HomeMy WebLinkAbout14-5775 MARO & MARO, P.C. cr Fll r-0
By: Paul S. Peters, III., Esquirer ` �f c f JF/C .
Attorney I.D. No.: 87421 2 , Qr 1, ,
1115 West Main Street
Norristown, PA 19401
(610) 275-9600 Pei,,
IN THE COURT OF COMMON PLEAS OF CUMBERLANDCOUNTY,
PENNSYLVANIA
RE: Joint Petition of A.P.C.R., LLC NO:
and W. Myers, Jr. .
JOINT PETITION FOR PARTIAL TRANSFER OF PAYMENT RIGHT
PURSUANT TO ACT, 40 P.S. 4000, ET SEQ,
TO THE HONORABLE JUDGES OF SAID COURT:
And now comes your petitioner, A.P.C.R., LLC., by and through its attorneys,
Maro & Maro, P.C., and joint petitioner, W. Myers, Jr., and in accordance with the
applicable rules of Pennsylvania Civil Procedure, hereby represents as follows:
1. Petitioner is A.P.C.R., LLC. by Assignment ("Buyer" or Transferee"),
with an office address located at 160 Greentree Drive, Suite 101, Dover DE 19904.
2. Joint Petitioner is, W. Myers, Jr. ("Payee"), an adult individual who resides in
the county of Cumberland.
3. This Joint Petition has been verified by the Transferee, A.P.C.R., LLC. and the
Petition includes all necessary information as prescribed by PA R.C.P. 229.2(d) et al and
Section 3 of the Act, 40 P.S. §4001 et seq.
4. Pursuant to PA. R.C.P. No. 229.2(d)(3) there are four (4) attachments
incorporated herein as follows:
a. PA R.C.P. 229.2(d)(3)(i) Payee's Affidavit in Support of Petition.
Please see Attachment/Exhibit"I"; and
1 7�L/
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 Paul. S. Peters, III.,
Esquire, attorney for transferee, A.P.C.R., LLC.; and
d. PA. R.C.P. 229.2(d)(3)(iv) A Final Order of Court Granting
the Petition.
5. Joint Petitioner, W. Myers, Jr., is the beneficiary of an annuity
owned by Aegon Assignment Corporation and issued by Monumental Life Insurance
Company. The structured settlement provides payment to the petitioner as evidenced by
Attachment/Exhibit"2".
6. Joint Petitioner, W. Myers, Jr., after having the opportunity to have this matter
reviewed by independent counsel of her own choosing including the implications of the
transfer and any tax ramifications, expressly waived her right to independent counsel. A
Copy of Joint petitioner's waiver is attached hereto, incorporated herein and marked
Attachment/Exhibit "3 '.
7. Joint Petitioner, W. Myers, Jr., proposes to enter into a purchase agreement
with A.P.C.R., LLC., its nominees, successors, or assigns, whose address is 160 Greentree
Drive, Suite 101, Dover DE 19904, who will purchase the following from Petitioner's
structured settlement as follows:
A) 116 monthly payments of 5147.24 each, beginning on
January 24, 2015 and ending on August 24, 2024.
8. The structured settlement is currently owned by owned by Aegon Assignment
Corporation and issued by Monumental Life Insurance Company, and the net amount in
return payable to W. Myers, Jr. is $6,600.00 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 $6,600.00.
10. Based on the net amount that the payee will receive from this transaction
$6,600.00 and the amounts and timing of the structured settlement payments that
would be assigned, the payee is, in effect, paying interest at a rate of 24.75% per
year.
11. The Buyer furnished W. Myers, Jr. 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 W. Myers, Jr. 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 minor
child. Joint Petitioner is employed. The purpose of this transfer is to assist petition with
obtaining a vehicle and to assist with child custody issues. Petitioner has thought about
this decision thoroughly and firmly believes that this is in his best interest. Petitioner
appreciates the loss he is taking but wants to proceed with the transfer. 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. Petitioner will provide written notice of the transfer to all interested parties,
including Payee and the Annuity Issuer and Owner. Non-redacted exhibits, identical to
those redacted exhibits filed with the court, have been served on all parties.
WHEREFORE, Joint Petitioner's respectfully requests this Honorable Court to
enter the Initial Order attached to this petition which shall schedule a hearing so that
Transferee and Payee shall have the opportunity to discuss the purpose and reasons for
the transfer and after hearing thereon, respectfully request that this Honorable Court enter
a Final Order approving the Transfer of Structured Settlement Payments Rights as is
mentioned herein.
Maro & Maro, P.C.
Respectfully Submitted:
By:
Wn
rs, III., Esquire
Transferee
VERIFICATION
I, Lori Borowski, Vice President of A.P.C.R., LLC, have read the foregoing
Petition 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.
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Tod Borowski, Vice President
Date
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CERTIFICATION OF ATTORNEY FOR TRANSFEREE
I, Paul S. Peters, III., Esquire, attorney for Transferee, A.P.C.R., 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, Paul S. Peters, III., Esquire, attorney for Transferee, A.P.C.R., 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.
•39
Date Paul . POrs, III., Esquire
A for Transferee, A.P.C.R.,
C.
MARO & MARO, P.C.
By: Paul S. Peters, III., Esquire
Attorney I.D. No.: 87421
1115 West Main Street
Norristown, PA 19401
(610) 275-9600
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
RE: Joint Petition of A.P.C.R., LLC NO:
and W. Myers,Jr. .
CERTIFICATE OF SERVICE
1, Paul S. Peters, III., 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: Monumental Life Insurance Company A.P.C.R., LLC.
Attn. Legal Dept/structured Settlements 201 King of Prussia Road
4333 Edgewood Road,NE Radnor,PA 19087
MS 2360
Cedar Rapids,IA 52499
Aegon Assignment Corporation W. Myers, Jr.
Attn. Legal Dept/structured Settlements
4333 Edgewood Road,NE
Cedar Rapids,IA 52499
Date:
By:
Paul rs, Ill., Esquire
Att ne or A.P.C.R., LLC.
MARO & MARO, P.C.
By: Paul S. Peters, III, Esquire
Attorney I.D. No.: 87421
1115 West Main Street
Norristown, PA 19401
(610) 275-9600
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
RE: Joint Petition of A.P.C.R., LLC NO:
and W. Myers,Jr.
Entry of Appearance
TO THE PROTHONOTARY/CLERK OF SAID COURT
Enter my appearance on behalf of: A.P.C.R., LLC.
Papers may be served at the address set forth below.
Respectfully Submitted:
Maro & Maro, P.C.
By:
Paul . P ers, III, Esquire
At rney .D. No 87421
Maro & Maro, P.C.
1115 W. Main Street
Norristown, PA 19401
(610) 275-9600(office)
(610) 275-9666(Fax)
ATTACHMENT/EXHIBIT 461"
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Payee's Affidavit in Support of
Petition to'i'ransfer,Structured Settlement Rights
I,W Myers,the payee,verify that the statements below are true,and correct:
Payee's name, address and-age: W Myers, Cumberland County,
Pegnsylvania
1. lVMantal.Status:
X:^Never Married;, Married;_,__Separated; Divorced
If married or separated,name of spouse: N/A
2 Mucor Children and other dependents:
G Myers,6 years old,
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3: Income: I
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Payee's monthly incomeand sources: I am working at a Tire Shop
earning approximately$30,000 annually,
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4. Child support,alimony or alimony pendente'lite:
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Obligation..to pay: .X—Yes __No I
If yes,state the amount of the obllgatlou,to whom payable,and whether there are
arrearages: $108/week,Franklin County Domestic,.and no arrears
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5. Previous transfers: Co1mpke the below for competition deals only or
BUCKS COUNTY if Amend. If prior transfers were with. then
just type See.Exhiult"A".
Have you previously tiled a petition to transfer payment rights udder the
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stilretured settlement that is the subject of this petition? Yes.—X—No
if yes, for each petition.that you.filed,
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(a) If the transfer was submitted for court approval,list the
court...the.cafe oaptloh:and case numbtsr,and state whether tha
a
-court approved or disapproved the transfer;If the transfer was i
appro'void"
(b). State tha:-name of the transferee and identify(listing due
dates an-0 payment nmoutlt(s))the payments involved in the
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traiisfer; �
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State the ampunt.ofinoney and themanow In which the nonny
was usod:
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(q) HAve you Iver transferred payments.without wWuit
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approvat+4 If so;pliftse explain:No I
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d, Iteasa im:for transhri
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•i..pttttt'to.14.0t110 forge frotn:this transaction for a down payment on a
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ettt and'for°guorttoy experises fox child custody, I
1PAyMont of debut
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rfyou.seok the transfer ha order to pay debts,list each debt,including the name of
the arerlito.r and fhearrio.U'litpresently owed.: i
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Doo t rodllor AmoWnt Owed
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Verifica tim►►
I'veriify that the state►Hants Made in this affidavit are true and correct:I.tiiicler�tand
that false s.totcmeptfi horein Ore►�nadc.siibject to.thepenalties of 1$_.Pa;G, :: 9.04,relat ng
to unsworn fdUfflcation to authorities.
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ATTACHMENT/EXHIBIT 642" ,
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114I.X011 4 x201 rl3 PH f°AGL-: IW-024 Cen.r•a1 67 nd&ra r mo
?,.ti= 9 cft the First PL.YI3uwL Dat% Aq will t4akc ih.v Ubwint ?p_vrt,-nfs.w
t(aa NzyeW CY the.r.-:jt tew! it 1kEJ aG 1t
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cati-aly Gar 4 yomp,'pmt bdgIftt sIPts=b*r 24, 2001. WC
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T thu A:r-.tiEA ftm grhw m fl•; €aet grtA,^#ftwd 'n tot€4tc.We %VriiJ.pA.V I
&ny r.cri1ul.n r.gWam1x: d v aa'dtx aV& w-,they bC+iiW-Ar,da.trot a be id4q
vb.*-n We i` ceive fillse Otauf iaf the AAA nt s -
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No lrt.Jtiitio.alar o nt is pwrabir,Ate'all t armw::ownwas#t€[ebar s
t�arae.
The Atln:.tifant, Payee,mdjor 5emt%ijry am p VAN do Ikot ham the light
to revisO On beot}13.t Va r►xt MSS. Thee parwr4A may nat he ae;:eleratc4, JeR i'red,
iniamed tir rI+rCr4aSLA 'they may "ti IIP-Wt cipated,sMd,a"-p erl or
+�tcurntier�d,
'Cite A nnu tattt, Papte,and/tip Kcretadary to tY;rol A"Op any paymewt; tatldtr the
somm't Wfore. the s'a c an di*.. TO the west lenlAtted by 12m, ra Dayments
tallier this stU text:w9t of siibItet to clic:fiat of trealtarr+af:trrJr mue.
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ATTACHMENT/EXHIBIT "Y'
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Account ID: 929167
Please complete and,sign.
STATEIIIENT OF PROFESSIONAL REPRESENLTATION
Please Choose Either Box A OR Box D Below,
Auer you have made your choice, SIGN AN,_ D DATE the appropriate box signature line.
YOU SHOULD SIGN ONLY O_NE BOX—THE BOX YOU HAVE CHOSEN.
A. I HAVE BEEN ADVISED BY
(i m)THAT I SHOULD OBTAIN INDEPENDENT PROFESSIONAL
REPRESENTATION CONCERNING THE LEGAL,TAX AND/OR FINANCIAL
IMPLICATIONS OF THIS'TRANSACTION. I FULLY UNDERSTAND THE,PURCHASE
AGREEMENT AND THE IMPLICATIONS OFTHE TRANSFER,INCLUDING THE TAX
RAMIFICATIONS OF THE TRANSFER AND I b0 NOT WISH TO SEEK OUT SUCH
INDEPENDENT PROFESSIONAL,REPRESENTATION.
A//-,/ Z3 4q
W MWERUR, Date
B. 1 HAVE OBTAINED INDEPENDENT REPRESENTATION AND I FULLY UNI)EMSTAND
THE LEGAL,TAX ANA/OR FINANCIAL IMPLICATIONS OF THE TRANSACTION,
THE PURCHASE AGREEMENT AND THE RELATED DOCUMENTS. I WAS NOT
REFERRED TO MY PROFESSIONAL ADVISOR BY THE NAME OF MY
PROFESSIONAL ADVISOR IS SET FORTH BELOW:
W, MY.IE RS A — Date.
To Be Completed By Certified PrufessionW Advi.sar
Only if you have.signed Box B Above
Name of Profaslonal! Attorney ID P
Phone Number:L_)
Address:
I have person211y met with and provided independent pmfcS60ndI advice to in respret of the Purchase Contract with
and the transaction contemplated thereby. W Myers Jr was reremd to me by the
Freressional's signatuTc Uatc
R9C�1&�C_8albb
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ATTACHMENT/EXHIBIT "4"
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ASSIGNMENT OF PURCHASE:CONTRACT
F�20M _ „...
O A;P.C.R., LLC
Y7S11: YER: W.1VXy+
For good and valuable Consideration;:the receipt,nd sufficiency of which is hereby acknowledged,
("Assignor")hereby assigns,t6 sfe►•s,sells and sets over to A.P.C.R.,LLC("Assignee"),all of its
right;title and interest in and to that certa►n Purchase Contract dated 9/23;M4 between Assignor,and W.Myers Jr and
all documents.executed.in connection therewith(hereinafter collectively feferted to as the"Property"),subject to all the
terms and conditions thereof
The partieshereto intend tliat the transfer of the Property hereby contemplated shall be,and shall be Treated.as,a sale by
Assignor to Asstgtiee;and not as a secured lending transaction: The sale h.eretinder shall be absolute,finial and without
recourse;except as is Otherwise.provvided.hetein.
If,notwithstanding the intent of the parties hereto or any other provision hereof,the Property sold and conveyed
hereunder were to be construed by a court of competent jurisdiction to constitute property of Assignor,or the sale and
conveyance of the Property hereunder were not treated as a sale by Assignor to Assigneem for all purposes,then this
Assignment also is intended by'the parties hereto to constitute,and hereby is,a security agreement within the meaning
of ibe Uniform.Commercial Code of the jurisdiction of organization of the Assignor,and the sale and conveyance of the
Property by Assignor hereunder shall be treated as a grant of,and Assignor hereby grants to.Assignee,a security interest
in,to and under all of Assignor's right,,title and'interest in and to all said Propel ty,and a security interest in,to:and
under any and all of Assignor's Accounts;`Chattel Paper(wiietlier tangible or electrolnte);Pa wont Intangibles;General
Intangibles,Instruments,Documents and Money and ali proceeds and products of the foregoing(in each case as such
terms are defined under the Uniform Commercial Code as in effect in the State of Delaware froni time-to-time),arising
out of or in connection with the Property,in each case to secure Assignor's payment and performance obligations
hereunder.and..under..any,.other.documents relat►ng heYeto,or ►s otherwise requ►red by,applic.,able law.
Assignor authorizes Assignee to file any UCC Financing Statements naming Assignor as"debtor"or"seller"
thereunder,and naming Assignee as"secured party"or"purchaser"thereunder;deemed necessary by Assignee to
perfect its security interest created hereby.
This Assignment shall be governed by the laws of the State of Nevada.
Dated this day of 4,in the year
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ASSIGNOR:
By:
ASSIGNEE:A.P.C.R.,LLC ,
BY:
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929767
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Account 1D: S•29707
PURCHASE CONTRACT
This is a Purchase Contract("Contract")for the sale of structured settlement payments between
,Y Myers Jr(Yon,Your), and (We, (Is,Our)
BACKGROUND
A. In connection with the resolution of a personal iniury claim,You or someone acting for You,signed a 1
Settlement Agreement that entitics You to receive certain future payments("Settlement Payments"),
according to a set schedule.
B. Those Settlement Payments are being paid to You from an annuity policy("Annuity Polioy")purchased by the Person
responsible for making the Settlement Payments to You("Ohligor").
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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
Settlomont Payments("Purchased Payments")to Us now for a lump sum.
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D. THIS CONTRACT CONTAINS AN ARBITRATiON PROVISION WHICH YOU SHOULD READ
CAREFULLY,AS IT WILL HAVE A SUBW.ANTiA.L TiViPACT ON HOW DISPUTES BETWEEN YOU AND
US ARE RESOLVED,
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DEFINED WORDS
Certain words used in this Contract have specific meanings,shown below,
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Affiliate An entity controlled by,controlling,or under common control with,another entity,
Annuity Policy The policy purchased by the Obligor to ensure that the Settlement Pavments are made to You as
required by the Settlement Agreement,
Closing Documents Any documents necessary to oarty out the purchase of the Purobased Payments,other
than the"Contract or Contract Documents"as defined below.
Contract or Contract
Documents Collectively,only this Contract and the Disclosure Statement.
Contract Date The date Your signature at the end of this Contract is notarized, Howover, if You happen
to sign this Contract before the number of(lays stated at the end of Your Uisclosure
Statement for waiting has passed,You will have no obligation under Your Contract until
that time has passed.
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Court Order A legally binding riding issued by a judge or properly empowered administrative officer,
approving the sale of the Purchased Payments to Us("Court Approval').
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Disclosure Statement The document which identifies for You,the Purchased Payments,expenses,Purchase Price
and various other disclosures.
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Encumbrance Any claim,right, lien,policy loan,or restriction. In addition,this includes any
limits on rights of ownership(such as the uso,voting,transfer,receipt of income,etc,).
Funding Date Tho date We pay You the Not Purchase Price.
issuer The insurance company that issued the Annuity Policy.
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Account ID: 92971:7
Obligor The Person who is obligated to make payments to'Y'ou under the Settlement Agreement.
Party One of You or Us. Parties means both You and Us.
Person Any natural person or legal entity.
Purchased Payments only those certain payments that We are purchasing from You under this Contract.
Purchase Price;
Gross Purchase Price The amount shown as the"gross amount payable to the seller(You)"on the Disolosuro
Statement. This is the sum We have agreed to pay You be-fore any deductions as set
forth in the Contract Documents.
Net Purchase Price The amount Shawn as the"net amount payai,le 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, I
Settlement Agreement The agreement that You and the Obligor signed to resolve Your personal injury claim.
Settlement Payments All of the payments that the Obligor has agreed to make to You in the Settlement
Agreement,
We, Our, or Us along with any of its successors,assigns,
and designccs.Some of the Contract Documents or Closing Documents may refer to Us
as the purchaser.
You nr 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 follows:
1. SALE OF THE PURCHASED 1?AYMf NTS i
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 receivc the Purchased Payments specifically identified.in the Disclosure Statement.
H. We will pay You the Net Purchase Price as agreed to in the Contract Documents,subject to certain conditions,
including meeting Our underwriting requirements,Court Approval and satisfactory completion of the Closing
Docutactrts.We will do this in exchange for You:
selling the Purchased Payments to Us;
changing the benc•ficiaty of the Annuity Policy to Your estate and not changing it again until We have
been paid all of the Purchased Payments,
having any current beneficiaries waive their rights to the Purchased Payments;and
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fulfilling Your promises under this Contract. I
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C. if Vire are buying only a portion of Your payments,this will have no effect upon Your rights in the unsold portion. l
You will continue to receive the unsold portion unless You have alrea.tly sold or encumbered that portion.
However,sometimes the Issuer,the Obligor or the court may require Us to receive the ctrtire amount of Your
payment. if so,We will them forward the portion of the payment still due to You and You hereby agree to this I
payment servicing arrangement.
2, PURCHASE,PRICE
A, The Gross and Net Purchase Prices are shoran on the Disclosure Statement and are fair and acceptable to You and 1Js.
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Acepuntio: 92976i
B. We will pay You the hTTet.Pnfch450 Price in the manner You designate for Us.
C. Before we pay You,You agree that We will adjust for the following amounts,if oppllcahlC,
• Purchased Payments Owed to Us--The Issuer may have already paid You some of the Purchased
Payments before We have,paid You for them.If that happens,We will deduct the amount of those
Purchased Payments.
• Holdbacks—Due to possible delays in the Issuer beginning to make the Purchased Payments to Us
instead of You,We will hold back an amount equal to any Purchased Payments that the Issuer owes Us
post Court Approval,that are due within 90 days of the Funding Date, It We subsequently receive those
particular Purchased Payments dircetly,We will return the Amount of any related holdback to You,
a 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 to take 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,You will immediately contract
Us, If We then determine that any deductions or holdbacks as set forth above are not enough to roimburse Us,We will
advise You of the amount You owe Us.You agree to immediately send that amount to Us by batik or certified check.
3. YOUR j;EPRESENTATIONS AND WARRANTIES
You represent and warrant to Us the following;
A. You understand that THIS iS A SALE AND NOT A.LOAN.
B. The Annuity Policy is in full force,You are the sole and undisputed recipient of the right to the Purchased Payments,
have the tight to sell them free and clear of any Encutnbrance5 and have not previously sold any of the Purchased
Payments to any other Person.
C. You understand that Cour.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 statement made by You in the Contract Documents and Closing Documents is true and complete,
E. No law,divorce decree or other legal obstacle:
• requires You to keep the Purchased Payments for the benefit of a current or former spouse,dependent children,
or other person,,or
• legally prevents You from contracting with Us,selling the Purchased.Payments or changing the Annuity
Poiicy's beneficiary.
F. Either:
You have never filed for bankruptcy,will not do so before the Funding Date and there are no lawsuits or efforts
by any of Your creditors to put You into bankruptcy or take any of the Purchased Payments;or
If You filed for bankruptcy,the Purdimcd Payments were not subject to the claims of Your creditors.You will
give Us a copy Of any of Your bankruptcy documenis that We request including evidence of a final bankruptcy
payoff or case closing,if any,
0. We can rely On Your representations,warranties,and promises in this Contract. These representations,warranties,and
promises are for Our benefit and the bmtfit of any future owners of the Purchased Payments_You understand that Our
reliance an any intentional mismprescntation by You may rosult in Our enforcing Our rights against You in court.
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H. You had enough time to consider the sale of the Purchased Payments,understand the terms 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 freely and voluntarily,enter into this Contract and agree to a.11 of its terns,
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 ofthis Contract with You prior to
Your execution oftlils 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 Ouch purpose,
K. If You are married,Your spouse understands all of the terms and conditions of this Contract including,but nqt limit:d to
the fact that,after the Funding Date,You(and Your spouse)will not receive the samo 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 tc)
seek any advice relating thereto,Your Spouse also understands that he or she will be giving up any property or contract I
rights that he or she may have in the Purchased Payments.
L. We may sell,transfer,or assign our right to the Purchased Payments in a sale,securitization,or other financing
transaction(resale)_ Any resale would involve disclosing certain information about You(inclu(ling Your personal
information)to the parties to a resale. !
Rf. 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 against You for violating any orthe
representations,warranties,or promises You made in this Contract.
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4_ YOUR PROMISES TO U5
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Jkfore and after the Fundint Datet I
A. You will tell us right away ifYour address or telephone number changes and do
everything necessary,including completing and signing all documents to: i
• sell the right to the Purchased Payments to Us;
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• change the beneficiary as required by this Contract;and
• correct any documentation errors in the Contract Documents or Closing Documents.
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A. You will also tell CJs if any of the following occurs:
• aviolation oftbis Contract;or
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• anything that could negatively affect the Annuity Policy,the Purchased Payments,or this Contract.
C. You will not:
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• agree to sell the Purchased Payments to any Person other than Us;
• change the Annuity Policy's beneficiary to any Person other titan Your estate until We havecollected all of the
Purchased payments;or
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• withdraw cash ficin,borrow against,or change the Annuity Policy.
D. You will give Us information necessary to update Your representations,warranties,and promises in this Contract.You
will also update any documents and information so they will be true and complete on the Funding Date,
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1M, We are now,and will continue in the future,to rely on the mptascntalions and waiTairties YOU have given Us.We will
confirm the accuracy of Your representations and warranties.You must cooperate with this confinnation and provide
complete access to any information We believe necessary.
F. You agree that updating representations,warranties,promises,documents and other information ,till not ouzo a breach
of any representation or warrat..tty 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 apprcrval
and Court Approval. Under no circumstances will We be liable for any consequential damages.
H. You hereby appoint Us and any of Our designees,with full power of substitution 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 olid interest that
You have in the Purchased Payments a,nd for Us to obtain all benefits contemplated by this transaction. Yau.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 lirigation or other proceedings related to lho
Purchased Payments.This power of attorney is coupled with an Interest and shall survive death or disability.
5, CANCELLATION BY US I
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We may cancel this Contract before the Funding Date i.f:
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A. You breach any representation,warranty,orpromise in any Contract Documents or Closing Documents,
B. The petition for the Court Order is contested,opposed,or not approved.
C. We are sued or threatened with a lawsuit or an arbitration about this Contract or the Annuity Policy,
D. There is any threatened,pending,or final action,or change in law or rule challenging the legality of,or negatively
affecting this transaodon.
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E. You file for,or are;forced into bankruptcy.
F. You die,
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G. Final approval has not been given by Our underwriting department.
14, The Purchase Contract is not signed by You and received back by Us by November 07,2014.
i.. A major rating agency downgrades the Issuer's credit rating.
J. The Issuer is,or becomes insolvent,or under regulatory 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,
G. CANCELLATION BY YOU
A, (1) YOU MAY CANCEL THIS CONTRACT WITHOUT PENALTY OR IFURTHER OBLIGATION AT ANY
TIME WITHIN FIVE(5).BUSINESS DAYS AFTER THE DATE YOU RFCFIVE PAYMENT
HEREUNDER FROM US. IN ORDER FOR THE CANCF,LLATiON TO BE EFFECTIVE,YOU MUST
SEND A NOTICE POSTMARKED AT ANY TIME WITHIN FIVE BUSINESS DAYS AFTER YOU
RECEIVE PAYMENT HEREUNDER FROM U5(This is the rescission period).
(2) YOUR NOTICE iS TO BE SENT EiTHER BY CERTIFIED OR REGiSTERED MAiL(RETURN
RECEIPT REQUESTED)OR F0EX OR ANOTHER MAJOR OVERNIGHT DELIVERY SERVICE,. THE
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AcmuntID: 929767
NOTICE MUST INCLUDE A BANK OR CERTIFIED CHECK MADE PAYABLE TO US,IN THE FULL
AMOUNT RECEIVED BY YOU.YOUR NOTICES MUST BF SENT TO:
}
B. CCEQRGiA RESIDENT, ; YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO 5:00 P.M.
OF THE TWENTY-FIRST DAY.FOLLOWING RECEIPT OF THE ENCLOSED"NOTICE OF
CANCELLATION RIGHTS"FORM,OR AT THE HEARING ON THE APPLICATION FOR
AUTHORIZATION OF A TRANSFER OF STRUCTURED SETTLEMENT PAYMENT RIGHTS,OR AT ANA'
TIME WITHIN FiVE(5)BUSINESS DAYS AFTER YOU RECEIVE PAYMENT HEREUNDER FROM US,
WHICidEVER EVENT OCCURS LAST(This is the Georgia rescission period). iN ORDER FOR THE
CANCELLATION TO BE EFFECTIVE,YOU MUST SIGN THE ENCLOSED"NOTICE OF
CANCELLATION RIGHT'S"FORM AND MAIL OR DELIVER IT TO US AS SPECIFIED IN THAT
NOTICE AND YOU MUST RETURN ALL AMOUNTS(PURCHASE PRICE OR OTHERWISE)RECEIVED
iiY YOU ACCORDING TO THE REQUIREMENTS Or 6(A)(2)ABOVE
C, WEST VIRGINIA RESIDENTS: IN ORDER FOR YOUR CANCELLATION TO BE EFFECTIVE,YOUR:
NOTICE CAN BE SUBMITTED VIA PHONE,MAiL,OR FACSIMILE, ANY AMOUNTS ADVANCED BY
US IN CONTEMPLATION OF THE TRANSFER SHALL BE IMMEDIATELY REFUNDED TO US, IF YOU
DISMISS YOUR ACTION AFTER APPOINTMENT OF A GUARDIAN AD LITEM,OR RESCIND YOUR
TRANSFER AGREEMENT(PURCiIASE CONTRACT)WITHIN TIM RESCiSSION PERIOD IN
6(A)(1)ABOVE,YOU SHALi,Bl;,RESPONSIBLE FOR THE I:ILIN. 0 FEE AND ANY GUARDIAN AD
LiTEM FEES.
D. With respect to A through C above,to the extent permitted by applicable Inw,the arbitration provision in Section
9 of this Contrnet shall survive the termination,cancellation or rescission orthis Contract.
7. NOTICE�
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A. All notices about this Contract must be in writing.
B. All notices must be sent either by: (1)certified or registered mail(return receipt requested):or(2)FcdEx or another major
overnight delivery service with a delivery tracking system and arc considered given when delivered as follows: If to You:
to the most recent address for You listed in Our files. If to Us:to the address listed in Section 6(A)(2)of this Contract.
S. YNE NNTS OF DEFAULT
You will be in default if You:
A, fail to comply with any terns or conditions of this Contract;or
}3. breach any of Your representations,warranties and promises in this Contract,
if You arc in default,even if You have not rejected the arbitration provision(see Section 9 of this Contract),Wo have the right to
enforce Our rights against Ycxt in court to make You perform Your promises or to get money from You. Tf 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 rcjcctod the arbitration provision,You will have the option of remaining in court or seeking to compel arbitration of that
Claim under the terms of the arbitration provision,
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9, A.RBiTRATiON PROVISION
To the extent permitted by applicable law,You and We agree to the following arbitration provision.
YOU HAVE THE RICHT TO REJECT THIS ARBITRATION PROVISION AS SET FOlr,TN BELOW. If You do not reject
this arbitration provision and a Claim is arbitrated,You will not have the right to;(l)have a court or a jury decide the Claim;
(2)engage in lnforxnotion gathering(discovery)to the same extent as in Court;(3)participate in a class action in court or in
arbitration;or(4)join or consolidate a Claim with claims of any other person. The right to appeal is more limited in
arbitration than iu court and other rights in court may be unavailable or limited in arbitration.
Claims Subject to Arbitration.A"Claim"subject to arbitration is any claim,dispute or controversy between You and Us(other than
an Excluded Claim or Proceeding as set forth below),whether preexisting,present or firture,which arises out of,or relates to the
Contract,the negotiations related thereto,the breach thereof or any ocher transaction conducted with us in.connection with the
Contraot. "Claim"has the broadest possible moaning and includes initial claims,counterclaims,cross-claims,third-parry claims and
federal,state,local and administrative claims. It includes disputes based upon contract,tort,consumer rights,fraud and other
intentional torts,constitution,statute,regulation,ordinance,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 the terms specified in this arbitration provision,
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Special Definitions. Solely for purposes of this arbitration provision,in addition to the meanings set forth in this Contract:(1)"We",
"Us"and"Our"also(a)refer to Our employees,officers,directors,parents,control ling.persc,w,subsidiaries and affiliates 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)"You"
or"Your"also refer to Your current or former spouse(s),children,heirs,estate,executors,successors,assigns,representatives and
beneficiaries.
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Excluded Claim or Proceeding, 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 courtand not an arbittatot to decide.
However,any dispute or controversy that concerns the validity or enforceability of the Contract as a whole is for the arbitrator,not a
court,to decide. in 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 different court.
Federal Arbitration,Act. Notwithstanding any other provision in.this Contract,You and We agree that this Contract evidences a
transaction involving interstate commerce and that the Federal Arbitration Act(Title 9 of the United States Code)("FAA")shall
govern its interpretation and enforcement and proceedings pursuant thereto. To the extent state low 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. Notwithstanding any other provision of this Contract,if a Claim is arbitrated,neither You nor We Mill
have the right:(a)to participate in a Class action,private attorney general action or other representative action in court or in
arbitration,either as a class representative or class member;or(b)to join or consolidate Claims with claims of any other
Persons. No arbitrator shall have authority to conduct any arbitration in violation of this provision(provided,however,that
the Class Action Waiver does not apply to any lawsuit or Administrative proceedini;filed Against us by a'statc or federal
government agency even when such agency is seeking relief on 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 such an Agency). The Class Action Waiver is
nonscverable from this arbitration provision, If the Class Action Waiver is limited,voided or found unenforceable,then this
arbitration provision(except for this sentence)shall be null and void with respect to sueb proceeding,subject to the right to
appeal the limitation or invalidation of the Class Action Waiver.
Arbitration Procedures. if You or We seek to arbitrate a Claim,the party seeking arbitration must notify the other Party in writing.
This notice can be given afler 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 6(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 will take place in a venue of Your
domicile.If a Party files a lawsuit in court asserting Claims)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 of the Party prosecuting the Claim(s)to select an
arbitration administrator in accordance with the paragraph below and commence the arbitration proceeding in accordance with the
administrator's rules and procedures.
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'rhe arbitration will be administered by the American Arbitration Association("AAA"), 1633 Broadway, l0'h Floor,New York,NY
10019,www.adr,org,1800-778-7879 or JAMS, 1920 Main Street,Suite 300,Irvine,CA 926.14,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 addresses listed above. If the
AAA and JAMS are unable or unwilling to serve as administrator,tile Parties may agree upon another administrator or,if they arc
unable to agree,a court shall 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 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 bo a practicing attorney with ten or more years of experience ora
retired judge, The arbitrator will not be bound by judicial rules of procedure and evidence that would apply ht a court,orb),state or
local laws that relate to arbitration proceedings. The arbitrator will honor statutes of limitation and claims of privilege recognized
under applicable law, In determining liability or awarding damages or other relief,the arbitrator will follow this Contract and the
applicable substantive law,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 the administrator and arbitrator to You for Claim(s)
asserted by You in arbitration after You have paid an amount equivalent to the fee,if any,for filing such Claim(s)in state or federal
court(witiehcver is less)in the judicial district in which You reside. (If You have alroady paid a filing fee 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 rulcs 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 Contract,the administrator'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 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,The 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.
Severability and Survival.If any part of this arbitration provision,other than the Class Action Wnivor,is deemed or found to be
unenforceable for any reason,the remainder shall be enforecable. 7'o the extent pennitted by applicable(.ow,this arbitration provision
shall survive the termination,cancellAticn or rescission of this Contract,
Effect of Arbitration Award, The arbitrator's award shall be final and binding on all Parties,except.for any right of appeal provided
by the.FAA. However,if the amount of the Claim exceeds$50,000 or involves a request for injunctive or declaratory relief that eould
foreseeably involve a cost or benefit to either Party exceeding$50,000,any Party can,within 30 days after the entry of th.c award by
the arbitrator,appeal the award to a three-arbitrator panel administered by the administrator.The panel shall reconsider anew any
aspect of the initial award requested by the appealing Party. The dcoision of the pane.)shall be by majority vote, Reference in this I
arbitration provision to"the arbitrator"shall mean the panel if an appeal of the arbitrator's decision has been taken. The costs of such I
an appeal will be borne in accordance with the above paragraph titled"Arbitration.Procedures." Any final decision of the appeal
panel is subject to judicial review only as provided under the FAA. j
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Right to RgJcrt A.rbitration 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 FedFx or another major overnight delivery service with a delivery tracking system;
must inolude a statement that You wish to reject the arbitration provision along with Your name,address,Account LD,uumbcr 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,Wo 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 i
with respect to whether You rejected this arbitration provision in a timely and proper fashion. This arbitrntion provision will apply
to You and Us unless you reject it by providing proper and timely notice as stated herein.
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10. MISCEELLANEQII$
A. You give Us permission to conduct background checks on You,including obtaining information from the credit bureaus,
in order to verify Your Legal residence,contact information,and any other information We deem necessary for ibis
transaction.We can also search records for UCC Flings,bankruptcy filings,judgments,Iferis and child support
obligations against You.
B. Thio Contract is the entire agreement between You and Us.
C. Ifthere is more than one of Us or You,this Contract applies to all of those people together,and to each of them on their
own,
D. Both parties must agree in writing to any change to this Contract or waiver of its terms,
E. Except as set forth in the arbitration provision in Scotion 9 of this Contract,if a court undoes any part of this Contract,
the rest of the Contract remains valid.
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F. You cannot voluntarily or involuntarily sell,assign,or transfcr this Contract or any of Your rights or duties under this
Contract,Any such action taken by You in violation of tins section shall be void and of no effect,
G. Except as otherwise required by applicable law,the law of the state of'Your domicile(where You regularly 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 heirs,and executors.This Contract benefits only You and Us,and no one else.
However,If properly assigned by Us,this Contract will bind and benefit Our successors and assigns_
1. Failure to enforce any provision of this Contract is not a waiver of that provision,
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J. The Parties may sign this Contract in one or more counterparts. Each counterpart will be considered an original, All
counterparts will form one Contract. A facsimile,pdf or other electronic cop),of the signed Contractor 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 information available to Us,have
identified no violation of any applicable state or federal law,
L., You will not receive att IRS Form 1099 from Us,
M. Titles and headings in this Contract arc for convenience only. Do not use them to interpret this Contract.
N. Except as otherwise set forth in this Contract(including the arbitration provision in Section 9 ofthis Contract),You and
We will pay our respective costs and expenses in carrying out this Contract,
0. You give Us permission to request from our Affiliates information and documentation You have previously provided to
them which we deem necessary for this transaction,including,bankruptcy filings,judgments,sett[urg documents,
annuity documents,liens,child support obligations,divorce documents,
You and Wei intending to be legally bound,have signed this Contract as of the Contract Date below,and agree to all of its
terms and conditions,including the arbitration provision.
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Account ID; 919767
By signing below,You Also Acknowledge that Yott wei-e advised by Us in writing,thnt Vou should obtain independent legal
Advice and professional tax advice about the sate of the Purchased Payments and to have those advisors review with You,the
terms and legal,tax and other effects of this Contract.
Sworn to and sub ribed SELLER:
before me this r day nf�mm,20 ("Contract
Date") /—"z/ SIGN H�I��
Notary y
oto aCOMMONWEALTH OF PENNSYLVANIA
Myers 1r
NOtattel Seri
b.Sanders,Notary Public
mnstwp FibnlfAnCountyAcknowledged and Agreed; miS5lone)Vr@s7an.7 2017
MEMDER,4ENNSnyNi1A A35WATIQII OF ROTARIES
Sworn to and subscribed SELLER'S SPOUSE(If applicable)
before me this—day of ,20_
Notary Spouse
US:
BY:
Sam Gottesman,Underwriting Manager
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AcOuntID: 934767
PENNSYLVANIA September 22,201.4
DISCLOSUR ST TT
we will purchase the following payments (Purchased Payments) from You:
A) 116 monthly payments of$147.24 each, beginning on January 24,2015 and pending on
August 24,2024
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(The remainder of the page intentional) left blank)
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Account TD, qmv
September 22, 2014
The aggregate amount of the Purchased Payments is$17,079.84.
The discounted present value of the aggregate Purchase Payments at the federal interest
rate of 2.20% is$15,303.70. 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 gross amount payable to seller(You) is$6,600.00.
The net amount payable to the seller(You) is$6,600.00.
Legal fees (this is an estimate of what Your attorney will charge You if
You choose not to waive representation): $500.00 i
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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 43.10% 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
tinning of the structured settlement payments that You are selling to Us, this is the
equivalent of interest payments to Us at a rate of 24.75% 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
ECONOMIC IMPACT OF THE SALE.
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Please be advised there are no penalties or liquidated damages payable by you in the event
of any breach of the transfer agreement by you.
By signing below, You are confirming receipt of this Disclosure Statement at least 10 days
prior to You first incurring an obligation with respect to the transfer.
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IMPORIAUNT NOTME
You are strongly urged to consult with an attorney who can advise you of the potential tax
consequences of this transaction.
B ;
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W _. MYERS J
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nnd u•}/�/�� C
� wUYn to and sl)I Serjb�,�
13efor n:e thi.
a r ,Zoe
Notary COmmom OF FE,N� NIA
�iot&1�I kalka1
oeverly
D.sanders,Notary PWIC
St-Thomas TWP•,FranMn County
My CtUnm 5510!1 a.pines Jan.7,2,017
= QF MIIARWS
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ATT Ac�MENT
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September 29,2014
Monumental Life Insurance Company
4333 Edgewood Road NE
MS 2360
Cedar Rapids,IA 52499
Attn: Legal Department/Structured Settlements
Aegon Assignment Corporation
4333 Edgewood Road NE
Cedar Rapids,IA 52499
Attn: Legal Department/Structured Settlements
RE: Notice of Sale/Assignment of Payment Rights
Your Contract#:
Payee: W Myers Jr
Dear Insurer:
Please be advised that 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:
PLEASE NOTE: No payments under this annuity should beheld until the courts have entered a final order
and we have forwarded this order to you.
Very truly yours,
By:
Lori Borowski,Vice President
�r.
Reserved for Court use.
TILED -OFFICE
OF THE PIROTHOPfTMViz 1
2e#h OCT -7 PM 3: 48
CUMSERLAND COUNT Y
PENNS YLVA$IA
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA £vi!Teri•
NO: 157n?5
RE: Joint Petition of A.P.C.R., LLC
and W. Myers, Jr.
INITIAL ORDER OF COURT
On this 71k -day of 0 Lev- 2014, it is ordered that a hearing on this
Petition to Transfer Structured Settlement Payment Rights will be held on
IJ`e avt-C , 7,-I°i`-% in Courtroom at 3.V o' lc ock. 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:
�s
Maro & Maro, P.C.
By: Paul S. Peters, III, Esquire
Attorney I.D. No.: 87421
1115 W. Main Street
Norristown, PA 19401
(610) 275-9600 Attorney for A.P.C.R., LLC
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
IN RE:Joint Petition of A.P.C.R., LLC NO: 2014-5775 Civil
and W. Myers, Jr.
CERTIFICATE OF SERVICE
I, Paul S. Peters, III, 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. e-- '' -.j
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A copy of the Notice is attached hereto.
Date: October 14, 2014 By: :> `
VS. Peters, III, Esquire F"
OMey for A.P.C.R., LLC - "�'
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MARO & MARO, P.C.
By:Paul S. Peters, III., Esquire
Attorney I.D. No.: 87421
1115 West Main Street
Norristown, PA 19401
(610)275-9600
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
RE: Joint Petition of A.P.C.R. LLCNO:
and W. Myers, Jr.
I
NOTICE OF HEARING ON PETITION TO TRANSFER PAYMENT RIGHTS
To: Monumental Life Insurance Company A.P.C.R., LLC.
Attn. Legal Dept/structured Settlements 160 Greentree Drive, Suite 101,
4333 Edgewood Road,NE Dover DE 19904
MS 2360
Cedar Rapids, IA 52499
Aegon Assignment Corporation W. Myers,Jr.
Attn.Legal Dept/structured Settlements
4333 Edgewood Road,NE
Cedar Rapids, IA 52499
You are hereby given notice that W. Myers,Jr. and A.P.C.R., LLC. has filed a petition to
transfer payment rights. A hearing in this matter has been scheduled on ► 1_, 2014 at
'.3 Mo'clock in courtroom no.�_courthouse,Cumberland County Court of Common
Pleas,Cumberland,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 A.P.C.R.,LLC.
160 Greentree Drive, Suite 101, Dover DE 19904, Tax I.D.No. 20-4728885.
BY:
Date Pau ters, III., Esquire
Arn for A.P.C.R., LLC.
lel W. Main Street
Norristown,PA 19401
(610)275-9600
(610)275-9666(facsimile)
Reserved for Court use. 1Lt 6-QF1 ;.
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214 OCT -7 PM 3.
CUWI RL y COUNTY
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
RE: Joint Petition of A.P.C.R., LLC NO:
and W. Myers, Jr.
L INITIAL ORDER OF COURT
On this JWay of A.40LEZZ,2014, it is ordered that a hearing on this
Petition to Transfer Structured Settlement Payment Rights will be held on
Sl
in Courtroom ?.�1_q_at :c0 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 I
certificate of service shall be filed with the court prior to the hearing.
i
BY THE COURT:
AWZ 9-2L
J.
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
RE: Joint Petition of A.P.C.R., LLC : No. 14-5775
And Wendell Myers, Jr.
FINAL ORDER OF COURT
On this 17th Day of December, 2014, the parties have entered into. a Stipulation of
the Parties, a fully -executed copy of which is attached hereto as Exhibit A, and it is ordered
that the Petition to Transfer of Structured Settlement Payment Rights is granted.
The court specifically finds that:
(1) Wendell Myers a/k/a Wendell Myers Jr. alk/a Wendell K. Myers a/k/a Wendell
K. Myers Jr. a/k/a Wendell K. Meyers Jr. ("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 A.P.C.R., LLC ("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 statute or regulation, or the order of
any court, governmental authority, or responsible administrative authority;
(3) the transfer complies with the remaining requirements of the Structured
Settlement Protection Act, including Sections 3(a)(1), 3(a)(2), 3(a)(4), 3(a)(5)
and 3(a)(6);
(4) the payments, associated with annuity no. 019268MS02Z, that are to be
transferred to Transferee are designated as follows:
• monthly payments of $147.24 each, beginning January 24,
2015 through and including August 24, 2024;
(collectively referred to as "Transferred Payment(s)"), and should be made
payable and sent to Transferee at P.O. Box 83364, Woburn, MA 01813-3364.
(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 Pa yee shall receive from the Transferee, as of Oa t, 11414 , the
amount of $6,600.00, from which no funds are owed for counsel fees,
administrative fees, or other costs, fees or expenses.
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BY
BY THE COURT:
EXHIBIT A
STIPULATION OF THE PARTIES
This stipulation of the parties ("Stipulation") is entered into as of this 17th day of
December, 2014, by A.P.C,R., LLC ("Transferee"), Wendell Myers a/lc/a Wendell Myers Jr. a/k/a
Wendell K. Myers a/k/a Wendell K. Myers Jr. a/k/a Wendell K. Meyers Jr, ("Payee"), AEGON
Assignment Corporation ("Structured Settlement Obligor"), as owner of the structured settlement
annuity No. 019268MS02Z (the "Annuity") and Transamerica Premier Life Insurance Company
f/k/a Monumental Life Insurance Company f/k/a Commonwealth Life Insurance Company
("Annuity Issuer"), as issuer of the Annuity (the Structured Settlement Obligor and Annuity
Issuer are sometimes collectively referred to as the "Companies").
RECITALS
WHEREAS, pursuant to 40 P.S. § 4001, et. seq. (the "Act"), this cause came before the
Court upon the Petition (the "Petition"), filed by counsel for Transferee, for Court approval of a
Transfer of Structured Settlement Payment Rights of the Payee to Transferee;
WHEREAS, the Companies have not objected, to the proposed Transfer;
WHEREAS, the proposed Transfer, after a notice, hearing and testimony by the Payee,
either in person, by affidavit, or telephonically, shall be approved in a final court order or order
of a responsible administrative authority (the "Court")based on express findings by such Court
or responsible administrative authority (the "Order");
WHEREAS, unless otherwise defined herein, capitalized terms shall have the meanings
set forth in the Act or the Order, as may be applicable.
NOW THEREFORE, in consideration of the mutual covenants and promises herein
contained, and for other good and valuable consideration, intending to be legally bound hereby,
the parties hereto stipulate and agree to the following:
STIPULATION OF THE PARTIES
Page 1 of 6 CASE NO.: 14-5775
1. The Recitals are incorporated herein by reference and made a part of this
Stipulation.
2. The Payee and Transferee represent and warrant to the Court and Companies that:
A. Transferee provided Payee a written disclosure statement which
meets all of the requirements prescribed by the Act.
B. Prior to the date set by the Court for the scheduled hearing on the
Petition filed under the Act, the Transferee filed with the Court and
served on all Interested Parties a notice of the proposed transfer
and the Petition for its authorization, which included all of the
requirements of the Act.
C. The Payee has been advised in writing by the Transferee to seek
independent professional advice regarding the Transfer and has
received such advice or has knowingly waived such advice in
writing.
D. The Payee has established that the Transfer is in the best interest of
the Payee, taking into account the welfare and support of the
Payee's Dependents, if any.
E. The Transfer complies with the requirements of the Act and does
not contravene any applicable federal or state statute or the order of
any court or responsible administrative authority or other
government authority.
F. The Transfer Agreement does not authorize Transferee or any other
party to confess judgment or consent to entry of judgment against
Payee.
G. Except as expressly provided for in this Stipulation, the
Transferred Payment(s) are not subject to the claims of any person
or entity.
H. The Transferred Payment(s) being transferred have not been sold,
pledged or alienated in any way and the Payee release any and all
security interest that the Payee may have in the Transferred
Payment(s).
I. The Payee has confirmed receipt of the disclosure statement, as
evidenced by the Payee's signature on the copy of the disclosure
statement.
Payee is obligated to pay child support. If Payee is behind on his
child support obligations as of the date of this hearing, Transferee,
STIPULATION OF THE PARTIES Page 2 of 6 , CASE NO.: 14-5775
on behalf of the Payee, shall send to the support agency a check in
the amount specified by the support agency to bring said child
support obligations current and to pay-off all past and present child
support obligations and arrearages. Transferee shall pay this
amount from the proceeds due to Payee prior to Payee receiving
the agreed net amount due as listed in the Disclosure Statement.
K. Payee has never filed or had filed against the Payee a petition in
bankruptcy under the Federal Bankruptcy Code.
3. The Transferee and its successors and/or assigns shall, jointly and severally,
defend, indemnify and hold harmless (collectively, the "Indemnity") the Companies from any
claims, liability or damages, including, but not limited to, reasonable costs and attorneys' fees,
arising from or in connection with (a) any disclosures made in or related to this Stipulation and
Order; and (b) compliance by the Companies with this Stipulation and Order. As security for any
amounts owed under the Indemnity, Transferee grants, and Payee consents to such grant, to the
Companies all rights of offset, setoff and recoupment with respect to the Transfer.
4. Notwithstanding anything to the contrary elsewhere, disputes under the Transfer
Agreement, including any claim that the Payee has breached the Transfer Agreement, shall be
determined under the laws of this state, and neither the Transferee nor any other party is
authorized to confess judgment or consent to entry of judgment against Payee.
5. Pursuant to the Act, the Structured Settlement Obligor and the Annuity Issuer are
hereby discharged and immune from all liability to: a) the Payee; b) anyone claiming through
the Payee; and c) to any other person or entity, for i) the Transferred Payment(s) and ii) for
disclosures made in or related to the Transfer Agreement. Provided, however, that the Annuity
Issuer remains liable to the Transferee for the Transferred Payment(s) pursuant to the terms of
this Order.
6. Compliance with the requirements and fulfillment of the conditions set forth in
the Act, and applicable law shall be solely the responsibility of the Transferee in the Transfer of
STIPULATION OF TEE PARTIES
Page 3 of 6 CASE NO.: 14-5775
the Transferred Payment(s), and the Companies shall not bear any responsibility for, or any
liability arising from, non-compliance with those requirements or failure to fulfill those
requirements or conditions. Without limiting the foregoing, the Companies may rely on the
entry of the Order in making the specified Transferred Payment(s).
7. The Companies are entering into this Stipulation strictly and solely in reliance
upon the Court's approval and upon the representations, warranties and agreements of the
Transferee and Payee and any other person or entity signing hereunder, and only for the purpose
of reflecting that the Companies have no objection to its terms, if approved by the Court at the
hearing set for this matter. Further, each of the parties acknowledges that each has had the
opportunity to participate in the preparation of this Stipulation and the Order and, as such, no rule
of construction shall apply which might construe this Stipulation and/or the Order in favor of or
against any party hereto.
8. The Transferee and Payee agree that the terms of this Stipulation and the Order
are based exclusively upon the facts, representations, and circumstances of this particular case.
Nothing in this Stipulation or in the Order shall . preclude the Companies from contesting any
other proposed transfer of Structured Settlement payment rights, whether on the basis of
applicable law, service of process or otherwise. The Order is to be entered without prejudice to
the rights of the Companies, and without findings regarding the enforceability of any non -
assignment provision(s) contained in the Structured Settlement Agreement or related documents;
provided, however, that the Transfer of the Transferred Payment(s) shall be valid and enforceable
against the parties hereto and their successors and assigns. Neither this Stipulation, the Order or
the Companies' lack of opposition to this matter, shall serve as precedent or evidence in any way
nor be cited in any matter (except in connection with enforcement of the terms of this Stipulation
and the Order). This Stipulation and the Order shall not constitute an admission or
STIPULATION OF THE PARTIES
Page 4 of 6 CASE NO.: 14-5775
acknowledgement by the parties that the Uniform Commercial Code does or does not apply to
the transaction at issue. Nothing contained in this Stipulation or Order shall be deemed to afford
the Payee or the Transferee any rights of ownership or control of the Annuity or shall otherwise
affect the exclusive ownership and control of the Annuity by the Structured Settlement Obligor.
9. The Transferee requests that the Transferred Payment(s) be sent by the Companies
to the address provided for in the Order, or such other address as the Transferee and its
successors and/or assigns may designate upon written notice to the Companies. Payee hereby
consents to the Structured Settlement Obligor and Annuity Issuer making the Transferred
Payment(s) payable to the Transferee or its successors and assigns. In no event shall the
Companies be required to divide or split any of the Transferred Payment(s) between two or more
transferees or assignees. Further, any such change of address or assignment by Transferee of its
rights to the Transferred Payment(s) shall in no way relieve the Transferee of its obligations
hereunder.
10. The death of the Payee prior to the due date of the last Transferred Payment shall
not affect the Transfer of the Transferred Payment(s) from the Payee to the Transferee, and the
Payee understands that he is giving up his rights and any rights of his estate, and any rights of his
heirs, successors and/or beneficiaries, to the Transferred Payment(s).
11. The Transferee shall also pay a $750.00 administrative fee to the Annuity Issuer in
connection with its review and processing of the Petition, regardless of whether the Order is
approved by the Court.
12. This Stipulation is subject to approval by Order of the Court. Counsel for the
Transferee shall mail certified copies of the Order, including any exhibits and this Stipulation to
the interested parties. This Stipulation may be executed in any number of counterparts, each of
which, when executed and delivered shall be deemed to be an original, and all of which, when
STIPULATION OF THE PARTIES
Page 5 of 6 CASE NO.: 14-5775
4
taken together, shall constitute one and the same. Signatures received by facsimile or telecopy
shall be deemed .originals.
13. The persons .signing below represent and warrant that they have authority to
execute this Stipulation. Such signatur,es shall be binding upon the parties; and shall inure to the
benefit of the parties heretO, P4-, their respeetiVe directors, shareholders, officers, agents,
employees, servants, sticeesSera, hoirS,exectiters, administrators, and assigns.
IN WITNESS WilEltEOF,-. the parties have executed this Stipulation by their duly
authorized representatives.
AGREED TO IN FORM AND SUBSTANCE:
PAYEE,
TRANSFEREE, by its authorized
representative,
Wendell Myers a s Jr. a/k/a
Wendell K. Myers a/k/a Wendell K. Myers Jr.
a/k/a Wendell K. Meyers Jr.
The undersigned bas no objections to the
foregoing:
ANNUITY ISSUER AND STRUCTURED
SETTLEMENT OBLIGOR, by their
attorney,
Priyanth P. Manjooraii, Counsel
Greg T. Slessor, Counsel
Andrew W. Martin, Counsel
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