HomeMy WebLinkAbout14-63273:
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 C.M.C.G., LLC
and J. Schiner
NO:N'tig).9
NOTICE OF HEARING ON PETITION TO TRANSFER PAYMENT RIGHTS
To: Fidelity and Gauranty Life Insurance Company
c/o Offit Kurman, P.A.
8 Park Center Court, suite 200
Owings Mill, MD 21117
Attn: Steven Kaufman, Esquire
United States Fidelity and Guaranty Company
Corporation Service Company
2711 Centerville Road, Suite 400
Wilmington, DE 19808
C.M.C.G., LLC
160 Greentree Drive, Suite 101
Dover, DE 19904
J. Schiner
You are hereby given notice that J. Schiner and C.M.C.G., LLC has filed a petition to
transfer payment rights. A hearing in this matter has been scheduled on
, 2014 at o'clock in courtroom no.
courthouse, Cumberland County Court of Common Pleas, Pennsylvania.
You are entitled to support, oppose or otherwise respond to the payee's petition, either in
person or by counsel, by filing written comments with the court prior to the hearing or by
attending the hearing.
The Name, Address and Tax Identification number of the transferee i . .M.C.G., LLC
160 Greentree Drive, Suite 101, Dover, DE 19904, Tax I.D. No. 20-472888.
Date
BY:
Paul et�.ffs, III, Esquire
Atto Sy 'or C.M.C.G., LLC
111 ain Street
No ristown, PA 19401
(610) 275-9600
(610) 275-9666(facsimile)
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 C.M.C.G., LLC NO:
t/koar)
and J. Schiner
JOINT PETITION FOR TRANSFER PURSUANT TO PROTECTION ACT, 40
P.S. 4000, ET SEQ.
TO THE HONORABLE JUDGES OF SAID COURT:
And now comes your petitioner, C.M.C.G., LLC, by and through its attorneys,
Maro & Maro, P.C., and joint petitioner, J. Schiner, and in accordance with the applicable
rules of Pennsylvania Civil Procedure, hereby represents as follows:
1. Petitioner is C.M.C.G., LLC, by assignment ("Buyer" or Transferee"),
with an office address located at 160 Greentree Drive, Suite 101, Dover, DE 19904.
2. Joint Petitioner is, J. Schiner ("Payee"), an adult individual who resides in the
County of Cumberland.
3. This Joint Petition has been verified by the Transferee, C.M.C.G., LLC and the
Petition includes all necessary information as prescribed by PA R.C.P. 229.2(d) et al and
Section 3 of the Act, 40 P.S. §4001 et seq.
4. Pursuant to PA. R.C.P. No. 229.2(d)(3) there are four (4) attachments
incorporated herein as follows:
a. PA R.C.P. 229.2(d)(3)(i) Payee's Affidavit in Support of Petition.
Please see Attachment/Exhibit "1"; and
O.IsPa
Ce_-4o/i/s)
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, C.M.C.G., LLC; and
d. PA. R.C.P. 229.2(d)(3)(iv) A Final Order of Court Granting
the Petition.
5. Joint Petitioner, J. Schiner, is the beneficiary of an annuity
owned by United States Fidelity and Guaranty Company and issued by Fidelity and
Gauranty Life Insurance Company. The settlement provides payment to the petitioner as
described on Attachment/Exhibit "2".
6. Joint Petitioner, J. Schiner, 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, J. Schiner, proposes to enter into a purchase agreement with
C.M.C.G., 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
settlement as follows:
A) 180 monthly payments of $394.06 each, beginning
on January 8, 2016 and ending on December 8, 2030.
8. The settlement is currently owned by United States Fidelity and Guaranty
Company and issued by Fidelity and Gauranty Life Insurance Company, and the net
amount in return payable to J. Schiner is $18,716.97 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 $18,716.97.
10. Based on the net amount that the payee will receive from this transaction
$18,716.97 and the amounts and timing of the settlement payments that would be
assigned, the payee is, in effect, paying interest at a rate of 21.00% per year.
11. The Buyer furnished J. Schiner 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 J.
Schiner 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)
J
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 currently single and has no
minor children. Petitioner has never transferred payment under the annuity in the past.
Unfortunately, Petitioner is behind on her mortgage and needs this money to clear up all
arrears. Further, Petitioner is in need of a new motor for her vehicle. Petitioner has
r
thought about this decision thoroughly and firmly believes that this is in her best 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.
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 Payments Rights as is mentioned herein.
By:
Respectfully Sub 'tted:
Paul
Atto
rs, III, Esquire
for Transferee
VERIFICATION
I, Lori Borowski, Vice President of C.M.C.G., 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.
/0. 1 -9 -"to
Date
CERTIFICATION OF ATTORNEY FOR TRANSFEREE
I, Paul S. Peters, III, Esquire, attorney for Transferee, C.M.C.G., LLC, hereby
certify to the best of my knowledge, information and belief, formed after reasonable
inquiry, that the Transfer will comply with the requirements of the Act (40 P.S. § 4000 et
seq.) and will not contravene any other applicable federal or state statute or regulation or
the order of any court or administrative authority.
I, Paul S. Peters, III, Esquire, attorney for Transferee, C.M.C.G., 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.
Dat0'7-6NY
e Pa / . ' e ters, III, Esquire
A orn-, for Transferee, C.M.C.G.,
L C
MARO & MARO, P.C.
By: Paul S. Peters, III, Esquire
Attorney LD. 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 C.M.C.G., LLC : NO:
and J. Schiner .•
CERTIFICATE OF SERVICE
I, Paul S. Peters, III, Esquire, hereby certify that a true and correct copy of the
Petition for Transfer of Settlement Payments has been served upon the following entities
via first class mail and/or certified return receipt requested and/or email on :
To: Fidelity and Gauranty Life Insurance Company
c/o Offit Kurman, P.A.
8 Park Center Court, suite 200
Owings Mill, MD 21117
Attn: Steven Kaufman, Esquire
United States Fidelity and Guaranty Company
Corporation Service Company
2711 Centerville Road, Suite 400
Wilmington, DE 19808
Date:
By:
C.M.C.G., LLC
160 Greentree Drive, Suite 101
Dover, DE 19904
J. Schiner
Paul S. , III, Esquire
Atto C.M.C.G., LLC
MARO & MARO, P.C.
By: Paul S. Peters, III, Esquire
Attorney LD. 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 C.M.C.G., LLC : NO:
and J. Schiner
Entry of Appearance
TO THE PROTHONOTARY/CLERK OF SAID COURT
Enter my appearance on behalf of: C.M.C.G., LLC.
Papers may be served at the address set forth below.
By:
Respectfully Submitted:
Maro & Maro, P.C.
Paul S,e rs, 111, Esquire
Atto ey .D. No 87421
Mar & Maro, P.C.
1115 W. Main Street
Norristown, PA 19401
(610) 275-9600(office)
(610) 275-9666(Fax)
ATTACHMENT/EXHIBIT "1"
Petition
ayee's Affidtvitin Support of
Transfer Structured Settlement Rights
1,1 Schiller, the payee, verify that the statements below are true -and correct:
's name, address and age:
1. Marital Status:
X Never Married;': Married; Separated; Divorced
•
If married or separated,:name of spouse: N/A
'2 Minor Children and other dependents: :
NONg
3.: Income:
. Payee's monthly income and sources: 1 am currently unemployed, and
receive $1,080 monthly from Social Security Disability:
4. Child'suppory alimony or alimony pendente•lite:
Obligation to pay: Yes X No
If yes, state the amount of the obligation, to whom payable, and whether there are
arrearage$: none
5. Previous transfers; Have you previously filed,a petition to transfer payment
rights under the structured settlement that is thesubject of this petition?
Yes X* No
If yes, for each petition that you filed, •
(a) . If the transfer, Was submitted for court, approval, list the
•
court, the 'case caption and case number, and state whether the
Schiner,
court approved or disapproved the transfer: If the transfer was
approved,
(b) State.thename o the transferee and identify (listing due
dates and payment arnount(s)) the payments involved in the
transfer:
State the amount of m
was used:
(c) Have you ever transferred pay
• approval? If so, please explain:.No
and the manner in which the money
6. Reasons for transfer:
Describe in detail your. reasons for :the'.proposed transfer; including an
explanation as to why a sale a lesser: amount of zhe structured settlement
amount will better serve your interests:.) want to use the money to get caught up
on my mortgage pay iments that I owe on and to also pay fora new motor on.my
car.
7.. Payment of debts:
If you seek, the transfer in order :to pay. debts,
the creditor and the amount presently.owed:
Debt Creditor :. Amount.Owed
Mortgage PA Housing Financial Agency $7,000
it each debt;. including the name of
Verification
. .
• I verify that the 'statements Made in this affidavit are true and correct. 1 understand
that false statements.herein are Made stibjecf•to the penalties of 1& Pa.C.S: §4904, relating
to unswom falsifitatiop to authorities. •-• . •.
ATTACHMENT/EXHIBIT "2"
To be supplemented on or before the date of the hearing.
ATTACHMENT/EXHIBIT "3"
Please complete and sign,
STATEMENT OF PROFESSIONAL REPRESENTATION
Please Choose Either Box A OR Box B Below:
After you have .made your choice, SIGN AND DATE the appropriate box signature line.
YOU SHOULD SIGN ONLY ONE BOX - THE BOX YOU HAVE CHOSEN.
Acconot ID: 940045
I HAVE REEK ADVISED BY
TI•IAT I_SHOULD OBTAIN.INDEIENDENT.PROFES$IO.NAL
REPRESENTATION CONCERNING THELEGAL, TAX AND/OR FINANCIAL
IMPLICATIONS OF.TIIJS TRANSACTION. .I FULLY UNDERSTAND THE PURCHAS
AGREEMENT AND TTIE IMPLICATIONS OF THE TRANSFER, INCLUDING THE TAX.
RAMIFICATIONS OF THE TRANSFER AND:I DO NOT WISH TO. SEEK OUT SUCH
INDEPENDENT PROFESSIONAL REPRESENTATION.
1-DotJ7II4'
. I HAVE OBTAINED INDEPENDENT REPRESENTATION AND I FULLY UNDERSTAND•
THE LEGAL, TAX AND/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:
SCHINER
To Be Completed By Ca -tilted Professional Advisor
Only if you have signed J3ox B Above
Name of Professional:
Phone Number: ( _)
Address:
I have personally met•with and provided independent professional advice to
and the transaction contemplated thereby. J Schiner was Wetted tome by the
Professional's Signature
Attorney di #
n
with
Date
ATTACHMENT/EXHIBIT "4"
0F ACT
. , TO C.M.C.G , LC
•(3r
gud
and..:yalaabloabaidalidon;. :i.a.Okitniand gi..0004.'nf..*.biOblaliaraby.:40T,07%00041 , .
cf.A.010in.?7ba.rebya'siOqi..ltan*tais sells.:and:Sets:oVet to . CA014'neeli. all
ofnatight;tida'and.iiitereSt,inaalto'dintnattainPnrabaie:OofritaCtdated7OCMber 23,2614 between AS4MOro.and.3.- •
Sol donumenta ekeented:iii:cenrieetien therewith (hereinafter bellectiVelyreferred as the Property"),
. „ . , .
subject to all tba:enns and COriditiOnS•thereof " • • • - : •
• • • • • „ . „
The.gartipahereM:ititend that thetratiSfer:Ofthe Property hereby .onenipisod**bad bel; and shall be treated as, a.sale by
4sotinnt..t.n.ssi.gnae; anditot a a secured lending transaction. The sale hereunder shall be absolute, Anal and without
• • -teAM.4e,. except as is otbarsOga-p-iniridadli. • • . •• • „...
If, notwithstanding the intent of tlieparties,hereto or any other provision .hereof, the Property aOlcIand•cOnVeyed -
hereunder were to construed by a cOurt'of.competentjuriSdiction to constittiteproperty of ASsignOr;orthe sale and
conveyance Of the Propotybarenndat. were not treated as a 'sale by Assignor M Assignee for allPiitiitise,s, then this .
Assignment also is intended by the,pa..itieS hereto to constitute, and hereby is, a:ScoUrity agreement within the Meaning
of the under* CO1111110014 Code of the jtirisdietiOn of organization of the Assignor, and the sale and aerieyanee Odle
Property by Assignor hereunder shall be treated as a grant of, and Assignor hereby grants to Assignee,.a securityinterest
in, to and under all of Assignor's right, title and interest in and to all said Property, and a security interest in, to and
under any and all of (*wbadni tangible or eiectronie), PaYnienfliiningibles,. General
Intangibles, Instruments, Documents and Money and all proceeds and products of the.foregoing (in each case as such
terms are defined under the Uniform- COrninercial Code as in effect in the State of Delaware from tinie-to7time), arising . •
out of orintonnection with theproperty,. in each case to secure Assignoei payment and perforMance. obligations
.hereunder and brider. any other oannients:ralating.hereto,..or, as. is .otherWises.aquitod by. applicable:law.
Assignor•authorizes Assignee to file any UCC Financing Statements riair.iing As.sigtior as "debtor" or "seller"
thereunder, and naming AsSignee as "secured party" or "purchaser". thereunder, deemed necessary by Assignee to
petted it 'sa.curity interest created hereby.
ThiS Assignment shall be governed by the laws of the State ofNevada.
940045
Dated this day of rtitFtt... , in the ye
ASSIGNOR:
. • By:
• ..?,.11,z'
ASSIGNEE: CMC.G., LLC
•
41•••••••••0•111•••.1111111•1.10M1111.mor,
PURCHASE CONTRA
•
This is a Purchase Contract ("Contract") for the Sale of structured settlementpayments between
3 Schiner (You, Your), and (We, Us, Our)
GENERAL INFORMATION .
A. In connection with,the resolution of a personal Injury daim, You Or 'someone acting for You, signed a Settlement
' • A9reernent-thatentities You to receive certain future payments ("Settlement Payments"), according to a set schedule.
• 13. 'Those Settlement.Payments are beinci•Pald. tci YoU frorn an.anihuity policy ("Annuity Policy"). purchased by the Person
responsible for Making the Settlement Payments to You ("Obil9or")..
• ..
C. Rather than Wait for the Settlernent Paymentil;to.be rnade•to.,(ou•ln. the fubire,, yOi.J., want to sill.allsor'some of thOsA
Settlement Payments ("Purchased PaymentS') to Us now tora' lump sun.. • ' • n •
• .
D. THIS CONTRACT CONTAINS AN ARBITRATION PROVISION WHICH YOU SHOULD READ CAREFULLY, AS.
- IT WILL HAVE A SUBSTANTIAL IMPACT ON 14014 DISPUTES BETWEEN YOU AND US ARE RESOLVED.:
. .
' E For additional cinfinNiorvs, see •Section 3 of this Conimit. • : . • l•
•
You and We agree as follows:
1. ALE OF THE PURCHASED PAYMENTS
A. Upon the signing of this Contract•and subject to certain conditions Including .Court •Approy air You sell, transfer and
assign to Us the right to receive the Purchased PayinentS:sPedficaliVIdentified;:in,the Disclosure StateMent.
. , .
. •
. . . . . . • . . . .
. .
. . . .
B. We will pay Yoil,the Net Purchase (Price as agreed to in the Contract DOCurnenti., subject to certain conditions,
Including Meeting Our Underwriting tequllements, Coin Approval and satisfactory completion of the dosing
Documents. We will do this in exchnge for You.
• selling the Purchased Payments
• changing the beneficiary of the Annuity Policy to:Your:estate and not changing It again until We have been
paid all of the Purchased Payinents; • ..• ' "
, . • •, •
• 'having any current beneficiaries Waive their rights to the Purchased Payments; and
• fulfilling Your promises under this Contract.
Page 1
o7/1211z
Account ID: '940045
C. if We are buying only a portion of Your payments, this will have'no effect upon Your rights in the unsold portion..You
will continue to receive the unsold portion unless You have already sold or encumbered that portion. However,
sometimes the Issuer, the Obligor or the court may require Us to receive the entire amount of Your payment If so,
We will then,forward the portion of the payment still due to You and You hereby agree to this payment servicing,
arrangement
2. PURCHASE Pucg
A. The Gross and Net Purchase Prices are Shown ori the Disdosuce•Statemmerit and are fair- a
B. •We will pay You the IYet Purchase Price in the manner You designate for Us.
acceptable to You and Us.
C. Before we pay You, You agree that We wilt adjust for the following amounts, If applicable:
• Purchased Payments Owed to Ds - The Issuer may have already paid You some of the
Purchased Payments before We_have.paid'Yoq for them. If that happens; We will deduct
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. if We
subsequently receive those particular Purchased Payments directly, We Will return•the.amount
of any related holdback bo You.
+ Payment of Debts Owed If You owe any'past due child support, bankruptcy payoffs or taxes,
or have any judgments or'Iiens against You or Your assets, We may pay those amounts and
deduct them from the amount We payYou; and•You hereby provide Us with, speciIc 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 bave.paid You for:them, Yqu will immediately contact
Us. If We then determine that any deductions or holdbacks asset forth above are not enough to reimburse Us, We
will advise You of the amount You owe Us. You agree to Immediately send that amount to Us by bank or certified
check. '
3. MEFINED WORDS
Affiliate
An entity controlled by, controlling, or under,comnion control with, another.errtity, 0
Annuity Polity
The policy purchased by the Obligor, to ensure that the settlement Payments are made to. You as required by the
Settlement Agreement•
Closing Documents
07/ 12/12
• Account 940015
• -7
Any documents necessary to carry out the purchase of the Purchased Payments,. other the "Contract or Contract
Documents" as defined below.
Contract or Contract Documents
Cdiectively, only this Contract and the Disclosure Sta
• •
merit
Contract Date
. . . .
The date Your signature at the end of this Contract is notarized. However; ifYou happen to sign this Contract before the •
Mather of days stated at the end of Your Disclosure Statement -for waiting has passed, You will have no obligation under
Your Contract untilthat time has. passed. • .
' Court Order
• A legally, binding ruling issued by a judge ar,pniPerlyernPowered administrative officer,;approving the sale of the
Pulthased Payments to Us eCourt Algp royai • • • •
DisclosureStatament •
The document which Identifies kr You, the Purbased Payments, expenses, PUrchese Price•and various other disdoSunas.
•
Encumbrance
Any claim, right, lien, pollcy loan, or restriction. In on, this includes any Milts on rights Of ownership (such as the • .
use, voting, transfer, receipt of Income, etc.): •
• e' '
Funding Date
The date We pay You the Net Purchase Price.
Issuer
The insurance company that issued the Armuity. Policy.
Obligor •
The Person who Is obligated to make payments to YoU under the Settlement Agreement.
Party •
One of You or Us. Parties means both You and Us.
Person
Any natural person or legal entity.
•
Purchased Payments
Only'thase certain payments that We are purthang from You under thls Contract.'
Purchase Price:
07/12/.1Z
Gross Purchase Price
The amount shown as the "gross amount (*able to the seller (You)" on the DiSdosure Statement. This Is the
sum We have agreed tppay You tiefore any deductions as setforth in the Contract Documents.
•
•
Net Purchase Price
_c
Accouot ID: 940045
The amount ShoWn as the 'net amount payable to the 'seller (Your on the Disclosure Statement. This Is the sum
We have agreed to pay You aRerany deduttions as set forth in the Contract DoCurnents.
. . .
. .
. .
Settlement Agreement
. . . .... . .
. .
Theagreement that You and the.Obligor signed to resolve Yotir persona l injury daim.
• .... . • .
Settlement Payments
AH of the payments that the Obligor has agreed to make to You In the SettleMent Agreement.
We, Our, or Us
4 . . .
.... along with any of Its Successors, ass4gtis, and designees. SOme of the Contract
Documents or Closing DocunientS may refer tO.Us as ite.pbrchiser. 0
. .
You or Your
The Person named on this Contract's first page. Some of the Contract Documents or Closing Documents may refer to YOU
as the seller.
•
4. YOUR,REPFtESENTATIONS AND WARRANTIES
You represent and warrant to Us the following: 0.
A. You understand that This ISA SALE AND NOT A 'LOAN.
B. The Annuity POIICy Is in full force, You are the pile and undisputed recipient of the right to.the Purchased Payments
have the right to sell them free and clear of any Encumbrances and have not previously sold any of the
Payments to any other Person. .
C. You understand that Court Approval is recjuired for this purchase; and You agree to fully cooperate with Usto obtain
that approval.-
• D. You gave Us all requested information and signed all documents necessary ID. complete the purchase. Every
statement made by You in the Contract DOCUtOOO6 and Closing Documents is true and complete. • •
E. No law, divorce decree or other legal obstade-:
• requires You to keep the Purchased Payments for the benefit of a current or former spouse, dependent
children, or other person; or.
• legally prevents You from contracting with Us selling the Purchased payments or changing the Annuity ,
Policy's beneficlarY.
F. Bther:
• You have never filed for bankruptcy,, will not doso before the Funding Date' and there are no lawOts or
• efforts bYany of Your creditors to put You into bankrUptcy or take any of the Purchased PayMefit5; or •
1?.aftie
070.2112 0
Account ID: 940045
• If You filed for benkruPtcY, the Purchased Payments were not subject to, the claims of Your credthrs. You will
give Us a copy Of any of your bankruptcy documents that We request including evidence of a final
bankruptcy. payoff or c;aSe dosing, if any.
G. We can rely on Your representabons,-WarrantieS, and promises in this Contract. These representations,. warranties,
' and prornises are for Our benefit and the benefit of any future owners ofthe Purchased parierits. You: understand
that Our reliance on any Intentional misrepresentationby'You may.resultin Our 'en(orcing Our rights against You in
. .
%court. . . . . • . .
. . . . . . . .
. - •
. ,.
H. You had enough time to considerthe sale of the Purchased Payments, under$tanci the terms of the Co*act.:. .' •
Documents and Closing Document (Including the arbitration pn?vision);* are of legal contracting ageandsOtind mind,
not under theinfluenceof drugs Or akotiol, and freely and voluntarily, enter into this Contract and agree to all.of Its
. . .
. .
. . . „ . . • ' • • • . .
. . . .
. .
. . .
I. You wens advised by us to obtain independent legal advici and professional tax 'advice abotithe tale of the.. . . • • .
Purdlased Payments and to have those adVisors review theterMs and legal, tax- and other effects of this -Contract with
You prior to Your execution of this Contract: Yo3j. have also explored all appropriate financial optIOnS beforeentering •
.into thls transaction. - . . .. . . • . , • . ' - - .
• . . • . . .
. . .
• 3. We did not prOvide tax, financial,.or legal advice taYou about this Coritract and have advised You that We maynot
refer You to any specific attorney forsuCh Otrpose, • . .
. . . -
K. If You are married,. Your spouse underStarfdiall Of the terms and Conditions of this Contract induclIng, but not limited
to the fact that, after the Date, You (and Your spouse) will riot receive the same amount of money On the '
same payment schedule as You woUldhave.received under the •Annuity Policy,' Your spouse has been provided withall -
Information :relating to the transaction and has had every opportunity to review the terms of the transaction and to
seek any advice relating thereto. Your Spouse also understands that he -or she will be giving up any property or
contract rights that tie.or she may' have in the Purchased Payments.
, . . .. .
L We may selloransfer, or assign Our right to the, Purchased Payments in a sale, seo.ritization, or other financing
transaction (resale). Any resale wouldlriyolve disclosingcertain information aboUtYoU (Including Your personal
Information) to the parties to a resale. •: ; • • • -. ..- • ,
M. Any future owner of the right to the PUrchated Payments Will. have all of the same rightt.We have, inducting the Hgnt
to the duties You owe Us 'under -this Crintiect. This Includes the right to Make a daim against Youfor violating any -of
the represeritatIons, WarrantieS, or promises You made in this Contract. . • . •
5. YOUR PROMISFS TO US
Before and after the Funding Date, .
A. You will tell us right away If Your address or telephone number Changes and do everything necessary, Induding
•completing arid Signing all doCumentsto:. '
• sell the -right to the Purchased Payments to
• • change the beneficiary as required by this Contract,
• correct any documentation errors in the Contract Documents or Closing Documents.
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07/12/12
Account ID: 940045
B. You will also tell Us if any of the following occurs:
• a violation of this Contract; or
• anything that could negatively_ affect the Annulty.Policy, the Purchased Payments, or this Contract.
C. You will not:
• • • agree to sell the Purchased Payments to any Person other than.Us;
• change the Annuity Policy's beneficiary to any Person other than Your estate until We have collected all of
the' Purchased Payments; or
• withdrawcash from, borrow against, or change the Annuity Policy.
D. You will give'Us Information necessary to update Your represe tions, warranties, and promises imtftis Contract Y
will also•update any documents and tnformationsq they,will Beatrice and complete On the'Fundtrig Date.
E. We are now, and wl l continue In the future, to rely on the representations and warranties You have glven,Us, We will
confirm the accuracy ofYour representations and warranties.•You'must cooperate with this confirmation and provide
complete access to any Information We believe'necessary, .
F. You agree that updating representations, warranties, promises, documents and other information will not cure a
breach of any representation or warranty made by you that.was not true and corriplette,
G, You agree that Our obligation to You under this Cont act is strictly Itmited to the rrquirement.tn' pay You -what We owe
You under the terms of this Contract, atter receipt and approval of the Closing Documents,•final underwriting approval
and Court Approval. Under no circumstances will We be liable for any consequential damages.
H. You hereby appoint Us and any of Crur designees, with full power of substitution 'as your Attorney in Fact, to act in
Your name and place for the purpose of asslgring and transferring ownership Of any and all right, title and Interest.
that You have In the'Purchased,Payments and for Us to obtaiinall benefits contemplated by thls transaction. You also
• give Us full authority to actin any way proper and necessary. to exercise this Attorney In Fact appointment induding,
• "but not limited to: (1)•negotiaang, endorsing• and. executing checks; draft and other instmments In Your name; and
(2). Instituting, maintaining, compromising, settling and terminating any Iltigabon pr other proceedings -related to the
Purchased Payments. This power of attorney Is coupled with an Interest and shall survive death or disability.
CANCELLATION BY l)$
We may cancel. this Contract before e.Funding Da
A.. You breach any representation, 'warranty, or onbmise In any COntract Docurnentstir
B. The petition for the CourfOrdehs contested, opposed,.Or not wowed:
C., We are sued or threatened With a lawsuit pr an,arbitration about this Contract or AnnultyPolicy.
• D. There .is any trreatened, Pending, Or. final. action, or change laws or rule challenging -the legality of; or negatively
•
affecting this transaction.
E. You file -for, or are forced Into bankru
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Account ID: 940045
• F. You die. •
•
G. Rnal approval has not been given by Our underwriting department •
H. The Ourchase Contract is not signed by You and receiVed back by' Ut by DecernberO8, 2014.,
I. A major rating agency downgrades. the Issuer's credit . :
1 The Issuer is, or becomes. insolvent, orunder regulatory supervision.
K
. . . .• • .
• • ,
With respect to A through above, to the extent perfoitted by applicable Iaw, the arbitration provision In Section 10 of
this Contract shall survive the terMinatton, cancellation or rescission: of this ContraCt.,
•.:,
7. CANCELLATION BY Y9U
A. (1) YOU MAY CANCEL THIS CONTRACT WITHOUT PENALTY OR• FURTHER OBLIGATION AT ANY TIME •
WITHIN FIVE (5) BUSINESS DAYS AFTER THE DATE YOU RECEIVE PAYMENT HEREUNDER FROM US. IN
ORDER,FOR THE CANCELLATION TO BE EFFECTIVE, YOU MUST SEND A NOTICE POSTMARKED At ANY
TIME WITHIN FIVE BUSINESS DAYS AFTER YOU RECEIVE PAYMENT HEREUNDER FROM US (This Is the
rescission period).
, • • • .. • :•,.
(2) YOUR NOTICE IS TO BE SENT EITHER BY CERTIFIEO,ORitEGLSTERED MAIL(RETU RN RECEIPT
REQUESTED) OR FEDEX OR ANOTHER MAIOR OVERNIGHT DELIVERY SERVICE.. THE NOTICE MUST
.• INCLUDE A BANK OR CERTIFIED CHECK MADE PAYABLE TO US, IN THE FULLAMOUNT RECEIVED BY
YOU. YOUR NOTICE MUST BE SENT TO: • .
B.
•
GEORGIA RESIDENTS: YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO 5;00 P.M.
OF THETWENIT-FIRST DAY FOLLOWING RECEIPT OF THE ENCLOSED "NOTICE OF CANCELLATION
RIGHTS FORM, OR AT THE HEARING -ON THE APPLICATION FORAUTHORIZATION OF A TRANSFER OF
STRUCTURED SETTLEMENT PAYMENT RIGHTS, OR AT ANYTIME WITHIN FIVE (i) BUSINESS DAYS
AFTER YOU RECEIVE PAYMENT HERE UNDER FROM US, WHICHEVER EVENT OCCURS LAST (This is the
Georgia rescission period).. IN ORDER FOR THE CANCELLATION TO BE EFFECTIVE, YOU MUST SIGN THE
ENCLOSED "NOTICE OF CANCELLATION RIGHTS" FORI4 AND MAIL OR DELIVER ET TO us AS SPECIFIED
IN THAT NOTICE AND YOU MUST RETURN ALLAMOUNTS (PURCHASE PRICE OR OTHERWISE) RECEIVED
BY YOU ACCORDING TO THE REQUIREMENTS OF 7 (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 tn. IF YOU DISMISS
YOUR ACTION AFTER APPOINTMENT OF A GUARDIAN AD krrrm; OR RESCIND YOUR TRANSFER
AGREEMENT (PURCHASE CONTRACT) WITHIN THE RESCISSION PERIOD IN 7(A) (I) ABOVE, YOU.SHALi
BE RESPONSIBLE FOR THE FILING FEB AND ANY GUARDIAN AD LITEM FEES
D. With respect to A through C above, to the extant permitted by applicable Iaw, the arbitration provision
in Section 10 of this Contract shitil:survive the termination, Cancellation or rescission of this Contract.
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'AccountID 9400
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$OTICES
A. All notices about this Contract must be in writing, . : , . .. .
, •._ . • , ..
B. All notices must be sent either by:. (I) certified or registered mall (return receipt regUested); or (2) FedEx or anther
major overnight delivery service with a delivery tracking system and are Considered given when delivered as follows: '
If to You: to the 'most recent address for You listed In Our files..no Us: to the address listed InSection 7(A) (2) of
els Contract... . ' . ,. . .
. ,
'•
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9. VENTS OF DEFAULT
You Mil be in default if You:
A. fail btt comply with:any terrnsor conditions of this Contract; or . '.
B. breach any of Your representations,warrantieS andProinises In this Contract: .
If You are in defaiult, even if Vey have not rejected the arbltration:Prevition (see Section ta of this Contract), We have the right , •
to enforce Our rights agaInSt YouIn court to make You perform YOur'promiSeS Or t� get rncheY froth You. If We sire You In ..
court in connection with a Claim that Is subject to 'arbitration under the arbitration Provision In Section 10 of this ContraCt, and" .
You have not rejected the arbitrationproviston, You.wIll have the option of remaining in court or 'seeldifg to Compel arbitration
Of that Claim under the terms of the b
aritration provision. • .
. . . .
'
10. ARBITRATION PROVISION • ' •
To the extent permitted by applIcablelaw, You and We agree tothe.folipwing arbitration provision. • • • .
. .
. ,. • . ,
YOU HAVE THE RIGHT TO RESECT THIS ARBITRATION'pRovisioNA$ SEI FORTH BELOW. If You dOnet reject
this arbitration provision andi Claim is arbitrated, You will not have the right to:. (1) have a court or a jury .. '
decide the Claim; (2) engage in Information gathering (diicovery) to the same eitteritas In court (3) participate
• In a class actin!' In court or in arbitration; or (4) join or consolidate a Claim Vfith claims of any:other primson. The
tight to appeal is more limited In arbitratIonthan In court and other rights In court may be unavailable•or '
• IhnIted in arbitration. . ' . • • , . .
,
. .
. . • • ,
Claims Subject to Arbitration. A "Claim" subject to arbitration is any claim, dispute 'or oorltroversybetween.You and Us
(other than an Excluded Claim or ProCeedng as set forth below), whether preexisting, preient or b.rbire, which aristnout of, or .
relates to the Contract, the negotiation i related thereto, the breach thereof or any other tra'nSacboricOnducted with .us in
connection with the Contract. 'Claim' has the broadest possible meaning and indi.cles Initial dairris,•countertialnis, Crois-
daims, thirdrparty dairns and federal, state, local and administrative claims. It indudes disputes based Upon tontract, ioit,
consumer rights, fraud and other Intentional torts, censtitution, statute, regulation; ordinance,. ccnirnon fail and eOulty.and '•
includes daims for money damages and injunctive or dedaratbry relief: Upon the dernandof You or Us, Claim(s) yrill be '
resolved by individual. (not dass or class -wide) binding arbitration In accordance with the tennsitpecifted In this arbitration •
.
provision- . • . . •
. . . ..
•
•.
. .
. . • • • • •
• .. •
. ,. •*
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, cont.:Killing persors, 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 'Tour also refer to Tour current or former spouse(s),,children..heirS, edtate, executors,
successors, assigns, representatives:and beneficiaries. .. ,
.
. .
" , •
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. Excluded Claim or Proceeding, -NoWithstanding the .foregoing,'''Clalmw.does riot Maude any dispute or controversy about
- the validity, enforceability, coverage or scope of thls.arbitration provision or any part thereof (Induding, without limitation; the
. 'Clam Action Waiver" setfOrth below and/cr this Sentence); all such disputes or controversies are for a ceurt*W not an .
arbitrator to dedde. Howevet,. any dispute or Controversy that cotxeitis the validity Or enforceability Of the COntract as a whole .*
, • • .
•
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• •
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Account ID: 940045
Is for the arbitrator, not a cOurt, to decide; In addition, We will not require You to arbitrate:any indlytcluai action brought by
You In small claims court Or•Your state's equivalent Court, unless such action is transferred, reirroVed",..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 (Tide 9 of the United States Code) •
(TAN) shall govern its InterPretation and enfOrCeMentand.proceedings pursuant‘thereto. To the extent state law is applicable
under the FAA, the law of the state of Your domidle (where Yob regularly reside on the ContractDate) shall apply,
• . .
, .
Class Action Waiver. Notwithstanding any other Provision of thiStorltract, if a Cleihtla ;arbitrated, neither You
nor We will have, the right (a) teparticipate in a daps actiiin, private attorney general' action or other • •
representative action in court or in arbitration, either asa class representative or class member; or (b) to join or
consolidate Claims with .daims of any other Persons. 'No erbitratoesitall hays auttuntity to conduct any • .
arbitration innitOlation of thitiprovIsiOn (provided, however, that.the Pais Action Waiver does. not apply to any
lawsuit or administrative proceeding filed against us by a state or federal ,governmerit agency even when Such
agency is seeking relief on behalf of a class of.borroviers. (including You. This means that We vaill.not have the
right to compel arbitration of claiMbrought-by ,suthan agency). The Class Action Waiver Is nonseverable
from this arbitration provision. If the Class Action Waiver is limited, voided or found unenlbrceable, then .this ' •
arbitration provlslon (except fortinis sentence) shall be null' and void With respect•to 'such proceeding, subject to'
the right to appeal the drnitadon or invalidation of. the Class Action Waiver. • - • -.
. . .
. „ .
Arbitration Procedures.. If You or We seek' to arbitrate a Claim, the Party Seeking arbitration Mist notify the other Party in
writing. This notice can be ghren after the beginning of a lawSult and Can be given In papers file.d in the lawsuit, such as a
motion to compel arbiiradcin, Otherwise, your notice must be sent to US at the address spedled. in Section 7 (A) (2) of this'
Contract and Our notice mist 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 Partytiles a lavisult In court asserting 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 qf the Party
prosecuting the Claim(s) to select*an.a.rbiliation administrator In accordance with the parag0Ph.1;ielew and COMMence the
arbitration proceeding in accordance with the administrator's rules and procedures
The arbitration will be administered by the American Arbitration ('AW), 1633Broadway,i0thAoor, New York, NY
10019, www.adr.org, 1-800-776-7879 or JAMS, 1920 Main Street, 'Suite 300, IrVine, CA 92614, 'wwW,jarosadr.corri, 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 AAAand JAMS are unable or unwilling to serve 'as adniinistrater, the Parties 'may agree upon another .
administrator or, If they are unable to agree, a court'shall determine 'the administrator., No company may serve as
administrator, without the consent of al Parties, if it adopts Or has in place any formal or informal policy.that is InconSistent
with and purports to•overrlde the terms of this arbitration provision. In the.eventof a conflict between the Provisionts. of this
arbitration provision, on the one hand, and other provisions ofthis Contract or any.applicable ruleof the AAAor JAMS or other
administrator used, orr the•otherhand; the provisions of this -arbitration provision shall contrtili ,
A single arbitrator will be appointed by the administrator and must be a practidng attorney with ten or more years of •
experience or a retiredjudge. The arbitrator Will not be bound by.judidal rules of procedure and.evidence that would apply in
a court, or by state or local laws that relate to arbitration proceedingS. The arbitratOr will honor statutes of limitation and
claims of privilege recogni;ed under applicable law. In determining liability or awarding damages orbther relief, the arbitrator
Will follow this Contact and the applicable.substantive law, consistent with theFAP, arid thls,Contract, that would apply if the
matter had been brought in, court. AtYour written request,' we will pay alt filing, hearing and/or other fees charged by the
administrator,ind arbitrator to Yoti fir Claim(s) asserted by Yotiln arbitration alter You have paid an, amount eqUvalent to the
fee, if any, for filing such aaim(s) in state or federal court (whic.hever is less) in the.judiclei..district. in•whicti:You reside...(1f
You have already paid, a filing fee for asserting the.Clairri(s)M Court You will not be required to pay that amount again). In
addition, the adrriinlstrator may have.a procedure whereby You can seek a waiver of fees charged to by the administrator
and arbitrator. We will always pay any fees or exPenses.that We are required to pay bylaw or the administrator's rules or that
We are required to pay for this arbitration Provision to beenforced. The arbitrator will have the allthoritY. to award attorneys'
and expert witness fees and Costs to the'extent permitted by this Contract, theadministrator's rules or applicable law. 'The .
arbitrator will always award You reasonable attorneys' and -expert witness fees and cost d (a) If and tothe eortent You prevail on
Claims ygu 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 e*planation of the grpunds-ftrithe decision. A judgment
on the award may be entered by any court having jurisdiction. • , • • • . • •
Pge9
Ont2f12
kcount ID: 940045
Severability and Survival. If any part of this arbitration provision, other than the Class Action Waiver, is deemed or found W
be unenforceable for any reason, the remainder shall be enforceable.To the extent permitted by applicable law, this '
arbitration provision shall survive the termination, cancellation•or rescission of this Contract. •
, .
Effect of Arbitration Award. The arbitrator's award shall be final and binding on ell.Parties,.except. for any right of appeal
provided by the FM. lioweVer,:if the amount of the Claim exceeds $5q,000 or involves a requestfOr injunctive or declaratory •
relief that could foreseeably involve a cost or benefit to either Party eiiiitechlig *50,000, any partfoan, withth36 days after the
entry of the award by the arbitrator, appeal the award to three -arbitrator Panel administered by the administrator. The panel
shall reconsider anew any aspect of the Initial award requested by the appealing .Partylhe dedslon of the panel, Shallbe by'
. majority vote. Reference in this arbitration proViSion to"the arbltrator'-shall mein the panel ifan appeal of the arbitrator's - •
decision has been taken. The costs of such an appeal will. be brine in.accordance 'withthe above paragraph titled "Arbitration
. Procedures.' Any final dedsion of the appeal panel Is subject to judidal .review•only as provided under the FAA. .
. .
Right to Reject Arbitration Provision. You may reject.thls arbitration prevision by Sending Us written notice of Your
• decision so that Wereceive it at the address fisted below withir.fforty-flve..(45) days of the Contact Date. SUclinotice must be
sent by certified or registered mail (return receipt requested)or by FedfIt' or -another Majoi::Ovemight delivery *vice with a
• delivery tracking system; must include a statement that You virstrto reject.the 'arbitration prevision alOrig•WthYour name,
address, Account 1.0. number and Your signattire; and Must be.defivered to Us at the. address SPedfied in ectior(A)(2)Ql
)
. this Contract . This. Is the sole and.only method by which You can reject thls.arbitratlon provision. 'Upon receipt of a rejection
notice, We will reimburse You for the standard cost•of a certified or registered letter or overnight delivery. Rejection of this
arbitration provision will not affect any other berm of this contract. and. will not result In any adverse consequence to You. You
agree that Our business records will befinal and conclusive.with respect to whether You rejected this arbitration prevision in a
timely and proper fashion. This arbitration provision will apply to You and Us uniesi you reject it by providing
.
proper and timely notice as Stated herein. • . • . • , •• • .. • • , .
11. NISCILLANEOpa
A. You give.Us Permission to CenduOt.background checks On You, 'including obtaining inforrnation from theredlt
bureaus, in Order to verify Your legal residence, Contact information, and any otherinforrntion We deernnecessary
for thls transaCtion. We can also search records for UCc.filingS, bankruptcy filings, judgmentS,Iiens and child support
• obllgabons against You.
B. This Contract is the.entire agreement between You and Us..
C.. If there is more than one of Us or You, this:Contract applies to allof the people together ; and to each of them on
their own. • •
. D. Both Parties must agree in writing to any Change tothis Contact or waiver of its terms
E. Except as set forthin the arbitration provision in Section lb ef this•.Conb-a.ot, if a. court undoes anyp.a.* of this
. .. .
Contract, the rest of the C.ontract',rernaInS valid, ..: . • . ' .. , . : - . *...' ' ' . .. • • - - - , •
• • •
. •
. . . ..• . • .
F... You cannot voluntarily or Involuntarily sell,' assign, prtranske this Contract, orany of Your rights or duties under thls
Contract.. Any'such action taken by You in violation of thlssection shall be vold and of:no effect
. . . . . .
. • . . .
. .
G. Except as otherwise required by applicable,law, the law of the state of Your. domidle (where You regularly reside cn
the Contract Date) will govern this Contract and dliputes .under thistontract shall be detentined in Your domicile
• State (where You 'regularly reside on theContract Date); . . - ... • : • • : . .; '. -
.
. •
. . .
• . .
• .
. . .
. . . . .
. . .
. . .
H. This Contract also holds responsible Your. heirs, and executorS:This.COntract benefits only You and us and no One
' . • • • else. Howelier;if properly assigned by Us, this' Ceritract will bind and:benefit Our successors and -assigns.
Page 10
07/1202
accoura ID: 94004. S •
1. Failure to enforce any provision of this Contract isnot a. waiver of that provision. '
. .
J. The Parties may sign this Contract In oneOr more.counterpaft :Each counterpart will be considered an original. All
counterparts will form one Contract A faiSirnile,pdf or other eleCtronlc. copy of thegned Contract Cr any counterpart
will be considered an originai 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 nfmaon available to Us,
have Identified noviolation of any applicable state or.federal.laW. '
L. You will not receive an IRS form 1099 from Us: .. . . .
. • •
M. Tides. and headings in ths.Contract aieforconVenience Only. • Qo not use them .to *rpret this Contract. -,
. •
. . . . • : . .
. . . ,. .
. ..
N. Except as otherwise set forth In this ContraCt (Including the arbitration provision in Section it) of this Contract),.Yoir
. and We will pay our respective costs '.anclexperises in carrying out this Contract. . ., s. - . • • • • "
. 0. ' You give Us permission bri request from•our Affiliates information and documentation You have previously provided to
them which we deem necessary for this transacdon, iriciciting, bankruptcy filings, jUdgmentssetding documents,
annuity documents, lieris, child support obligationa, divorce dcxximents. ..:i .., '• ••• .• . '',, . . • • -
• .
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[REMAINOER OF. PAGE INTENTIONALLY LEFT BLANK]:
Page 11
07/12/12
::•
',account ID: 040045
• You and We, Intending to be legally bound, have signed this Contract as of the Contract Date below, and agree to ell
of its terms and conditions, including thearbitration provision. • • •
By signing below, You also adcnowledge that You viereaditised by Us in writing, that You should obtain
Independent legal advice andprofessional tax adViee about theriale of the PUrchased. payments and to have those .
advisors review with You, the terms and legal, tax andother efkcts of this Contract. .
• •
Sworn to and substtibed • , SELLER: •
before me this aVday of 00013 13 lit9er ,; ("Contract
• Date)* ' * • ' •
AUK • •
,.......____._a_COMMONWEALTWDF PE NNSTLVANIA.
• NOM- (HAPT---_77"--1. ,
• Melissa Lightner; Notary Public •
knowledged and Agreed: feet Pennsboth Township, Cyneritisn4 County
C"rnissiellbes. ' !W1 IET('S SPOUSE (if appilcabie) •
before me thia daY of
• is
Sworn to and subscribed
Notary
US:
orl Sorowsi:i, Vice President '
• • Page 12
07/12/12
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' . • 'Ac,conntlp: 910045
06t9ber-23, 2014
PENNSYLVANIA
DISCLOSURE STATEMENT
We will purchase the follOwing payments (Purchased Payments) from You:
A) .180 monthly payments of $39406 each, beginning on January 8,2016 and ending on
December 8,2030
•
. •'
The re ainder of the page intentionally left blank)
Account ID 930045
.October 23,2014
The aggregate amount of the. Purchased. Payments is $70,930.80.
The discounted present value of the aggregate Purchase Payments at the federal interest
rate of 2.20% is $58,997.39. The discountedpresent 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 $18,716.97.
The net amount payable to the seller (You) is $1.5,716.97.
Legal fees (this is an estimate of what Your attorney will charge You if
. You choose not to waive representation): $500.00.
No other expenses are incurred by You.
The net amount: that You will receive. from Us in exchange for' Your future structured
settlement payments represents 31.70% of the estimated current value of the payments
based upon the discounted value using the applicable federal rate..
Based on the net amount that You will receive in payment from Us and the amounts and
timing of the structured settlement payments that You are selling. to Us, this is the
equivalent of interest payments to Us at a rate of 21.00% 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.
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.
signing below, You are confirming receipt of this Disclosure Statement at least 10 days
prior to Yon first incurring an obligation with respect to the transfer.
CONNECTICUT
DISCLOSURE STATEMENT
Account ID: 940045
October 23, 2014
We will purchase the following payments (Purchased Payments) from You:
A) 180 monthly payments. of :$394,06 each, heginning on January 8,: 2016 and ending on
December 8, 2030
REMAINDER OP MC PAGE INTENTTONALLY.L?
AccountID: 940045
October 23, 2014
The aggregate amount of the Purchased Payments is $70,930.80.
The discounted present value of the aggregate Purchased Payments at the federal interest
rate of 2:20%. is $58,99739. 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 is $18,716:9.7..
No other expenses are incurred by you.
The net amount payable to. the seller. (You) is $18,716:97.
Based on the net amount that You wi11 receive in payment from Us and the amounts and
timing of the structured settlement paymentsthat You .are selling to Us, this is the
equivalent of interest.paymen.ts •to_ Us ata rate of 21.0.0%..per year.. PLEASE NOTE •
THAT THIS IS NOT A.LOAN, BUT.A SALE OF PAYMENT BIGtfJ'S ANIl-TAF.
INTEREST FIGURE IS ONLY PROVIDED AS AN. ILLUSTRATION OF TIIE.
ECONOMIC IMPACT OF THE SALE.
Notice of Cancellation Rights:
You.may cancel without'penalty or further obligation, not later than the fifth business. day
after Yourreceipt of, payment from Us under the transfer agreement (Purchase Contract).
• Please be advised there are no penalties or liquidated damages payable by You in the
event of any breach of the transfer agreement (Purchase Contract) by You.
By signing below, Youare confirming receipt of this Disclosure Statement at least 3 days
prior to You executing the transfer agreement (Purchase Contract).
•
Acccent ID: 940045
• October 23, 2014
MARYLAND
DISCLOgUR E STATEMENT
• We will purchase the following payments (Purchased PaymentS) from Yon:
A) 180 monthly payments af 8394.06 each, beginning on. January 8, 2016 and ending on December 8,
2030 •
(THE REMAINDER. 0*. THE PAGE.INTENTIONALLYLEIrT BIA
•
•
The aggregateamount of the Purchased Payments is $70,930.80.
The discounted present value of the aggregate Purchased Payments at the federal interest rate of 2.20%
is 558,997,39. The discounted present value is the calculation of the current value of the transferred
structured settlement payments under federal standards for valuing annuities.
The gross amount payable to seller (You) is 518,716.97.
No other expenses are incurred by You.
The net amount payable to the seller (You) is 518,716.97.
940045
. October 23, 2014
The net amount that You will receive from us in exchange for. Your future structured settlement'
payments (Purchased Payments) represents 31.70% ofthe estimated currentvalueof the payinenti
(Purchased Payments) based upon the discounted value using theapplicabie federal rate.
Based on the net amount that You will receive in payment from Us aad the amounts and.tinuing of the
structured settlement payments that You are selling to Us; this is, the equivalent of interest payments to
Us at a rate of 21.00%.per year. PLEASE NOTE THAT THIS ISNOT 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.
IMPORTANT NOTICE
You are strongly urged to consult with an attorney: Who can advise you of the potential tag
consequences of this transaction,
COMMA WEALTH 4F PENNSYLVANIA
• •Melissa phtneA .No'tal. ty Public •
Eeet Ponrisbom Tovtn,hlp, Cumbe lbad County
My.Conimisilon Expllei Daoembei lb; 2017
ATTACHMENT/EXHIBIT "5"
October 28, 2014
Fidelity and Guaranty Life Insurance Company
C/O Offit Kurman, P.A.
8 Park Center Court, Suite 200
Owings Mills, MD 21117
Attn: Legal Department/Structured Settlements
United States Fidelity And Guaranty Company
Corporation Service Company
2711 Centerville Road, Suite 400
Wilmington, DE 19808
Attn: Legal Department/Structured Settlements
Notice of Sale/Assignment of Payment Rights
Your Contract #:
Payee:) Schiner
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 be held until the courts have entered a final order
and we have forwarded this order to you.
Very truly yours,
By:
Lori Borowski, Vice President
S:: IiL-L r lO
Ur THE PRO t HONG (AR
8: 142
IN RE: JOINT PETITION O 01 O ��I
C.M.C.G.,LLC and J. SCHINCEERBERLAND C UNTY
PENNSYLVA 1
' ountp of Cumberti nb
IN THE COURT OF COMMON PLEAS
OF THE NINTH JUDICIAL DISTRICT
2014-6327 CIVIL ACTION
IN RE: PETITION FOR TRANSFER OF SETTLEMENT PAYMENTS
ORDER OF COURT
AND NOW, this 5th day of November 2014, upon consideration of the Petition for
Transfer of Settlement Payments, a HEARING on the petition will be held on 7 January
2015 at 11:30 a.m. in Courtroom Number Six of the Cumberland County Courthouse.
The payee shall bring income tax returns for the prior two years to the hearing
Within ten (10) days of this order, 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,
D *ibution:
./Paul S. Peters, Ill, Esq.
Offit Kurman, P.A.
United States Fidelity and Guaranty Company
C01.3 /rat
if 10M
Tho i'h s A. Placey C.P.J.
11
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
OF THE fiPRO i H0NO AR\r
3
2OifJOW-7 Pt 1:31
CUMBERLAND COUt�•�' �'
PENNS }'LVANIAA tbrney for C.M.C.G., LLC
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
IN RE: Joint Petition of C.M.C.G., LLC
and J. Schiner
CERTIFICATE OF SERVICE
NO: 2014- 6327 Civil
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.
A copy of the Notice is attached hereto.
Date: November 6, 2014
By:
2i S. Peters, III, Esquire
Attorney for C.M.C.G., LLC
MARQ & 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 C.M.C.G., LLC
and J. Schiner
NOTICE OF HEARING ON PETITION TO T
To: Fidelity and Gauranty Life Insurance Company
c/o Offit Kurman, P.A.
8 Park Center Court, suite 200
Owings Mill, MD 21117
Attn: Steven Kaufman, Esquire
United States Fidelity and Guaranty Company
Corporation Service Company
2711 Centerville Road, Suite 400
Wilmington, DE 19808
NO: 1 -- 2.7
NSFER PAYMENT RIGHTS
C.M.C.G., LLC
160 Greentree Drive, Suite 101
Dover, DE 19904
J. Schiner
You are hereby given notice that J. Schiner and C.M.C.G., LLC has filed a petition to
transferpayment rights. A hearing in this matter has been scheduled on
, , 201(at //.` 3d Q il . o'clock in courtroom no.,
OPP courthouse, Cumberland County Court of Common Pleas, Pennsylvania.
You are entitled to support, oppose or otherwise respond to the payee's petition, either in
person or by counsel, by filing written comments with the court prior to the hearing or by
attending the hearing.
The Name, Address and Tax Identification number of the transferee i;i M.C.G., LLC
160 Greentree Drive, Suite 101, Dover, DE 19904, Tax I.D. No. 20-47288
Date
19--)-9-1Y
BY:
Pau
Atto
111
No
s, III, Esquire
C.M.C.G., LLC
aim Street
istown, PA 19401
(610) 275-9600
(610) 275-9666(facsimile)
r
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
PENNSYLVANIA
Re: Joint Petition of C.M.C.G.,LLC
And J. Schiner Case No. 2014-6327
ORDER APPROVING TRANSFER OF STRUCTURED
SETTLEMENT PAYMENT RIGHTS
COME NOW, Petitioner C.M.C.G, LLC ("CMCG" or the "Transferee")
as assignee of Peachtree Settlement Funding,LLC ("Peachtree")pursuant to an
Assignment of Purchase Contract dated on or about October 28, 2014,by counsel,
and June Schiner("Ms. Schiner" or the"Payees"), upon the Joint Petition for
Transfer of Structured Settlement Payment Rights pursuant to the Pennsylvania
structured settlement protection act, 40 P.S. §§ 4001 et. seq. (the"Pennsylvania
Act").
Accordingly, upon hearing and upon a review of the papers filed in this matter
and the evidence presented, the Court finds that:
1. Ms. Schiner is entitled to receive payments from an annuity, contract
number I405388 (the "Annuity"), issued by Fidelity and Guaranty Life Insurance
Company("FGLIC" or the "Issuer"), and owned by United States Fidelity and Guaranty
Company("USF&G" or the "Owner"), which funds payments (the"Periodic Payments")
due under a Release and Agreement entered into on or about April 18, 1985(the
"Settlement Agreement"). The Periodic Payments include monthly payments of
$1,394.06 commencing January 8, 1995 through and including December 8, 2030 (the
"Monthly Payments").
2. Pursuant to a Purchase Contract dated on or about October 23, 2014 (the
"transfer agreement"), Ms. Schiner agreed to transfer to CMCG, as Peachtree's assignee,
her rights to receive a$394.06 portion of the Monthly Payments commencing January 8,
2016 through and including December 8, 2030 (the "Assigned Partial Payments").
3. Not less than ten days prior to the date on which Ms. Schiner first incurred
any obligation with respect to the transfer, Peachtree provided Ms. Schiner a separate
disclosure statement, in bold type no smaller than 14 points in size setting forth the
disclosures required pursuant to § 4003(a)(2)(i)-(vii) of the Pennsylvania Act and other
applicable structured settlement protection statutes.
4. The transfer is in the best interest of the Payee,taking into account the
welfare and support of the Payee's dependents, if any.
5. The Transferee had given written notice of its name, address, and taxpayer
identification number to the annuity issuer and the structured settlement obligor and has
filed a copy of the notice with the Court.
6. The Payee has expressly waived in a separate written acknowledgement
independent professional advice regarding the legal, tax, and financial implications of the
transfer;
7. The Transferee disclosed to the Payee the discounted present value.
8. The Payee resides in this State, making this Court an appropriate forum
for the filing and prosecution of this application.
2
9. The proposed transfer complies with all requirements of the Pennsylvania
Act,together with the applicable portions of the Connecticut structured settlement
protection act, Conn. Gen. Stat. Ann. §§ 52-225g et seq. (the "Connecticut Act") and the
Maryland structured settlement protection act, Md. Code Ann. § 5-1101, et seq. (the
"Maryland Act")to the extent they differ from the requirements of the Pennsylvania Act.
10. The proposed transfer will not contravene other applicable Federal or State
statutes or regulations or any applicable law limiting the transfer of workers'
compensation plans, or order of any court or other responsible administrative or
governmental authority.
Based on the foregoing findings, IT IS HEREBY ORDERED ADJUDGED
AND DECREED that:
A. The transfer of the Assigned Partial Payments be and hereby is
APPROVED, and, FGLIC is hereby authorized and directed to send the Monthly
Payments beginning January 8, 2016 through and including December 8, 2030 to CMCG
at the following address:
P.O. Box 83364
Woburn, MA 01813-3364
or to such other address as CMCG may designate, by written notice to USF&G and
FGLIC, signed and acknowledged by an authorized officer of CMCG and given at least
sixty(60) days before the date when such change is to take effect.
B. Because Ms. Schiner has transferred to CMCG her rights to receive less
than the full amount of the Monthly Payments commencing January 8, 2016 through and
including December 8, 2030, CMCG shall, within three(3) business days after receiving
3
each such payment from FGLIC, remit to Ms. Schiner the unassigned portion of the
corresponding Monthly Payment. If CMCG fails to make any such remittance to Ms.
Schiner within the time period specified in the immediately preceding sentence, CMCG
shall be obligated to pay Ms. Schiner interest on the amount of such remittance at an
annual rate equal to the sum of four percent(4%)plus the prime rate as published in the
"Money Rates" column of the Wall Street Journal on the first publication date following
the date of CMCG's receipt of the Monthly Payments commencing January 8, 2016
through and including December 8, 2030.
C. CMCG and Peachtree shall be jointly and severally liable to USF&G and
FGLIC for any and all liabilities and costs, including reasonable costs and attorney's fees,
arising from compliance with this Order or arising as a consequence of any failure of
CMCG or Peachtree to comply with the Pennsylvania Act, the Connecticut Act or the
Maryland Act, or to comply with this Order.
D. CMCG and Peachtree shall jointly and severally defend, indemnify, and
hold harmless USF&G and FGLIC, and their respective predecessors, representatives,
affiliates, successors and assigns, from and against any and all claims, liabilities, damages,
losses and expenses, including reasonable attorney's fees and disbursements, arising out
of, related to or in connection with the transfer agreement between Ms. Schiner and
Peachtree, including the redirection of any of the Assigned Partial Payments to CMCG.
Without limiting the generality of the foregoing, Peachtree and CMCG shall jointly and
severally defend, indemnify, and hold harmless USF&G, FGLIC and their respective
predecessors, representatives, affiliates, successors and assigns, from and against any
liabilities and costs, including reasonable attorney's fees and disbursements, arising from
4
(i) any failure or alleged failure of CMCG to make any timely remittance that is required
under Paragraph B above; or(ii) any claim to any of the Assigned Partial Payments
arising through Ms. Schiner, including any such claim made by any actual or purported
assignee or transferee other than CMCG. To the extent CMCG or Peachtree fail to honor
this indemnification and defense obligation, St. Paul, F&G Assignment, and FGLIC may,
in addition to all other remedies afforded by law, satisfy the same by withholding to their
own credit the Assigned Partial Payments.
E. USF&G and FGLIC are discharged and released, as to all parties
whatsoever except Peachtree and CMCG, from any and all liability with respect to the
Monthly Payments commencing January 8, 2016 through and including December 8,
2030.
F. This Order shall be binding upon Ms. Schiner, Peachtree, CMCG, USF&G,
FGLIC, and all other interested parties.
G. This Order is entered without prejudice to the rights of USF&G and
FGLIC under, and the Court makes no finding concerning the enforceability of, any non-
assignment provision contained in the Settlement Agreement,the Annuity or related
documents. Nothing contained in this Order shall be deemed to afford the Payee any
rights of ownership or control of the Annuity or shall otherwise affect the exclusive
ownership and control of such Annuity by F & G Assignment and FGLIC, and shall
under no circumstances be required to make any payment that they would not have been
obligated to make if the transfer had not occurred.
5
H. the payee shall receive from the transferee, within ten (10) days from the
date of this Order, the amount of$18,716.97, from which no funds are owed for counsel
fees, administrative fees, or other costs, fees or expenses.
I The Clerk of this Court is directed to transmit a certified copy of this
Order to counsel of record for the Transferee at the following address:
Paul S. Peters, III, Esq.
Maro & Maro
1115 West Main Street
Norristown, PA 19401
Such counsel shall send certified copies to all other interested parties.
ENTER this day of January, 2015:
Judge
SEEN AND AGREED TO BY:
Peachtree Se ent g, LLC
BY:
o ert Maro, Esquire is Counsel
j ate c
6