representatives and beneficiaries. Excluded Claint or Proceedag. Notwithstanding the foregoing, "Claim" does not include any dispute or controversy about the validity, enfartreability, coverage or scope of this arbitration provision or any part thereof (including, without limitation, the "`Glees Action Waiver" set forth below and~or this sentence); al l such disputes rn• caontroversies are far a court and not an arbitrator to decide. However, any disptrte or controversy that ctnrcerns the validity ar enforceability of the Contract as a whale is far the arbitrator, not a court, to decide. ht addition, We will not require You to arbitrate any individual action brought by You in small claims court or Your state's equivalent court, unless such action is transferred, removed, or appealed to a differ«rr court. Federal Arbitration Act, Notwithstanding arty other provision in this Contract, You and We agroe that this Contn3ct evidences a transaction involving interstate commerce and that the Federal Arbitration .Act {Title 9 afthe United States Code} {"FAA") shall govern its interpretation and enforcement and proceedings pursuant thereto. Ta the extent state law is applicable under the FAA, the law of rite state of Your domicile (where You regularly reside on the Contract Date) shalt apply. Class Action Waiver. Notwithstanding any other provision of this Contract, if a Claim is arbitrated, neither Yau nor We will have the rlgltt: (a) to participate in a class action, private attor~y general action or ether representative actba in court or in a rbitration, etcher as a lass repr+rseatative or class member; or {b) to join or consolidate Chums with claims of any gther Persat~. No arbitrator shall have authority to conduct any arbitration in violatiien of this provis€aa (provided, however, that the Class Actia~n Waiver does not apply to any lawsuit or adm€aistrative prtteeediing filed against us by a state er fede+raE gavernmeat agency even molten such agency is seeking relief an behalf of a class of borrowers including You. This means that We will not have the right to compel arbitration of any claim brought by sack an agency). The Class Aetioa Wa€v+er its nonseverabte from this arbitration prtrvisien. If the Class .Action Waiver is limited, voided or found trtieufiarncrable, then this arbitration provision (except far this sentence) shay be nub and void with respect to salt praceedittg, subject to t>te izgttt to appeal the limitation or invalidatiaa of the Class Action Waiver. Arbitration Procedures. if You ar We seek to arbitrate a Claim, the Party seeking arbitration must notify the other Party in writing. This notice can be given slier the beginning of a lawsuit and can be given in papers filed in the lawsuit, such as a motion to compel arbitration. Otherwise, Your notice must be sent to Us at the address specified in Section b (A) {2) of this Contract and Our notice must be sent to the most t+ecent address for You in our files. Any arbitration hearing that Yau attend will take place in a venue of Your domicile. If a Party files a lawsuit in raourt asserting Claim(s) that are subject to arbitration, and the other Party files a motion to compel arbitration with the court, which is granted, it will be the responsibility afthe Party prosecuting the Claim{s) to select an arbitration administrator in accordance with the paragraph. below and commence the arbitration proceeding in asxmdartce w5th the administrator's rules anti procedures. Aug 2912 09:21 p Hope Culley 7177666860 p.19 Accomt ZD: 3685$4 The arbiUation will be administered by the American Arbitration Association {"AAA"), 1ti33 Broadway, lOs` Floor, New York, NY 10019, wwnv.adr.org,1-800-77&7879 or JAMS, 1920 Main Street' Suite 300, Irvine, CA 92614, www.jamsadr.com, I-800-352-52b7. The rules and forms ofthe AAA and !Ants may be obtained by writing to these organisations at the addresses listed above. If the A.AA and JAMS are unable or unwilling to serve as administrator, the Parties may agree upon another administrator or, if they are unable to agree, a coact shall determine the administrator. No carxtparry may serve as adrainistrabor, without the c~r'tsent of all Parties, if it adapts or has in place any formal or informal policy that is incastsistent with acrd purports to override the terms of this arbitration provision. In the event ofa conflict between the provisions of this arbitration provision, on the one hand, and other provisions of this Contract or any applicable rules of the AAA or TAMS or ether administrator used, on the other hand, the provisions of this arbitration provision shall control. A single arbitrator will be appointed by the administrator and must be a practicing attorney with teat or more years of experience or a retired judge. The arbitrator will not be bound by judicial rules of procedure and evidence that would apply in a court, or by state ar local laws that rr,.~te to arbitration proceedings. The arbitrator will honor statutes of limitation and claims of privilege neco~tized under applicable law. to determining liability or awarding damages or other relief, the arbitrator will follow this Corriract and the applicable substantive Iaw, consistent with the FAA and this Contract, that would apply if the matter had been brought in court. At Your written request, we will pay all filing, hearing and/or other fees charged by dre administrator and arbitrator to You f'~ Claim(s) asserted by Yau in arbitration aflrrYau have paid an amount equivalent to the fee, if any, far fling such Claim{s) in state or federal court {whichever is less) in the judicial district in which You reside. (If You have already paid a filing lice for asserting the Claim(s) im court, You will nc~ be required to pay that amount again). In additxart, the administrator may have a proeedtme wbereby Yau can seek a waiver of fees charged to You by the administrator and arbitrator. We will always pay any fees or expenses that We are required to pay by law or the administrator's rules or that We are required to pay for this arbitration provision to be enforced. The arbitrator will have the authority to award attorneys' and expert witness fees and oosts to the extent permitted by this Con#raci;, the admittistratior's rules or applicable law. The arbitrator will always award You reasonable attorneys' and expert witness fees and costs {a) if and to the extent Yau prevail an Claims you assert against Us in an arbitration eammenced by You and. (bl to the extent requa ed under applicable law for this arbitration provision to be enforced. T'he arbitrator shall write a brief explanation of the grounds for the decision. A judgment on the award may be entered by any court having jurisdiction. SevenbiUty and Sdrroival. (f any part ofthis arbitration provision, other than the Class Action Waiver, is deemed or found to be unenforceable for any reason, the remainder shall be enforceable. 'i`o the extent permitted by applicable law, this arbitration prevision shall survive the termination, cancellation or rescission oftbis Contract. Effect of Arbitration Award. The arbitrator's award shall be final and binding on all Partite, except for any right of appeal provided by the FAA. However, ifthe amount of the Glaim exceeds $0,000 or involves a request for injunctive or declaratory relief that could faeseeably involve a cost or benefit to either Party exceeding $50,000, any Party can, within 30 days after the crRry afthe award by the arbitrator, appeal the award to athree-arbitrator panel administered by the administrator. The panel shall reconsider anew any aspec* of the initial award requested by the appealing Party. The decision afthe panel shall be by majority vote. Reference in this arbitration provision to "die arbitrator" shall mean the panel if an appeal of the arbiuatar's decision has been taken. The costs of such an appeal will be borne in accordance with the above paragraph titled "Arbitration Procedures." Arty final decision of the appeal parcel is subject to judicial review only as provided under the FAA. Ri~rt to Reject Arbitration Provision. You may reject this arbitration provision by sending Us written notice of Your decision so that'We receive it at the address listed below within forty-five (45) days of the Contract Date. Such notice must be sent by certified or registered mail {return receipt requested) or by FedEx or another rtmjor overnight delivery service with a delivery tracking system; must include a statement chat Yau wish to reject the arbitration provision along with Your name, address, Aocourrt J.D. number and Your signature; and must be delivered to Us at the address specified ur Sectmm 6 (A) (2) ofthis Contract This is the sok and only method by whidt You cart reject this arbitration provision. Upon receipt of a rejecti~r notice, W e will reimburse You for the standard cost of a certified or registered letter ar overnight delivery. Rejection of this arbitration provision will not affect any other terms of this Contract and will rat result in any adverse consequence to You. Yau agree that Our business retards will be final and conclusive with respect to whether You rejected this arbitration provision in a timely and proper fashion. Thy arbitration provision will apply to You and Us unless you reject it by providing proper and timely notice as stated herein, Aug 2912 09:22p Hope Gulley 7177666860 p.20 Ae~unt tD: 368584 10. MISCELIl..A1~lE0US A. You give Us permission to conduct bacdcground checks on You, inciudmg obtaining information from the credit bureaus, in order to verify Your legal residence, contact information, and arty other information We deem necessary for this transaction. We can also search records far UGC filings, barilcruptcy $linns, judgments, liens and child support. obligations against Yoa. B. 'Phis Contract is the entire agreement lretween Yau and Us. C. Lf there is more than one of Us ar You, this Contract applies to all ofthase people together, and to each of thtm on their own. D. Both Parties must agree in writing to arty change to this Contr~t ar waiver of its terms. E. Except as set forth in the arbitration provision in Section 9 of this Contract, if a court undoes any part of this Contract, the rest afthe Contract remains valid. Yau cannot voluntarily ar involuntarily sell, assign, or transfer this Contract, or any of Your rights or duties utrcler this Contract. Any such action taken by You in violation of this section shall be void and of no effect. C'i. Except as otherwise required by applicable law, the law of the state of Your domicile (where You regularly reshfe at the Contract Date) will govern this Contrarx and disputes fader this Contract shat) be determined ut Your domicile State (where You regularly reside on the Contract Date). l3, This Contract also holds responsible Yau heirs, and executors. "I"bis Contract benefits only You and Us, and nv one else. However, if property assigned by Us, this Contract will bind and benefit Chtr successors and assigns. 1. Failure to enforce any provision of this Contract is not a waiver of that provision. The Parties may sign this Contract in one or mare counterparts. Each counterpart will be considered an original. All counterparts will form one Contract. A facsimile, pdfor other electronic Dopy of the signed Contract or any caunuerpart wip be considered an original and treated as such in any court. [or ati~itraton] proceeding. K. We have investigated the proposed transfer ofthe Purchased Fayments and, in light of information available to Us, have identifted na violation of any applicable state or federal law. L. You w711 not receive an IRS Farm 1099 from Us. M. Titles and headings in this Contract are for corfvenience only. Do not use them to interlxet this Contract. Tt. Except as otfienvise set forth in this Contract (including the arbitration provision in Secticm 9 of this Contract), Yau and We will pay our respective costs and expenses in carrying out this Contract. You amd We, intending to be legally board, have signed this Contract as of the Contract llate below, and agree 28 ai of its terms and corrditierrs, including the arbbratuua provision. Aug 2912 09:22p Hope Culley 7177666860 p.21 AccnunttD: 368584 By s~rdng bek+w, You aka aciawrvtedge that You were advised by lls is writing, that Yon shaald obtai' imlependent legal advice said professional tax advice aboat the sale of the Purchased Payments sad. to have those advisors review with You, the terms and kgab tax and other effects of this Contract: S~rorit to and subs:-ritxu beforr me tltis~= dad of, 30~?~ ("Contract SELLER: Btanden Hippensteel Acknowledged a'+d Agreed: Sevorn to and si~bscribcci before me this day of ___~, 2~ SELLER'S SPQUSE (if app>Micalde) Nomrti Spouse h~~ShiW'~Al,7ki OF PE~lNSYI.VAltiTK US: J.G. Wentworth Originatians, LGC ' t~dai Seat Public k Nape t. fultey, fVota end Counh' r Upaer Nlen Twp., GumuE t~l~~ Car' m~s~on Expkes FeD. 28, 2013 ,/`"'' r, r~ BY: ~~ Sam Crottesman, Underwriting Manager Aug 29 12 09:16p Hope Culley 7177666860 p.8 ~a~co~n,r ta: 3bxssa August 29, 2t}12 PENNSYLVANIA DISCLOSURE STATEMENT We wiU parchase the following payments (Purcla~ased Payments) from You: A} 1 payment of ~-130,000.00 on March 11, 2014 (The remainder of the page intentionally Ieft blank) Aug 2912 09:16p Hape CuileY 717?666860 p.9 Aca>unt Ii?: 36$S&t August 29, 2012 The aggregate amount of the Purchased Payments is $130,000.00. The discounted present value of the aggregate Purchase Payments at the federal interest rate of lA0% is 5128,028.70. 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 grass amount payable to seller (You) is 5100,000.00. The net amount payable tv the seller (You) is 5100,000.00. Legal fees (this is an estimate of what Your attorney will charge You if You choose not to waive representation}: $500.00 No other expenses awe incarred by You. The net amount that You will receive from Us in eaehange for Your future structured settlement payments represents 78.1.0°l0 of the estimated current value of the payments based upon the discounted value using the applicable federal rate. Based on the net amount that You will. receive in payment from Us and the amounts and timing of the structured settlement payments that You are selling to [Ts, this is the equivalent of interest payments to Us at a rate of 18.b3% per year. PLEASE NOTE THAT THIS IS NOT A LOAN, BUT A SALE OF PAYMENT RIGHTS AND THE INTEREST FIGURE IS O1YLY PROVIDED AS AN ILLIISTRATI©N OF THE ECONOMIC IMPACT OF THE SALE. Please be advised there are no penalties or Liquidated damages payable by you in the event of any breach of the transfer agreement by you. By signing below, You are confirming receipt of this Disclosure Statement at feast 10 days prior to You first incurring an obligation with respect to the transfer. ~~ ~ _ BIZANDEN 13IPPENSTEEL -~_ sxcN r~x~ _2_ Aug 29 12 09:16p Hope Cuiley 7177666860 p.10 Acaow-t(D: 36858A August 29, 2012 TEXAS DI$CLQSURE STATEMENT We will purchase the following payments (Purchased Payments) from You: A) 1 payment of $130,000.00 on March 11, 2014 ('Che remainder of the page intentionally left blank} -1- Aug 2912 09:16p Hape Culley 7177666860 p.11 .4rcount IU: 358584 aug~t z9, znlz The aggregate amount of the Purchased Payments is $130,000.00. The discounted present value of the aggregate Purchased Payments at the federal interest rate of 1.00% is $128,028.70. The discounted present value is the calculation of the current value of the transferred structured settlement payments (Purchased Paymeats) under federal standards for valuing annuities. The gross amount payable to seller (You) is $100,000.00. rio other expenses are incurred by You. The net amount payable to the seller (You) is $100,000.00. Based on the net amount that You will receive in payment from Us and the amounts and timing of the structured settiexnent payments that You are selling to Us, this is the equivalent of interest payments to Us at a rate of 18.63°lo per year. PLEASE NOTE THAT THIS IS NOT A LOAN, BUT A SALE OF PAYMENT RIGHTS AND THE INTEREST FIGURE IS ONLY PROVIDED AS AN ILLUSTRATION OF THE ECONtI-MIC IMPACT OF THE SALE. N+ntice of Cancellation Rights: You may cancel without penaKy or further obligation, aot later than the fifth business day after Your receipt of payment from Us wader the transfer agreement tP'urchase Contract). Please be advised there are no penalties or liquidated damages payable by You in the event of any breach of the transfer agreement (Purchase Contract) by You. By signing below, You are confirming receipt of this Disclosure Statement at [east 3 days prior to You executing the transfer agreement (Purchase Coatract). ~~ ~~~ __... SIGN HERE BRAN"DEN I3IPPENSTEEL -Z- Aug 29 12 09:23p Hope Culley 7177666860 p.22 IMPORTANT NOTICE You are strt-ng~y urged to consult with an ariorney who can advise yon of the pc-tential tax consequences of this transaction. Sworn to and snibcribed ?Yrft r'~' ~~~ ~~ ~~~ By: BRANDEN HIPPF,NSTEEL cor~Marawial.~i of ~~ulusY~v~rvra NotaAal Seal trope L. Cu~y, Notary Pubic MY COlTNT164biIR~1 k7cp1!ers ~@p, IR 2013 M°m~~ `~'~ ania A~sacfa~tN! df Nf~,'~rlBs e t • J . July 19, 2012 Western National Life Insurance Company 205 E. 10th Ave Amarillo, TX 79101 Attn: Legal DepartmentlStructured Settlements American General Assignment Corporation 205 East 10th Avenue Amarillo, TX 79101 Aun: Legal DepartmenUStructured Settlements RE: Notice of Sale/Assignment of Payment Rights Your Contract #: ..... Payee: Branden Hippensteel Dear Insurer: Please be advised that J.G. Wentworth Originations, LLC and/or its successors and assigns, have entered into a transaction with the above-referenced annuitant who is seeking to transfer certain of his/her rights to the payments scheduled to be received under the above-referenced annuity policy. We are currently seeking court approval pursuant to the applicable structured settlement transfer statute. Pursuant to the statute, please note the following information about the Purchaser: J.G. Wentworth originations, I.I.C 201 King of Prussia Road, Suile 200 Radnor, PA 1x9087 Tax ID # 20-4728885 PLEASI N01~L-': No payments under this annuity should be ttelcl until the courts have entered a Cnal order and we have forwarded this order to yau. Very truly yours, .1,(i. Wentworth Originations. LLC r;:,., By: Lori Borowski, Vice President 201 KING OF 1'RUS51,4 ROikD, SUITH 200 • RADNOR, f'A 1 90$7 PHONE: ($00) 790-4016 • E'AcX: (215) 56'7-G(?96 Maro & Maro, P.C. By: Robert A. Maro, Esquire Attorney I.D. No.: 89585 1115 W. Main Street Norristown, PA 19401 (610)'47-75-9600 Attorney for JG Wentworth Origination, LLC IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN 0: Joint Petition of JG Wentworth NO: 2012-4580 Civil Originations, LLC and Branden Hippensteel CERTIFICATE OF SERVICE I, Robert A. Maro, Esquire, hereby certify that a true and correct copy of the NoticO of Hearing was served upon the Payee, The Structured Settlement Obligor, The Ann*y Issuer, the Payee's Spouse and any person receiving child support, alimony or alimony pendente lite. A copy of the Notice is attached hereto. Date;, September 4, 2012 B = 4-; Robert A. Maro, Esquire Attorney for JG Wentworth cn'r- Originations, LLC =C-, N z__ Cs? r 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: 12-4580 Civil Originations, LLC and Branden Hippensteel NOTICE OF HEARING ON AMENDED PETITION TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS To: Western National Life Insurance Company J.G. Wentworth Originations, LLC Attn. Legal Dept./structured Settlements 201 King of Prussia Road 205 E. I& Street Radnor, PA 19087 Amarillo, TX 79101 Attn: Legal Dept/Structured settlement American General Assignment Corporation Branden Hippensteel Attn. Legal Dept/structured Settlements 205 East 10'h Avenue Amarillo, TX 79101 You are hereby given notice that J.G. Wentworth Originations, LLC has filed an amended petition to transfer structured settlement payment rights. A hearing in this matter has been scheduled on O 0 2r` to , 2012 at ?T clock in couttroom 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 per?on or by counsel, by filing written comments with the court prior to the hearing or by atte$?ding the hearing. The Name, Address and Tax Identification number of the transferee is J.Nentworth Originations, LLC. 201 King of Prussia Road, Radn r, 1908 Tax I NoJ 20-4728885. BY: Dade "Iert . M , squire Attorney for J.G. Wentworth Originations, LLC. 1115 W. Main Street Norristown, PA 19401 (610) 275-9600 (610) 275-9666(facsimile)