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HomeMy WebLinkAbout14-0454 f Mw N i MARO & MARO, P.C. t� F� sJt`riutag.� �ga , By: Robert A. Maro, Esquire;: Attorney I.D. No.: 89585� ` � , f 1 1115 West Main Street tt Norristown, PA 19401 "i , J S YL � UN Y (610) 275 -9600 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA RE: Joint Petition of Peachtree Settlement NO: y- �sy 6 Funding, LLC and Baron Chism 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, Peachtree Settlement Funding, LLC, by and through its attorneys, Maro & Maro, P.C., and joint petitioner, Baron Chism, and in accordance with the applicable rules of Pennsylvania Civil Procedure, hereby represents as follows: 1. Petitioner is Peachtree Settlement Funding, LLC. ( "Buyer" or Transferee "), with an office address located at 3301 Quantum Boulevard, 2 Floor, Boynton Beach, FL 33426. 2. Joint Petitioner is, Baron Chism ( "Payee "), an adult individual who resides in the County of Cumberland, 313 W. Shady Lane, Unit E, Enola, PA 17025 -2245. 3. This Joint Petition has been verified by the Transferee, Peachtree Settlement Funding, 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. � a 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) A certification by Robert A. Maro, Esquire, attorney for transferee, Peachtree Settlement Funding, LLC.; and d. PA. R.C.P. 229.2(d)(3)(iv) A Final Order of Court Granting the Petition. 5. Joint Petitioner, Baron Chism, is the beneficiary of an annuity owned by Farmers Services Corporation and issued by Farmers New World Life Insurance Company. The structured settlement provides payment to the petitioner as described on Attachment /Exhibit "2 ". 6. Joint Petitioner, Baron Chism, 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, Baron Chism, proposes to enter into a purchase agreement with Peachtree Settlement Funding, LLC., its nominees, successors, or assigns, whose address is 3301 Quantum Boulevard, 2 nd Floor, Boynton Beach, FL 33426, who will purchase the following from Petitioner's structured settlement as follows: A) 1 payment of $10,000.00 on December 22, 2016; and B) 1 payment of $25,771.00 on December 22, 2019. t w 8. The structured settlement is currently owned by Farmers Services Corporation and issued by Farmers New World Life Insurance Company, and the net amount in return payable to Baron Chism is $16,000.00 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 $16,000.00. 10. Based on the net amount that the payee will receive from this transaction $16,000.00 and the amounts and timing of the structured settlement payments that would be assigned, the payee is, in effect, paying interest at a rate of 17.62% per year. 11. The Buyer furnished Baron Chism 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 Baron Chism 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 11 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 currently single and has one (1) minor child. Joint Petitioner is only transferring a partial amount of the structured settlement. Petitioner is currently employed. The purpose of this transfer is to assist petitioner with paying of high interest credit card debt and paying for his daughter's education. Petitioner wants to relieve himself of making monthly only interest payments and wants to ensure his daughter obtains a solid education to assist her with a career later in life. Petitioner has thought diligently about this transfer and firmly believes that this is in his families bet interest. Based upon the foregoing which shall be expanded upon at the time of trial, the transfer is clearly within the best interest of petitioner. 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. Roe d: By: uire Aee VERIFICATION I, Lori Borowski, Vice President of Peachtree Settlement Funding, LLC, have read the foregoing 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. Lori Boro ki, VP Date CERTIFICATION OF ATTORNEY FOR TRANSFEREE I, Robert A. Maro, Esquire, attorney for Transferee, Peachtree Settlement Funding, 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. 1, Robert A. Maro, Esquire, attorney for Transferee, Peachtree Settlement Funding, 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. Date ZAttorney b . aro, Esquire for Transferee, Peachtree Settlement Funding, LLC i 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 Peachtree Settlement NO: Funding, LLC and Baron Chism 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: Farmers New World Life Insurance Company Peachtree Settlement Funding, LLC Attn. Legal Dept/structured Settlements 3301 Quantum Boulevard, 2 "d Floor 3003 77th Avenue Southeast Boynton Beach, FL 33426 Mercer Island, WA 98040 -2890 Farmers Services Corporation Baron Chism Attn. Legal Dept/structured Settlements 313 W. Shady Ln 3003 77th Avenue Southeast Unit E Mercer Island, WA 98040 -2890 Enola, PA 17025 -2245 Elizabeth Lebro Respectfully Submitted: Maro & Maro, P.C. Date: By: A. aro, Esquire Attorney for Peachtree Settlement Funding, 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 Peachtree Settlement NO Funding, LLC and Baron Chism Entry of Appearance TO THE PROTHONOTARY /CLERK OF SAID COURT Enter my appearance on behalf of. Peachtree Settlement Funding, LLC. Papers may be served at the address set forth below. Respectfully Submitted: Aara B re 5 Maro & Maro, P.C. 1115 W. Main Street Norristown, PA 19401 (610) 275- 9600(office) (610) 275- 9666(Fax) ATTACHMENT/EXHIBIT "1" Payee's Affidavit in Support. of Petition to Transfer Structured Settlement Rights I. Baron Chism, the payee; verify that the statements below are true and correct: Payee's name, address and age: Baron Chism, 313 Shady Lane Unit E Enola, PA. 17,025 Age 43 (Cumberland County) I. Marital Status: X — Never Married; Married; Separated; Divorced If married or separated, name of spouse: N/A 2 Minor Children and other dependents: Son, 7 years old, 313 Shady Lane Unit E Enola, PA 17025 3. Income,.: Payee's monthly .income and sources — need employer, position and annual salary: 1 am working Highmark Blue Shield, earning $35,000 annually and Cracker Barrel .Restaurant making $10 an hour. 4. Child support, alimony or alimony pendente lite: Obligation to pay: X _ Yes No If yes, state the arnount of the obligation, to whom payable, and whether there are arrearages: I pay $265 a month in child, support to the state and I have no arrearage.s. S. Previous transfers,' Have you previously filed a petition to transfer payment rights under the structured settlement that is the subject of this petition? Yes _X No If yes, for each petition that you filed, 01/16/2014 06:28 717 -599 -5476 JOHN 8 BELaAK A PAGE 14/34 court approved, or disappmved the trans.fom I'fthe transfer wos approved, (b) State the name of the traresfgoc and ideMif (Iisftg flue dates and payMent amoutnt(s)) the paynAmts involved in the transfer State the amount of n»ney nd, the manAcr in whiolt the moncy was uacdt (c) Have you; eves transfcrred payments without court approval? If so, please explain: No 6. Reasons for transfer: I will we this transfer to pay oft interest credit card,, bills and tQ help pay for my daughters' education. "nis'will bamefit me by elinlinating the debt that I havo ae =od and allow myself an opportunity to create a saving,, as Opposed to paying i.nterost charges. ?. Payment of delfts: I# ynir seek the. traiist'er In ordW t4 pay.debts list each debt, including the name of the creditor and the amount presently owed- Credit Card 06artk ,$5000 01/16/2014 06:23 717 - 599 -5478 JOHN B BELSUK JR PAGE 15/34 Verification 1 ve ffy that, 'he statements made in this affidnitt arc true and correct, I understand ithat false statenims herein ate made subject to the penalties of 18 Pa.C.S. §4904, relatiq. Yeti unswora falsification to authorities: Ali B r hisiu ATTACHMENT/EXHIBIT 662" 12/03/2008 20:02 FAX 7175411187 FEDE/ KINKOS HARRISBURG a016/017 Policy Specifitalions POLICY NUMBER 500084459 ANNUITANT CtIvl` ... y ISSUE DATE MARCH 22, 2002 PAYEE BARON CHISM DATE OF BIRTH DECEMBER 22, 1969 OWNER t�tl ��ER111�1�5r���t�'�J�ATIQ�1. ;t� SEX MALE SCHEDULE OF BENEFITS AMt`1 nAl S THIS CONTRACT DOES NOT HAVE ANY LOAN VALUES OR CASH SURRENDER VALUES. 1998 -SSA NONPARTICIPATING SINGLE PREMIUM STRUCTURED SETTLEMENT ANNUITY CONTRACT. SINGLE PREMIUM PAYABLE ON ISSUE DATE. ATTACHMENT /EXHIBIT "Y' 01/16/2014 06:23 717 -5478 JOHN B BEL3AK JP. PAGE 30/34 h� Account TD; $$546 .Please complete and Ogn. S'I'A'IyEN.IENT OF I'RCyFESSIOI'�1AL RFPRE�ENT1�,'I''�lV ? e� : Ck crge Either Box A l Box R Below. After you h mado your gboi,ce, STGN kNp DA_,'3f'�. the alxpro�ri,a1� box signattrrc Zinc. YOU SHOW D Sr0 ONLY O�*ll±r I QX — THB DOX YOU ItAVE CHOSEN. A. I HAVE I3FEN ADVI BY P EAC I3TRU'E SE TTLFWNT FUND, LLC ( "j 'I'i3AT I SITOU LD. OETAIN INDEPENDENT PROF ESSIONAL REPAESI' Nz+A iTION CONCERNING TkW, ,LEGAL, TAX AND /OR ;FINANCIAL XIYJ PUCA730NS OF THIS TRANSACTION. I FULLY .DERSTAND THE'vVRCH.ASE AGR11WAMT ANID THE TWtTC.ATIONS O.F.TkI,E TRANSI+ER, ICNCL[7i7IN+C TUE TAX RAM FTCA'I''IO NS OIP `ITS TRANSI+ER AND 1 NOT.V4'IS,�TO SEEK OUT SUCH IIVD PiDE P FEMONA REPRESENTATION. G1�lsM Dire B. I HAVE OBTAINER INDEPENDENT REPRESENTA'J['XUN AND I FULL' UNAFRSTAND T TE LEGAL, TAX A"/OR FINANCIAL EV PLI!CATIONS OF TM TPLk NSACTION, THE PURCRASE AGREEMENT AND THE RELATED DOCUMENTS. I WAS NOT RFFERRED To my :PROFESSIONAL AD'VIISOR RY PTST -NV. TEE NA.IVIIE OF MV PROMSSIONAL ADVISOR IS SET FORTH BELOW: P ARON CFI)SM. Date To Be Comp141ed I0y C'op*yii Prnfessinnal AdATor Only ffyou htav©sr�ned Box B Above Name o£Profossionak . _ .. Attomoy ID # Phonc Number: (_) Address: I Imvc pers0nt?37y mct with And ptovMcd independent profn9ainnal ndvicc to in respect of tha himhase Contract Ivith F SFNV and the transaction contempbtgo t'h mr y. FSmmn Chum ivoc referred tq ma L the }Atl'��93.I9JIra5 $tgllatUTe f�atc 99c�1Hb'C saiC9 'S,i ?�11 / t4 +,' 1di61cllstt Fumi ;uP LL(' ,I I ATTACHMENT/EXHIBIT 46 4" i 01/16/2014 06:23 717 - 593 -5476 JOHN B MLSAK JR PAeE 29/34 A=uTTt ID: 589546 PURCHASE CON1 RACT 17tii5.iS a hrehasa Contract("Cghtrael for the Me of stuc uted settlement Payme»js between Baron thl5in (You, Ywic), grid peacbtm 5ettietherlt: Funding, LLC (We, :Us, Our) 3993 HoWar.d Hughes Parkway, Suite 204, LaS Vegas, NV 8%604754 GIENERAL. INFORMATION A. in connection with the resolution Qf a personal injury daim, You or someone acting for You, signed a Settlement Agreement that entities You to recBive certaln future payments ('Settlement Payments% according to a set schedule, B. Thane 6ettlerrimt Payrnots are being paid to You from an annuity policy (''Annuity Pollcy) purchased by gie Person responsible for matdng.fih6 - c4t#lement Paymrenfs to You ("Obligor`). C. . Rather than :wait for the Settlomet t payments to be. made to You In the future, You want to sell ail or sonle of those Settlement Payments C'Purchased Payments'! -to Us now for a Jump sum. D. THIS CONTRACT CONTAXNS AN A9131 - F RA"CA N PROVISION WHICH YOU SHOULD READ CAREFULLYi AS rr WtLL HAVE A suaSTAiNTtAL IMPACT ON HOW 0XSPl!TES DMEEN YOU AND US ARE RESOLVED. E. RW adiditidrtal definitions, sap- 5octivn -3 of O is +Contrac't. Yalti acid We agree as foilaWs: I. SALIE iE IM PUKH,AS90 M A, Upon the signing of this Coaft6tt and subject to certain conditions including Court Approval, You sell, transitr and assign to t1s the right to receNe the Purchased Payments specifically identTiied in the I3J -Wwure Stat aMent- 6. We will pay You the Net Purchase Price as agreed to in the Contract, Documents, subject to Left-sin conditions, mciuding meeting Our undewrit;ng requirements, Court Apptoval and satisfactory completion 6f the G"i[ssing DDijrnents: We will do this in exchange for You: ® sellirtg:the Purchased Payments to U5; changing the beneflclory .of the Annuity Policy to Your estate and not changing It again until We have. been pair) all of the Purchased Payments; o having any current henoficiaries waive their rights to the Purchased Payments and fulfilling Your promises under this.ContrscN. PaqJ 1 o7 /1,zltz (b 201.1 rru,<, 6tva %tttemcmt Rending, i,le 01/16/2014 ©E:23 717 - 699-5478 JOHN 3 BELSAK JR PAGE 19/34 AccountIO: MM C. Lf we are buying only a purl on of Your paymerU, t)1is will have no effect upon Your r ights in the unsold po tlon. You wilt ondaue to receive the unsold port9 n unless You have already sold or encumbered that portion, k sometiirfes tlie.lssuer, the Qbllgor or the court may require Us W receive the MUM amount of Your payment. If so, tide will thEln forward the poftn of the payment aU due tb You and You hereby agree to this payment servicing �ITSn�erri�itt 2. EMOM RI�l4Cl* A. The Gross and Not Purchase Prices are siavwn on the Distlosure Statement and are flair and acceptable to Yot, and Us. B. We will pay You the Net Purchase Price in the manner You des)gnate for us. C. Before we pay You, You agtoe tfiat we will adjust for the following amounts, ifapplicabl�; + pumbosed Payments owed to US —'the 15suer may have already paid You some of the Purdimed Payments befaM WO have paid You for them. If that happans, We will deduct the amount of those Purthased. Payments, fialdb2dko Due to possible delays in the Issuer begivioi►ng to make,t he Purchased fsaymen'w to Us inskoad isf Youp we w,il tiQ1t11?ac An amount equal to any Purchased paym that the issuer [,wens Us post Court Approvaky that are due within 00 dey5 of the Furnlipg 14ste. If W subsemiantly reative titer parlkuiar Ptirthased Payments directly, We will return the nnwunt. of any rolated holdback to You. Payment 0 4ms Owed — if You owe any past due chila suppor 4 b payoffs or taxeSsr or have any judgments or belts against You or You assents We may pay those amotuds m4 deduct them from the atrnowrt We pay You and You hereby provide Ug with specific authb ty to w e sudi ;ofiim Wo vgli provide You with notice of the amounts that Wears going to pay, prior to actual payrnenl, D. If any PurcbasW Payments are rnistakcn(y sent to Yoe after We have paid You for thern, You will imrnediately contact tit. if We then determine that any deductions or holdbacks as set forth above are not.enough to reimburs� Us, we Ml) advls You of'tte 4Sm6ut7t YOU owe Us. You agroe to immediately send that omuwnt to Us by bank a certified Cheek. 3. D �lnfQRQ6 Certain words used in this Contract: have the specific meanings shown below. 1�7<iEil ➢af, An enfity controlled by controlling or Wida.r cornmon contro) vvit31, another entity. AfinuitV Miry The pouts purchased by the Obligor to ensure that the Settlement; Payments are made to Yoii as required by the Settiernent Agreei ient +rloslrig ©trrxrrn'✓n� Pty} {r 07/1.412 (E. 2GII FkIn ding, Lt,C 01/16/2014 06:23 717 - 599 -5475 JOHN B BELSAK JR PAGE 20/34 Acmu014: 584546 Any documents nece carry out stile purchase of the Purchased Payments, other than the "Contract or Contract DOCurne nts" as dead below. Contract or contr€+ t Dowmeil coliettivetyr, only this contract Arid thd 'DisClo5uM Statenld t Contract Data The date Yc signature at the end of tills Contract Is notarized, However, if You happen to sign this Contract before the number of days stated at the end oP Your Disclosure Statement for uniting has passed, You will have no.obligation under Your cofltract until thatt.tirne has passed. Court ardar A lagaJiy bidding ruling Issued by a judge or properly empowered administrative officer, appmving the sale of the Purchased Payments to Us CCourt Approval'). Disclv�re Sf�t�ameht The docurtt nt wlikil icterrMfIRs far You, 4he Purchased Payments, expenses, Purchase aria and various other disclosures. Ertrta>��rance Any oi�im,:ri hfi, ftrr, policy loan, or resbtction. In addliion, arts includes any limits on.rights of ownership (such as the use, voting, transfer, receipt of income, etc). F4ndinrg Date The dab` We pay. You the Net Purchwc2 Price. Issuer The Insurance tympany that isrsued the Annuity Poli.o/. Obligar The Person %vh6 is obligao2d to mo.ke peyments to You under the Settlement Agreement Party Ohe of You or Us. Parties means both You and Us. Person Arty natural Berson ar lerpal entity. Purchased Payments Only those certain paymo is that We are purchasing from You under this Contract. Purchase Price: Gross Purchase Price TheAmount s1I Own 'as.the "gross amount Payable to the sellor (YOU)" on rho Disclosure Stotement, This Is tie sum WI; have agroodt;o pay Yaw bafte any deductions as setfnrth in the Contract Documents. Net Pumbaw Price Poop 3 4 ?1 �.1J12 i�: i(Ia1. P*ir4 rem . rot Rghling, LLC 01/16/2014 05:23 '717- 599 -5478 JOHN! B BELSAK JR PAGE 21/34 Account id: SD9546 The amount shown as the ` net amount payable to the .seller (You)" on the Disclosure $Mement, This is the sum we have agreed to pay You afferany deductions a$ sin forth in the Contract Documents. �ett{gtiirar�i~ A�IrBptt't�ent The agreement that You and the obligor signed to resolve Your personal Injury Claim. Satti�iriarillr: P�y�nterrxs All of the payments that the Obligor has (agreed t4 make : to You in the Settlement Agreement, Wa our, or Us Peachtree Settlement Funding, LLC ateong with any of Its successors, assigns, and degignez Some of the Contrad . Documents i7r Closing Documents may refer to us as the purchaser, Ynu Olryour The Person named on this Contract's first page. Some of the Contract Documerbs or Closing Document may refer to You as the seller. 4. '+)'ir1 M jjE.I? - RM 9TAYI*N iANI5 You represe nt algid warrant; to Us the following: A. YAu underslAnd thart THIS LS SALE AND NOT A LOAN, S. The Annuity Policy is in full force, You aretht pole and undisputed redpient of the right to #1e Purchased Payments have. tYi+ Yi9ht to sell titeni free and clear of any Encumbrances and have not previously sold any of the Purchased Payments to any other Person. C. You undeMtand that Court Approval is required for this purchase; and You agree to fully cooperate with Us to obtain, that; approval, D. You. gave Us all requested information and signed all documents necessary to complete the purchase. Every st6tement ma de by You in the Contract Documents and Closing Documents is true and complete. E, No taw, divorce decree or other legal obslacte: rftquire$ You to keep the Purchased Payments for the benefit of a current or former spouse, dependent ctiildrett, or other person;. or legally prevents You from contracting with us; selling the purchased Nym(entr or eltanging the Annuity Policy's beneficiary. F. either: You have never fled for bankruptcy, will not do so before the Funding Mitt and there arl no lawsuiks or efforts by any of Your rreditvrs to put You Into bankruptcy or take any of the Purchased Payments; or Yn1l'% a (?7J12112 (t,/ ::O7,t fi� <11r4t'r@ "ktttte3At <ttrt r'nlidlpg; LU.' 01/16/2014 06:23 717 -599 -547° JOHN B BELSAK JR PA5E 22/34 Amount M 5895% s le . ,.. V You filed for bankruptcy, the Pu rchosed Payments were not suWed to the claims of Your creditors. You Will give Us a copy of arty of Your. bankruptcy dommenrs that WA request inciuding.eViderice of a final bankruptcy payoff or case closing, if any. G, W6 can rely an Your r0prese+nt+ations, warranties, and promises in this Contract. "these representations, wwr�ntles, and.promises are for Our benafit and the. benefit of arty future owners of the Purchased Payments You understand that Our reliance on any intentional misrepresentation by You may result in Our enforcing Our rights against You In court. H. You Tied. enough time to consider the sale of ifyo Purchased Payiner?ts, understand the terms of the Contract Documents and Closing opt m ents (I the artibatioll provision), are of legal co age and sound mind, not wilder the Influence of drugs Or alcohol, and freely and voluntarily, enter into th Contract and agree to all of its terms. T. You were advised by V.4 to obtain independent legal advice and professtonol tax advice about the sale of tho Purchased Payment's 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 finandel options Iv0om entering into this transacton. J. We did.not prpyide tax, flnanctal, or legal advice to You about this Contract and have advised'You that vile may not r4ftr You to oily specific attorney for such purpose. K. zf 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 bate, you (and Your spouse) will not Deceive the same amount of money on the same payment schedule as You would have rocsrived under the Annuity Polity. Your spouse has been provided with ail iriFormation relating to the transaction and has had every opportunity W ravfew the terms of the tnansa6on and to seek any Fadv)6-- relating thereto, Your Spouse also understands that he or she will be giving up any property or contract rights that he or she may have In the Purdlesed Payments. L, W may sell, transfer, or assign Out right to ttte Purchased Payments in a sale, securitization, or other financing transacton (resale). Any resole would involve disclosing certain informat)on about You (including Your personal Inkmat(on) to the parties to a resale. K Arty future owner o f th right to the Purchased Payments will have all of the some rights vve have, including the right to the duties You awe cis under thus Contract, This Includes the tight to make a maim against You fbr violating any of I he representations, warra►rdes, or promises You made, in this Contract 5. YQ.�PLtC1t°[;CSFS7'1;1115 Be f+orA a nd :after the Funding Date: A. yqu Wit tall u5 ii, ght.pway if Your address or telephone number changes and dpi everytjiing necessary, including completing and signing all documents to: soil 'file right to tite Purc hased Payments to Us; M change the beneficiary as required by this Contract; correct any dowmentation errors in the Contract DocumeriM or Closing Documents. tar�c: s �7/t,2,�72 te7 �0].l Pn;�chtl'�. ". Sc' ?il {Ctti4ltt 1'Urttlltty. I,LC 01/16/2014 06:23 717- 599 -66478 JOHN B BELSAK JR PAGE 23/x^4 Account m: ss9546 B; You wAl also tell Us if any df the tnilovMg occurs, * a violation Of'this Contract; or * anything that could negatively affect the Annuity. Policy, the Purchased Payments, or this Contract. C You will not: • agree to sell the Purchased payments to any Person other than Us; * change the Annuity Policy's beneficiary to any Person other than Your estpte unto we have.coffected ail of the Purchased Payments; or r withdraw cash from, borrow against, or change the Annuity Po)[W. D. You will give Us information rrfeessory to update Your representations, warranties, and promises in this Contract, You Will also update any documents and informaWn so they will be true and complete on the Funding bate, 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 rnoparate with thfs confirmation attd provide WMplets aecam to Ony information .we beileve necessary. F. You agree that updOting representations warranties, promises, documents and other information will not cure xa breach of any representation or warranty made by You that was not true and complete, G. You agree that Our obl)gntion to You under this Corttraet is strictly limitted to the requirement to pay You what We owe Yost under the terms of this Contract, after receipt: and approval of the Clbsiiia Documents, final underwr approval and Court Approval, under no aircumsfiances Will We bo liable for any consequential damages, H. You hereby.appaint US arid. any of Our desighees, with full power of substitution as your Attomey in Fact, toot In ;tour name and place for the purpose of assigning and transferring ownermhip al: env and 611 right, title and 10081: that: You hve in the Purchased Payments and for Us fie obtin all benefits oorib mplated by this transaction. You also giver us full authoiity to act In any way proper and necessary to exercise this Attorney in Fact pppintmertt lncludlirg, but not limbd tot (i) negotiating, endorsing and executing checks, drafts and ether Instruments in Your name; and (2) jmtkiitigg; maintoiping, cornpromising, setiifng and terminating any litigation or other pr4ceed1ri9s related to the Purchased PayMenbs, Yh'i$ power of attorney is coupled with an interest arid shall survive death or disabi[4. We may caneel this CorrVact before the Funding Date 9, A: You breach any representation, warranty or promise in any Contract Documenft or Closing Documwts, a, The peiltion'for the Court Order is contested, opposed, or not approved. C. We are sued or threatened with a iawsutt or on arbitration about this contract or the Annuity Policy. D. There is any tirreaberted, pending, or final act i), Or change In law or rule challongincg the iegailty of, or negatively affecting this transaction, E You file for, or are forced into bankruptcy. Pam 6 W11 Pwiditrea S(etitement Funding, LLC 01/16/2014 06:23 717- 599 --5476 JOHN S BELS AK JR PAGE 24/34 A=unt ID: 989546 # F, You die. G. Final appvvO has not been given by Our underwriting department. H. ne Purchase Contract is not signed by iron and received back by Us by February 24, 2014. L A major rating agency dowtiomft the issuer's credit rating. J. The Issuer is, or becomes tosohrent or under regulatory superv)5lon. K. With respect to A through J above, 0 th4 6xtmt permitted by applicable law, the arbltraton profsion in Section 10 of this Contract shall survive the terminatiari, cancellation or resdssl4ri of this Contract. 7. MC UATIi!_1V_6_Y_YOU A. (t.) YOU MAY CANCEL TM!; CONTRACT WITHOUT PENALTY OR FURTHER OBLIGATION AT ANYTIME WXTHIN (5) BUS INESS DAYS AFTER THE DAM YOU AECEIYE PAYMENT HERIrUND911 FROM US,. Ito ORDER FOR THE CANCELLATION TO BE EFP9C3IVE, YGU MUST SEND A NOTICE POSTMAMI) AT ANY TIME WITHIN FIVE BUSINESS DAYS AFTER YOU RECEIVE PAYMENT HEREUNDER FROM Its (This is the rescission pedod). (2) YOUR NOTICE IS TO BE SENT EITHER EST CERTIFIED OR RWI5TERM 13 MAIL (RETURN RECIXPT REQUEsTEp) OR FED14K OR ANOTHER M"OR OVERNIGHT DELIVERY SERVICE. THE NOTICE 14VST INCLUDE A BANK OR CER77FIED CHECK MADE PAYABLE TO US, IN THE FULL AMOUNT RECEIVED BY YOU. YOUR NOTICE MOST BE SENT TO: Pesaohtree Settlement Funding, LLC Attention: Manager of Operations 3993 Howard Hughes Parkway, Suite 204 Las Vegas, NV $9169 - 6754 9. O it , Ilx� I'd YOU MAY CANCEL THIS TRANSACITON AT ANYTIME PRIOR TO 5,00 PrK QT= THE TWENTY-FIRST PAY FOLLOWING RFCIUPT OF THE ENCLOSED "NOTICE OF CANCELLATI RIGHTS" FORM, OR AT THE HEARING ON THE APPLXCATIOIV .FORAU THORLZA1TION OF A TRANSFER OF SIROCTUREA SE't'1'I.EMENT PAYMENT RIGHTS, OR AT ANYTIME WFITHXN FIVE (5) BUSINESS PAY'S AFTER YOU RECEIVE PAYMENT HERE UNDER FROM US, W"ICHLVZ9 EVENT OCCURS LAST MIR is the Georgia rescWsion period). IN ORDER FOR THE CANCELLATION TO lag 15FFECYtV15, YOU MUST SIGN THE ENCLOSED ^NOTICE OF CANCELLATION RIGH76" FORM ANO FLAIL OR DELIVER X' iro UsAssPmr -xi5D IN TkiAT NoTwE AND You Miw r RETURN AL4 AMOUNTS (PURCHASE PEACE OR OTHERWISE) RECEIVED BY YOU ACCOROXNA TO THE REQUIREMENTS OF 7 (A) (2) ABOVE. C: VILE ](,141 gXW ESX0- f;NTS IN ORDER FOR YOUR CANCELLATION TO BE FFPF_CTIVE, YOUR NOTICE CAN BE SUBMITTED. VIA PHONE MAIL, OR FACSIMILE: ANY AMOUNTS ADVANCED tIY.US IN CONTEMPLATION <tF THE TRANSFER SHALL 131E IMMEDIATELY REFUNDED TO US.. IF YOU DX5MX59 YOUR ACTION AFTER. APPOINTMENT OF A GUARDIAN AP L TE.M, OP. RESCIND YOUR'TRANSFER AGREEMENT (PURCHASE CCINTFIACT) WITHIN T14E RESCISSION PERXOD IN 7(A) (1) ABOVE, YOU SHALT. RE RESPONSIBLE FOR THE FILING FEE AN13 ANY G JARD>:AN Ab LIT EM FEES, C�. With tesifpa to A through C above, to the "tent perrn"rtted by applicable lamr, the arbitratimi provision in SecKon 20 of this Contract shall surtinre the terminaiion, cancellation or rescission of this Contract; F''A;l . T 07/1,2/12 Ua �0(l P rt�4 ntreh 5t:tzl¢,rnent Ffiniling, LOG 01/16/2014 06 :23 717 - 599 -5478 ZHN B BELSAI{ JR PAGE 25/34 Acrnunt TD. 56'9546 S. N.OTICF.s A. All noticea about this Contract must be in writing, B, All notices must be tent either by; (1) teriitied or registered mail (return receipt requested); or (2) i=edEx or another major overnight: delivery service, With a delivery tracking system and are considered given when dellveted as foil" -. It to You to th most recent address for You listed In Our flits. If W Us: to the address listed in Section 7(A) (2) of this Conb-acL 9. .EVENTS :4F_LzaE;1FAMT You will be in default if You: A. fall to comply with any terms or conditlons of this Contract; or 6. breach any of Your rapreserlOdOns, warranties and promises in tilts Contract If You are in default, even if You have not rejected the arbitration provision (see Section 14 of this Contract), We have the right to enfom wr fights against You in court to make You perform Your promises or to get money from You, If Wo sue You in court in connection with 4 Clalm diet is Subject to. drbi ration under the arbitration provision in Section 10 of this Contract; and You have not rejected the arbitration provision, You will have the option of remalning In court or seeMng to compel arbWation of that Claim under tfie tents of the arbitration provision. 10. M TRAT O P89 STCIN To the extent Permitted by applicable law, You and We agree to the following arbitration provision, YOU HAVE THE RIGHT TO RMECT THIS ARRMA17ON PROYMON AS M FORTH BELOW. T# You do riot reject 13l is ari�i#satiaxt pravdslciii ansl a Claim is arbiLiated, You will not havo the right to (x) haw a :; =rt or a jury de6de the claim; (2) engage in informaklonl gaf` nr'ing (discovery) to the some extent as in court, (3) portly tipate in al class action i col]I't Or arbitration; or (4) juTn or consolidate a Claim with claiMs of any other persd.fl. The right to anal is more lirnAnd Pn arbitration than in court and other rights in court may be unavailati� nr limited in 8rbitmtion. GlaiM& Subject to Arblit"onr A "Cl.aimf ' subject to arbitration is any daim, dispute or controversy between You Arid us (other than an Excluded Claim or Proceeding as set forth below), whevier preexisting, present or future; which arises out of, or relates to the Contract, the negotiations related thtrebo, the breach thereof or any other transadlon conducted With us in cbnnedicin vdith the Contract, "Claim° has the broadest possibia meaning and Includes initial cairns, counterclaims, cram- tlainns, third -party clalri99 Ind federal; s and administrative claims, It includes disputes based upon coiltrM, tort, consumer rights, fraud and other intention ,)l tarts constitu state, regulatlon, ordinance, common lave and equity and incudes claims for money damages and injunctive or decWratbry relief. Upon, the demand of You or Us, Claims) will be resolved by individual (not class or class -wide) binding arbitration in.accordance with the terms cpaclfled In this arbitration provision, p8ci1 �i1PtiC+rts. Solely for purposes of this 2rbrtratian provision, In addition to the meanings set forth in thiS.ConttaCt: (7) "We;'r "us" and °Our. ":also (a) refer to Our employees, affGe►s, directors, parents, controlling persons, sub cidiaries and Allates and (b) apply to third parties if You assert a Claim against such third parties in connection with a Claim you assert against Us: and (2) "'Yeu"ar "Your" alsa refer to Your currvn't or f6rmer spoume(s) children. heirs, estate, executors, suca -mors, assigns,' representatives and beneficiaries. occluded Clair" or Prdc irrg, Notwithstanding the foregoing, "Claim" does not include any dispute or controversy about the validity, enforceability coverage or scope of this arbitration provision or Any part thereof (including, without limitation, the "Class Action Waiver" set forth below and /or this sentence), all such disputes Or Controversies are for a Court itid not a n arbitrator in deride. However, any dispute or contmversy,that concerns the validity or enforceability of the Contract as a whole f`crliu� J Ci�J't.�l'i L (ra Llt ;19 Set leroernt. Fundini;, LLC 01/16/2014 06:23 717 -599 -5478 JOHN B BELSAK JP PAGE 26/34 Aaaurit I0: 58M6 is for the arbitrator, not a court, to decicle, In addidon, We will not require You to arbitrate any Individual action brought by You in Small claims Court, or Your state'$ equivalent court, unless such o0on is transferred, removed, or appealed to a different: court, pederal Arbitraftn Act. ivotwithstanatng any other provision in this Contract, You and We agree that this Contract evidences o tran6ai't n Involving interstate commerce and that the Federal Arbitration Act (Title 9 of the Unfked States Code) ( "FAA') shall govern its Interpretation and enforcement and proceedings pursuant thereto. To the extent state law is applicable under the FAA, the law of the state of Your domicile (where You regularly reside on the Contract Date) shall apply. class Action 'Waiver, IYot ovitbaending any other provision Of'this Contract, If it Claim is arbitrated, neither You nor We will Nhv ei the right: (a) to pi1rti0Pake In a etas¢ ; #ion, PH%rate attorney general action or oftr irepresentative action iii court or in arbitration, either a s a C la ss representative or dm m of (b) to Yaln or consalldate Cta hf)s with daint8 of any other Persons. No arbitrator shall have authority to conduct any arbitration in violiation of this provision (provided, however, that the Class Anion Waiver does not apply to any lawsuit or admilr:Mmtive proeaeding fled against us try a state or fedaral gavemrnent agency even when such agency is seeklirxg relief o" behalf of a class of burrowers including You. This means that we wlil rat have the right to compel arbitration of any diairn brought lay such an agency). The Class Acti waiver is nonsever from this arbitrations provision. if the Class Action Waiver is limited, voided or found uttenforceable, then this arbitration provision (except for this sentence) shall be null and void with respect to such proceeding, subject to the 'right to appMl the !imitation or invalidation of the Class Action Waiver. llrllttration Procedures, If You or We seek to arbitrate a Mim, the Party seeking arbitration must notify the other Party in wrtUng. this notice on be given after the beginning of a lawsuit and can be given in papers tiled In ate lawsuit, Suth as a motion to compel arbitration. Citherwise, Your notice must be sent to Us at the address specified in Section 7 (A) (2) of this Contract and Our notice must be sent to the most recent address for You in our files. Any arbitration hearing that You attend Wig take place in a venue of Your domicile, If a Party files a lawsuit in court asserting Clalrn(s) that are subject tx, arbitration, and the other Party files a m6on to compel arbitration W161 the court, which fs granted, it will be the responsibility of the Party prosecuSng the Claim(s select an arbltratlon administrator in accordance with the paragraph below and commence the arbitration proceeding In accordance with the administrator's rules and procedures. The arbitration will be administered by the American ArMtratlon AZowation ("AAA'D, 1633 Broadway, 10h Floor, New Yorp, NY Loolo, www,adr.org, 1. 800-77$ -7$79 or JAMS, 1920 Main Street, Suite 300, Irvine, CA 92614, wwwJamsadr.mm,1- 800 -352- 9267, The rules and forms of the AAA and JAMS may be obtained by writing to these organizations at the addresses listed above, If the AAA and JAMS are unable or unwilling to serve as administrator, the Pr)rtles may agree upon another administrator or, if they are unable tv agree, a court slug 4atermine the administrator. No company may serve as administrator, without the consent of ell Parties, if it adopts or has in place any formal or informal pol(cy that is inconsistent with and purporis to override the terms of this arbltratlon provlslpn, In the event of a confilct 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 JAMS or other 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 he a practicing attorney with ten or rncTe 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 COUit, or by std or local laws that relate to arbitration proceedings, The arbltrdtor will honor statutes of limitation and claims of priviiege reeognizmd under applicable law. In determining liability or awarding damages or other relief, the arbitrator will fOow this Contract and the applicable substantive law; consistent with the FAA and this Contr�tt, that taeaalld 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 the administrator and arbitrator to You for Claims) asserted by You in arbitration after You have paid An amount equioldnk to the fee, if any, 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 fee for asserting the Claim(s) in court, You will not be required in pay that �imvunt again), In addition, the administrator may have a. procedure whereby You can seek a waiver of fees charged to You by the edminLstmtor and arbitrator. We will always pay pity foog or expemes that We are required to pay by law or the adrtifnistrat f's rules ort We are required to pay for this arbitration provision to be enforced. The arbitrator wili have the authority to award dttorbeys' and expert witness feet and e ost5 to the extent permitted by this Contact, the adrrilni5trator's rulFS or applicable law. 'the.. arbitrator will always awtird You reasonable attorteySl and expert: witne� feed and tests (a) if and to the extent You prevail on Claim$ you assart against Us In an arbftre0on commen by You and (b) tra the extent required under applicable law for this arbitration provision to be enforced. The arbitrator shall write a brief explanation Of the grounds for the decision. A judgment On the-award trtiay be Entered by any court having jurlsdictlon. � / '/ i> 07, t Ge,,n 7trFr 5e113rrimnt,, FIvild1n, LLC 01/1612614 06:23 717--599 -5478 JOHN B BELSAK JR PAGE 27/34 ACcountTD, 589546 f 5Oeverability and Sufi vfaa L If any part of this 'orbitration provision, other than the Gass Action Walver, is deemed or found to bo vnerif eeable 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, Effett pf Arbitration Avrard. T he arbttrator's award shall be (inal and binding on all Parries, exceptfot any tight of appeal Provided , by #7e FAA. however, if the amount of the Claim exceeds $30,0DO or Involves a request for injuncttve pr dedarooty relief th could foreseeably involve a cost or benefit to elther Party exceeding $50,000, any can,. within 30 days alfier tbo ehtry of the award by the arbitrator, appeal the award to a three- arbitrator panel »dmin'stered by the administrator. The panel shall reconsider anew any aspect of the initial award requested by the appearing Party. The decision of the panel shall be by r 4ority vole Referenw in this arbitration provision to "the arbitrator" shall mean the p anel if an appeal of the arbltrator`s decision has been taken. The costs of such an appeal will be borne In accordance with the above paragraph tit "Arbitration Procedures." Any final decision of the appeal panel is subj= to judicial review only as provided under the FAA, Right to Reject ArWratian provision. You may reject this arbitration provision by sending Us written notice of Your deddion so that We receive it at the address listed below within forty -five (45) days of the Contract Onto, Such notice musk be Sent by Wit Mid or registered n73D (return receipt requested) or by PedEx trr another major overnight delivery service with a delivery tracking system, must Include a statement that You wish to reject the arbitration provision along with Your name, address Account I.D. number and Your signature; and must be delivered to Us at the address sped tad in section 7 (A) (2) of this Contra t. This is the sole and only method by which You can reject this srbitrounr Droyisioh. Upon receipt of.a rejection notkp-, We will reimburse You for the standard cost of a certified or registered letter or overnight delivery R*Won of tW ai•bitm tt ri prevision will not affect any Other terms of this Contact and will not result in any adverse consequence to You. You afire t that Our busine5s records will be final and conclusive with respect to whether You rejected tt,is arbitration provision in a t imoly and proper fashion, This arbitration provlsian vAll apply to You am Us vmlless you reject it by providing proper atilt I trely native as stated herein. ZI. M>ISCpt.LANEOtl3 A. You give Us peTmisslon to conduct; background checks on You, including obtaining information' from the credit bureaus, in older to verify Your fegal residence, contact information, and any other tniormation we dean nmeRary for this trnnsat&h. We can raiv seardi record- for UCC filings, bankruptcy filings, judgments, liens and child support; dbligations aga'mst You. B. This Contract is the entire agreement between You and Us. C. If there fs more than one of US or You, this Contract appl MS to all of those people together, and to each of them ore their own. D. both Parties must agree in writing to any diange to this Con"ct cr waiver Q its terms. E. Except as set forth in the arbitration provision in Sedion xA of this Contract, if a caurbundoes any part bf this Contrac> the resit of the Contract remains valid, F. You cannot voluntanly or involuntarily sell, assign; or transfer this Contract, or any of Your rights or dut4es under this Contract. Any such aciion taken by You in violation of this section shaft tie void and of no effect. G. gxcept as otherwlser. required lay. applicable law, the law of the state of Your domi(;ik3 (where YOU regularly reside an the CentraCt Date) will govern this ContraLt and disputes under this Contract shall be determined in Your domidle State (where You rwukarly reside on the Contract pats). H. This Contract also holds responsible YoUr heirs, and executors, This Contract benefits only You and Us, and no one else. However, If properly asslgned by Us, this Contract will bind and benefit Our succMars and assigns. p;K17, t0 n7Jt,2/72 C� �IPAS. k;a,';sG�trFei rclkS�mrrt; ft.mtSiflg,1J C 01/18/2014 06:29 717 - 599 -6478 JOHN S BELSAK JR PAGE 28134 Accourit1b; 589546 I. Failure to enferce any provision of this Contract is not a waiver of that provision. 7. fhe �attlPS.rrtay.si n.tlliS.CoCitlact In ono or morn counterparts; inaeh coun%#4ft will be considered n original: All o6untarorLS will form one Cpl act. A facstimlle, pdf orother, electronic copy cif the signed Contr'act or ally counterpart w1N be mnspde an origin 1 and Heated as sucti.in any court [4r arbltrration] proce ing. K. WP have InVeS1l9ated the proposed transfer of the Purchased Payments.and, in light of iiifo matipn dvalfabMD Usj have iden8fied no violation of any applicable state or federal law. L. you will not receive an IFS Form 1099 from Us: M, 'Titles and headings in this Contract are for.convenience only. Do not use them to interpri t this Contract. N. Except: as otherWise set "h in this Contract (including the arbitration provision in Section 10 of this Contract), You and. We will pay our respective costs and expenses in carrying out this Coninct, 0, 7bp give Us permission to request from our Affiliates information and documentation You have prevlovsiy provided to theM.which we necessary for this tmnsattCon, including, bankruptcy filings, judgments, settling doaiments, annuity doa,m" liens, child support obligations, divorce docutnerits. [RRMAJpIDRR OF PAGE INTENTIONALLY U1 PT BLANK] . Pr,y�e 17, r}7j1 ?,f i;� ic, 201.1 fi�:ae;htrea �r�tir:,rnenr r'vizdirry, tl.� 01/16/2014 06:23 717- 599- 5478 JOHN B BELSAK JR PAGE 29/34 A�oiiuntl;D: 589546 you algid IMO, .,Mband'rng to use 169al ly bt3Und, have gigriad this Contract as of the Conbrack Date Wow, and agree to all . of:itr terms and cond�tomi ificludiitg the arbitra# ion provision., eYsiy»'rF►�BefoYu,YuiI Ito Ackhdwiedge that You were advised by (is in writi77g, tCtatYou should ahtain ilttlaptni etik [ l aciaR+ aha prafe lvn;'al trax �dvh: about the sale of the Purchased P yrn fs and to have those C1vlsdTS r,ani,ai+V "With You 'fer rns. iind legal tax artd officer eaMt s of thisCootroct. ND7Af�lAl:;�):AL aoF{N:l:B LSAKJR 1�atnry Public... . I<styorn to an�. � d � P SELLER MIQDV:pAXrON YWP. DAOpHIN CQUNV befora is Y of 20 rconttract My GomMI931on EXPOU Ju127, 2014 Bate' ' ���:';. in rte iu �•, }� or 'I'M wary Baron C}ifscn Adnowledged and Agreed: Sworn to And subscribm SELLER S:SPOUSE (if apptitable) b44r. a me Wis day of �...� - �., 20_.... .parer it ifdY ti ti� : ��y� ry 1p i i��K eyt,t "I M M'�' v 9TI�YM, �: gk'an'�F4� 1 9:jtW . }gin,; : !: i I1�7itib' a ; I� ' { {.� ?r:..N•�i �:;;i�i�'.;e! iuX°l Notary Spouse U Peachtree Settleteent.Funding, LUC Lori Borowski, Vice President PE1ys; ,x 07(a,fi_(12 CZd 201,t r i1C,tltf�P 5P.11A MIGAT: f "iAMIng; ll<; 01/16/2614 05: i3 717 - 599'-5478 JOHN B BEL.SAK JR PACE .09/.39 �,oubune?Ss� 58454fi Ja axy 9, 203.4 ;P'EI' NSYLV;A NIA: RXscLOSURE ST—AfV N T we will..rurchgse the follr�mog payments (lour A5 Payments) from You: A) < ayina nt af�l 14, X4.4 . 1 e mbez 2, 21J► l) l p ynie�ot of $2S J7 1 t (The r emaiTkder, of the page intent o)Ially left blunlo 'I"'10 I } PU4Vllvm tiats�nrm ttiiinfiv },r,. t.,1,J.; 01/16/2014 06:28 717 -599 -5478 JOHN B BELSAK JR PAGE 10/84 �tCCAllntm: 5$9 $40. January 9, 2014 The aggregate amount of the Putrellased Payments The discounted present value of the aggregate Purchase Payments at the federal interest (rate of 2.20% li5 $32,017.75. The discounted pr esent . value is the +CSileohfion of the current value of the transferred structured settlement payments (Purchased, Payments) under federal standards for val annuities. The gross mnount payable to seller (Yo'u) The net amount payable to the seller (You) is $161,000.00. Legal fees (this is an estimate of what Your attorney vdll eba,rge You if Your choose not to 'waive representation): ation): $500.00 No other W eASes are incurred by You. The net amount that You will receive froxra 'Us to exchange for Your future structured settlement payments represents 50.00% of the estimated current, valuo of the p aymehts based upon( the discounted value using the applicable federal. rate. Based on the net amount that You will receive in payment from Us and th+e amounts and timing of the structured settlement payments thAt 'You are selling to Vs, this is the equivalent of interest payments to Us at a rate of 17 02'1'% per yeas. PLEASE NOTE THAT TIUS IS NOT A LO^13UT A. SALE OF PA'YMENT ,RI..GHTS AND THE Xt'+T'X'.EI AST FIGURE IS ONLY PROVIDED AS AN ILLUSTRATION OF THE ECONOMIC IMPACT OF THE SALE. Tease be advised there are no penalties or Uquidaated damages payable by you in the event of any breach of the transfer agreement by you. Sy sig tug below, You are confirming receipt of this Disclosure Statement at least 10 days prior to You first incur, ring an obligation witb respect to the transfer. BAR 0 GRIST .Z_ ' SP'1f11 t'cnrhnx: F.Vf)r^Anri lrindlnu. l „1,('; 01/1612 014 @6':23 717 -589 -5478 JOHN B 8EL5AK JR PAGE 34/34 ORTANT N[t TIQF, you are stroug#y urged >to consult with an oftornq Who Can advise you of the pntcotyal tnx col�SEgUel�ccs b��t�is tzanshctiori. lay Swum m Rid m Ilmd V . Ee£M c xv this. ally , z0 NOTARIAL SEAL JOHN 9.9ELSAK JR Wiry, Publ!6 MIDDLE PAXT TWP, DAUPHIN COUNTY �y,Dnmmiss)ot1 ExplresJuCZ7, 201.E . , w ?tI) I f' «arbin r SwAilfoeat Fundinp, i.r,4,,, ATTACHMENT /EXHIBIT 6'5" 4 4 January 22, 2014 Farmers New World Life Insurance Company 3003 77th Avenue Southeast M'ercerIsland;.WA 9804.0 -2890 Attn: Legal Department /Structured Settlements Farmers Services Corporation 3003 77th Avenue Southeast Mercer Island, WA 98040 -2890 Attn:. Legal Department /Structured Settlements RE: Notice of:Saie /Assignment of Payment Rights Your Contract #: S00084459 Payee: Baron Chisin Dear Insurer: Please be advised that Peachtree. Settlement Funding 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: Peachtree Settlement Fundirig, LLC 201 King of Prussia Road, Suite 200 Radnor, PA 19087 Tax ID # 45- 2795843 PLEASE NOTE: No payments under this annuity should be held until the courts have entered a final order and we have forwarded this order to you. Very truly yours, Peachtree Settlement Funding, LLC By: Lori Borowski, Vice President 201 KINQ QF PRUSSIA: ROAD, surr3 200 > tiADNOR, Pik. 1 9067 1'l-lom : (8QQ) 444 -8641 • FAX: (866) 45a -8067 Reserved for Court Use. 1LEEJ Ur lt.t_ THE PROTHONO1 R'T 2014 JAN 29 PH 2: 2 1 CUMBERLAND COUNTY PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA � RE: Joint Petition of Peachtree Settlement NO: 010144 — ( ``{S4J C,iVlL Funding, LLC and Baron Chism INI AL ORDER OF CO T On this tA day of 2014, it is o ered that a hearing on this Petition to Transfer Structured Settlement Payment Rights will be held on 5 � J / h , 2014, in Courtroom C:2 at 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 C URT: r7,„ J. A-5 . Amos A.Placey Maw L..ommon Pleas Judge //a9A? 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 Peachtree Settlement Funding, LLC IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE:Joint Petition of Peachtree Settlement :NO: 2014-00454 Civil Funding, LLC and Baron Chism CERTIFICATE OF SERVICE I, 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. A copy of the Notice is attached hereto. : Z.. Date: February 4 2014 By:/ �� Robert A. Maro, Esquire Attorney for Peachtree Settlement Funding, LLC rn W -ter .:cY 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 01U."-t RE: Joint Petition of Peachtree Settlement NO: ) - -I (.1• Funding,LLC and Baron Chism NOTICE OF HEARING ON PETITION TO TRANSFER STRUCTURED SETTLEMENT PAYMENT RIGHTS To: Farmers New World Life Insurance Company Peachtree Settlement Funding, LLC Attn. Legal Dept/structured Settlements 3301 Quantum Boulevard,2"d Floor 3003 77th Avenue Southeast Boynton Beach, FL 33426 Mercer Island, WA 98040-2890 Elizabeth Lebro- Farmers Services Corporation Baron Chism Attn. Legal Dept/structured Settlements 313 W. Shady Ln 3003 77th Avenue Southeast Unit E Mercer Island, WA 98040-2890 Enola, PA 17025-2245 You are hereby given notice that Peachtree Settlement Funding, LLC has filed a petition to transfer suctured settlement Rayment rights. A hearing in this matter has been scheduled on 3 / .5 , 2014 at 3296 to"clock in courtroom no. 6 courthouse, Cumberland County Court of Common Pleas, Pennsylvania. You are entitled to support, oppose or otherwise respond to the payee's petition, either in person or by counsel, by filing written comments with the court prior to the hearing or by attending the hearing. The Name, Address and Tax Identification number of the transferee is Peachtree Settlement Funding,LLC. 3301 Quantum Boulevard,2nd Floor, Boynton Beach, FL 33426, Tax I.D.No. 45-2795843. 03-/ BY: / Date A. Taro, Esquire Attorney for Peachtree Settlement Funding, LLC. 1115 W. Main Street Norristown, PA 19401 (610)275-9600 (610)275-9666(facsimile) Reserved for Court Use. Ft/.ED`Ok 1Cl' i t RRO THONG TAW- 2314 JAN 29 2: 21 CUMBERLAND COUNTY PENN'S YLVA NIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA RE: Joint Petition of Peachtree Settlement a _ ti S� Funding, LLC and Baron Chism • NO: �°►vl� INI AL ORDER OF CO_ T On this� day of i 2014, it is o ,tired that a hearing on this Petition to Transfer Structured Settlement Payment Rights will he held on , 2014, in Courtroom -- at a Mo'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 CIIURT: arid mos A.Placey 4:a;Amon Pleas Judge IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA RE: Joint Petition of Peachtree Settlement Funding, LLC and Baron Chism NO: 2014 -00454 Civil FINAL ORDER OF COURT Payee: Obligor: Issuer: Transferee: Hearing Date: 3.5.2014 Baron Chism Farmers Services Corporation Farmers New World Life Insurance Company Peachtree Settlement Funding, LLC AND NOW, this 5th day of March, 2014, upon consideration of the unopposed petition of Peachtree Settlement Funding, LLC ( "Peachtree "), and the Order or settlement agreement approving the underlying structured settlement, the Court hereby finds as follows: 1. The payee, Baron Chism ( "Mr. Chism "), has established that the transfer is in the best interest of Mr. Chism and his dependents, if any, taking into account the welfare and support of his dependents, if any. 2. Based on the certification by an attorney for the transferee, Peachtree Settlement Funding, LLC ( "Peachtree "), 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 statute or regulation, or the order of any court or responsible administrative authority, or any applicable law limiting the transfer of workers' compensation claims. 3. The transfer complies with the remaining requirements of the Pennsylvania Structured Settlement Protection Act, 40 P.S. § 4001 et seq., including sections 4003(a)(2), 4003(a)(4), 4003(a)(5), and 4003(a)(6). tl 1 Based on the foregoing findings, IT IS HEREBY ORDERED THAT: The payments that are to be transferred are designated as follows: one lump sum payment of $10,000.00 due on December 22, 2016; and one lump sum payment of $25,771.00 due on December 22, 2019 (the "Assigned Payments "). FNW Life shall forward the Assigned Payment(s), within 7 days of the date due, to "Peachtree Settlement Funding, LLC," at P.O. Box 83364, Woburn, MA 01813 -3364: by check made payable to: one lump sum payment of $10,000.00 due on December 22, 2016; and one lump sum payment of $25,771.00 due on December 22, 2019 . 4. The terms of this Order shall survive the death of Mr. Chism and shall be binding on Mr. Chism's heirs, beneficiaries and assigns, and her death shall not affect the right of Peachtree to receive the Assigned Payments. 5. In the event Peachtree further assigns or otherwise transfers the Assigned Payment(s) (or any portion thereof or interest therein) to another person or entity (a "Reassignment "), Farmers will not itself be obligated to redirect the Assigned Payment(s) (or any portion thereof) to any person or entity other than Peachtree or to any payment address other than that specified herein, and Peachtree shall remain obligated to comply with all terms and conditions herein. 6. All remaining Periodic Payment(s) (and /or portions thereof), if any, that are not the subject of the Proposed Transfer and not previously assigned, shall be made payable to Mr. Chism and will be forwarded by FNW Life, when due, to Mr. Chism's most recent known address or any payment address designated by Peachtree, subject to Farmers' consent. 7. Peachtree shall defend, indemnify, and hold harmless Farmers, and its directors, shareholders, officers, agents, employees, servants, successors, and assigns, and any parent, subsidiary, or affiliate thereof, and their directors, shareholders, officers, agents, employees, servants, successors, and assigns, past and present, from and against any and all liability, including but not limited to costs and reasonable attorney's fees, for any and all claims made in connection with, related to, or arising out of the Purchase Agreement, 'the Proposed Transfer, the Assigned Payment(s), any Reassignment, or Farmers' compliance with the parties' Stipulation or this Order, except with respect to claims by Peachtree against Farmers to enforce Farmers' obligations to Peachtree under the parties' Stipulation. To the extent that Peachtree fails to honor this indemnification and defense obligation, Farmers may, in addition to all other remedies afforded by law, satisfy the same by withholding to its own credit the Assigned Payment(s). 8. Farmers' lack of opposition to this matter, or its or Peachtree 's stipulation hereto or compliance herewith, shall not constitute evidence in this or any matter, and is not intended to constitute evidence in this or any matter, that: a. payments under a structured settlement contract or annuity or related contracts can be assigned or that "anti-assignment" or "anti-encumbrance" provisions in structured settlement contracts or annuities or related contracts are not valid and enforceable; or b. other transactions entered into by Peachtree and its customers constitute valid sales and/or secured transactions; or c. Farmers has waived any right in connection with any other litigation or claims; or d. Peachtree has waived any right other than as expressly set forth in the parties' Stipulation and/or this Order. 9. Peachtree and Mr. Chism, for themselves and for their respective directors, shareholders, officers, agents, employees, servants, successors, heirs, beneficiaries, contingent beneficiaries, executors, administrators, and assigns, and any parent, subsidiary, or affiliate thereof, and their directors, shareholders, officers, agents, employees, servants, successors, and assigns, past and present (the "Releasors"), hereby remise, release and forever discharge Farmers and their directors, shareholders, officers, agents, employees, servants, successors, and assigns, and any parent, subsidiary, or affiliate thereof, and their directors, shareholders, officers, agents, employees, servants, successors, and assigns, past and present (the "Farmers Releasees"), of and from any, and all manner of actions and causes of action, suits, debts, dues, accounts, bonds, covenants, contracts, agreements, judgments, settlements, damages, claims, and demands whatsoever, in law or in equity, in connection with, related to, or arising out of any claim or allegation that was or could have been asserted in connection with, related to, or arising out of the Purchase Agreement, the Assigned Payment(s), the Proposed Transfer, or the parties' Stipulation, which against each other or the Farmers Releasees, the Releasors have or had from the beginning of the world through the date of this Order, except for claims of Releasors against the Fat niers Releasees to enforce the Farmers Releasees' obligations to Releasors, if any, under the parties' Stipulation or this Order. 10. Mr. Chism will receive $16,000.00 in exchange for one lump sum payment of $10,000.00 due on December 22, 2016; and one lump sum payment of $25,771.00 due on December 22, 2019. DONE IN OPEN COURT this 5th day o Judge P.,