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HomeMy WebLinkAbout06-2081 IN THE MATTER OF JOSEPH CLARK : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PENNSYLVANIA : ~t.o - ;)...6 <6 ( . NO, CIVIL PETITION FOR APPROVAL OF LUMP SUM PAYMENT OF STRUCTURED SETTLEMENT PURSUANT TO THE STRUCTURED SETTLEMENT PROTECTION ACT AND NOW, this day of April, 2006, comes Joseph Clark, by and through his attorney Michael D. Rentschler, Esquire, who files the within Petition, as follows: 1, The Petitioner is Joseph Clark, an adult individual who is currently residing at 95 Wagner Street, Carlisle, Cumberland County, Pennsylvania 17013 (hereinafter referred to as "Petitioner/Payee"). Petitioner is married and has one child with his wife, 2. This Petition is being filed pursuant to the Structured Settlement Protection Act, 40 P.S. 4000, et sea, (The "Act"). The Act requires Court approval of transactions such as the one contemplated herein, 3. Following the wrongful death action relating to the death of his natural father asserted against the tortfeasor, the matter was settled by Petitioner's natural mother through her attorney. The settlement amount to Petitioner was placed in an annuity. The current owner of the annuity is Fireman's Fund Insurance Company, The issuer of the annuity is First Colony Life Insurance Company. 4. Petitioner/Payee now desires to sell the structured settlement annuity comprising an aggregate amount of $125,000.00, which represents 2 payments, as follows: one (1) payment of $50,000,00 on March 11,2011 and one (1) payment of $75,000.00 on March 11, 2016. The discounted present value of the aggregate payments at 5,60% is $81,854.68. 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 due to the Seller is $53,500.00, There is no compliance or administrative fee. Consequently, the net payment to the Seller is $53,500.00, Petitioner/Payee intends to use the proceeds of this transaction to pay credit card bills and to make improvements on their house. 5, Prior to the enactment of the Act, Court approval was not necessary in order to effect a transaction sale such as the one contemplated herein, 6. On April 12, 2006, Petitioner/Payee executed a Purchase Agreement with 321 Henderson Receivables Limited Partnership, whereby 321 Henderson Receivables Limited Partnership agrees to purchase those structured settlement payments and give Petitioner/Payee a lump sum payment. A true and correct copy of the Purchase Agreement is incorporated herein, made a part hereof, and attached as Exhibit "A", 7. Schedule 1, entitled "Disclosure Statement", advises Petitioner/Payee of certain disclosures and statements concerning the transaction. Said Disclosure Statement is incorporated herein, made a part hereof, and attached as Exhibit "B". 8, According to Exhibit "B", the Petitioner/Payee will be entitled to a lump sum payment of $53,500.00 which amount is the lump sum payment from 321 Henderson Receivables as described in Exhibit "B", 9. This transfer is in Petitioner/Payee's best interest and represents the settlement of his settlement as a beneficiary of the wrongful death claim concerning his father's death that originally arose out of a traffic accident. First Colony Life Insurance Company, the issuer owner of the annuity, and Fireman's Fund Insurance Company, the owner of the annuity, will receive a copy of this Petition, 10, First Colony Life Insurance Company and Fireman's Fund Insurance Company may file comments indicating its respective agreement or disagreement with this Petition by filing said comments in the Prothonotary's Office in the Cumberland County Courthouse, Carlisle, Pennsylvania 17013. WHEREFORE, it is respectfully requested that this Honorable Court grant the within Petition and, therefore, approve the lump sum payment from the Petitioner/Payee's structured settlement, pursuant to the Act, consistent with the statements contained herein. Respectfully submitted, ~~ ~' / ~---- MICHAEL 0, RENTSCHLER, ESQUIRE 28 North 32nd Street Camp Hill, PA 17011 (717) 975-9129 Attorney for Petitioner/Payee VERIFICATION I, Joseph Clark, do hereby swear and/or affirm that the information contained in the forgoing Petition is true and correct to the best of my information and belief. I understand that any false statements may be punishable pursuant to 18 PaCS Section 4904, relating to unsworn falsification to authorities. PURCHASE AGREEMENT This is a Purchase Agreement. The date of this Agreement is , 206__ Joseph Clark is the Seller. 321 Henderson Receivables Lim.ited Partnership, a Nevada Limited Partnership, its successors and/or assigns is the Buyer. In this Agreement, Joseph Clark is referred to as "You. or "Your" and 321 Henderson Receivables Limited Partnership or its nominee, is referred to as "We", ~sn or "Our". BACKGROUND OF THIS AGREEMENT 1, Your or someone on your behalf signed a Settlement Agreement (the ~Release" or the "Settlement Agreement"), in connection with the resolution of a personal injury claim, 2, The insurer funded the Payments by buying an annuity contract (Ihe "Annuity") issued by First Colony Life Insurance Company (the "Annuity Company"), 3, A list of the Payments being sold under this Agreement is attached to this Agreement as Exhibit "AIf, 4, You desire to sell and assign to Us all of Your rights to receive all or a portion of the Payments under the Release, as described on Exhibit "A", all of the other rights You have under the Release and the other rights as described in Section l(a) below, We desire to purchase all of Your rights and benefits, on the terms and under the conditions described in this Agreement. You and We agree as follows: I. Purchase and Sale. a, You now sell, transfer and assign to Us all of Your rights in the "Assigned Assets" as listed in Exhibit "A"_ By Our signing this Agreement, We are hereby purchasing and accepting the sale and assignment of all of the Assigned Assets described above, b, The Gross Purchase Price is Fifty-Two Thousand Eight Hundred Eighty-Five Dollars and 69/100 Cents ($52,885.69), The Net Purchase Price payable to You is $52,885,69 (the "Purchase Price"). The Net Purehase Price will be paid to You when both You and We sign this Agreement and We have completed Our internal process, 2, Acknowled1!ment. a, You will agree after Your signing of this Agreement to deliver to Us, addressed as We may require, other notices, instructions or documents, and copies of them, as We think are necessary or proper to carry out this Agreement. b, When You and We sign this Agreement, You will also deliver to Us: (1) a letter addressed to the Annuity Company direcling thaI all paymenls of Ihe Assigned Assets after Your death shall be sent directly to Us, and (2) a Change of Beneficiary Form changing Ihe beneficiary of Ihe Assigned Assets, after Your death, to "321 Henderson Receivables Limiled Partnership", as sole beneficiary [(1) and (2) above are referred to as the Change of Beneficiary Form], The Change of Beneficiary Form will slate Ihal the instructions may never be revoked and that no change may be made in the instructions or ,"".t- .. @.200S 321 Henderson Receivables Limited Partnership in the payments (including as to the payee or the manner or plaee of making such payments) without Our prior written consent You will also, wflen this Agreement is signed by You and Us, deliver to Us, addressed as We may rtlquire, such other notices, instructions or documents, and copies of them, as We think are necessary or proper to carry out this Agreement. c, Before You and We sign this Agreement, You will deliver to Us an acknowledgment of Estate of Joseph Clark, as primary beneficiary of the Assigned Assets, of the terms of this Agreement. Estate of Joseph Clark will agree that they are not entitled to any rights to any of the Assigned Assets. d, You agree to sign all other documents which We may request forever naming Us as the only beneficiary of the Assigned Assets, including but not limited to an agreement to provide in Your Last Will and Testament that all of Your rights to the Assigned Assets were sold to Us (a "Testamentary Agreement"), e, You acknowledge that We advised You to obtain independent professional tax advice to detennine whether this transaction will result in any adverse federal and/or state tax consequences. f You acknowledge that We advised You must obtain independent legal representation prior to executing this Agreement and that We have advised you that We may not refer You to any specific attorney for such purpose, 3, Your Renresentations and Warranties. You now represent and warrant to Us that: a, You own (and are selling and assigning to Us under this Agreement) all of the Assigned Assets, free and clear of all claims, liens, charges, security interests, encumbrances, and agreements of any nature (other than this Agreement), and when You and We sign this Agreement, no one other than Us shall have any present or future right to the Assigned Assets, b, This Agreement and all of the other documents signed in connection with this Agreement have been properly signed by You, and they represent Your legal, valid and binding obligation, enforceable against You in accordance with their terms. c, The signing and perfonnance of this Agreement by You and the transactions described in this Agreement: I. do not conflict with any other obligations of Yours; ii. will not cause a violation under (or create any right of termination, cancellation or acceleration or similar right under) any contract or agreement by which You or Your assets, including the Release, are bound or may be affected; Ill. will not create, or give any party (other than Us) the right to create, any lien, charge, security interest or encumbrance in, to or on any of the Assigned Assets; and iv. will not create a present or future right in any other party to make any claim against You or Your assets, or any of the Assigned Assets. '",. Cf- .. 2 @2005 321 Henderson Receivables Limited Partnership Initial: d. You understand the terms and provisions of this Agreement and You have been represented by tax and accounting advisors and a lawyer ill the signing of this Agreement. ' e, Neither You nor anyone else have to do anything else for (I) the proper signing and performanee by You of this Agreement and any transactions intended to be done in this Agreement, or (2) the carrying out by Us of any of Our rights and remedies under this Agreement. No other person has made a claim in any rights in or to the Assigned Assets, f. You have valid reasons for selling Your interest in the Assigned Assets rather than obtaining a loan with the Assigned Assets as collateral, and You agree that the transaction set forth in this Agreement is not a loan or other financing transaction. g, This Agreement is a valid sale, transfer and assignment to Us of the Assigned Assets, h, Your residence and legal address is as described in Paragraph II of this Agreement. During the last years, You have lived at such address. i. No representation or warranty of Yours in this Agreement or in any of the documents delivered in connecti@n with this Agreement or in any agreement required by this Agreement, is inaccurate or contains any untrue or misleading statement. j. The signing by You of this Agreement will not violate any other promise or agreement you have made with anyone else, You understand that any and all restrictions on the assignability of the Scheduled Payments were included in the Release and/or Annuity at Your request, for Your benefit and not for the benefit of any other person. These restrictions, if any, were included by You as a precautionary measure to make sure You were allowed favorable tax treatment under the Internal Revenue Code, You understand that by entering into this Agreement, you may be giving up this favorable tax treatment. You understand that any income earned by You on any investment or use of the Purchase Price may be taxable to You, You may have to pay more in taxes as a result of this Agreement. For Our benefit and the benefit of Our assigns or successors, You agree to WAIVE AND RELEASE all of Your rights in, to, or under, such restrictions on assignability, if any. k, You have not before the date of this Agreement, sold or assigned Your right to the Assigned Assets or any part of the Assigned Assets, You do not owe any money to Your present or former spouse for support maintenance or similar obligations, nor do You owe any money to any of Your children or guardians of Your children, The Assigned Assets are not subject to any community property or similar marital rights of any person, -- 3 @2005 32 I Henderson Receivables Limited Partnership L Your right to the Assigned Assets is not affected by ~ny mortgage, pledge, lien, charge, security interest, encumbrance, restriction or adverse claim of any nature, You understand that any violation of any of Your representlll:ions in this agreement will result in an act of fraud by You which could result in You being held responsible for damages in favor of Us, with money to be paid by You to Us, m, You are not in violation of any obligations concerning child-care, alimony or support, n, You now give up forever all Your rights in any agreement that says that You cannot assign or sell Your rights in the Assigned Assets to Us, You have not requested and You do not expect to receive from Us, a Form 1099 or any other documentation which could make the transaction described by this Agreement taxable to You in any way. You further understand that We have not given to You any advice about any of Your taxes in this transaction, You have relied on Your own professional advisors concerning taxes. 0, As of the date of this Agreement, You are of legal age in the state noted as Your address in Section 11 of this Agreement, mentally sane, and of a sound mind, You have never been convicted, of a felony or any other crime involving dishonesty, p, You are very familiar with Your tinancial affairs and condition. With that full understanding, You certify that (I) on the date We pay You the Purchase Price and You sell to Us the Assigned Assets, the fair value of Your assets are and will be greater than all of Your debts; (2) You presently intend to pay all of Your creditors when such payments are due; and (3) You have not intentionally hidden the fact from any creditor of Yours that You have entered into this Agreement and the other documents referred to in this Agreement. q, You do not intend to file for bankruptcy and there are no lawsuits or other efforts by any of Your creditors to put You into bankruptcy or to take the Assigned Assets, r. The Purchase Price is not Your only or most important source of income and You do not have any mental or physical problems that would prevent You from having a paying job, s, You promise to us that no broker, tinder, or other person other than those persons named in the broker statement signed by you in connection with this Agreement was involved in or important in arranging the purchase transaction in this Agreement. No other person has a right to any fee, payment, commission, or other compensation because of this Agreement. t. You agree that We have not forced You to give to Us copies of any confidential documents, You agree that We told You that We only needed to see those documents which described the Assigned Assets so we could buy from You the Assigned Assets, You agree that We do not intend to tell any other party about what is included in those documents, You understand that if We do so, it will only be for the sole purpose of buying the Assigned Assets, '"""~ - .. 4 @2005 32! Henderson Receivables Limited Partnership u. You understand that it usually takes six to eight weeks to complete this process, but that it could take longer. You understand that we have to obtain court . approval of this transfer, YOU UNDERSTAND THAT, DUE TO OCCASIONAL DELAYS, WE WILL ESCROW THE AMOUNT EQUAL TO THE NEXT TWO MONTHLY PAYMENTS DUE TO YOU FROM THE ANNUITY COMPANY TO INSURE THAT WE RECEIVE ALL OF THE PAYMENTS THAT WE PURCHASE. YOU UNDERSTAND THAT WE MAY EITHER PAY OR ESCROW FUNDS TO SATISFY ANY JUDGMENTS, TAX LIENS OR CHILD SUPPORT AGAINST YOU OR THE ASSIGNED ASSETS AND DEDUCT THOSE AMOUNTS FROM THE PURCHASE PRICE. YOU UNDERSTAND THAT WE WILL DEDUCT FROM THE PURCHASE PRICE ANY AMOUNTS OF PAYMENTS RECEIVED BY YOU PRIOR TO FUNDING, IF SUCH AMOUNTS ARE NOT COVERED BY THE ESCROWED FUNDS. 4, You promise Us that: a, You will not, and will not allow any other party (except Us or Our assignee, if applicable) to take funds away from the Assigned Assets, You will not do anything else to affect the Assigned Assets, You will not say You still own the Assigned Assets, You will not do anything or allow anyone else to do anything that could in any way interfere with or lessen Our rights in the Assigned Assets, b, You will not do anything that will, or could in the future, violate the Release, or any of the agreements required to be executed by this Agreement, You also agree to cooperate with Us to help Us to obtain all of the rights that Weare buying from You in this Agreement and in the Release, c, You will give to Us at least thirty (30) days written notice of Your intention to move Your residence or change Your legal address from the address in Paragraph II of this Agreement d, You will not make any change in Your instructions to the Annuity Company regarding payments to be made to You, f.. 5 @2005 321 Henderson Receivables Limited Partnership e, You understand that the Annuity and the Release may say that You agree not to sell Your rights to the Assigned Assets, f. You agree to continue to cooperate with Us, This includes Your obligation to immediately deliver to Us any checks, funds or other fonn of Payment received after the date of this Agreement by You or anyone other than Us, If any Payment is ever denied, delayed, or withheld frnm Us, as detennined by Us in our reasonable discretion, directly or indirectly on account of any act or omission by You or any person acting for Y 011, then You shall be in default under this Agreement (and an Event of Default under ~8 shall be deemed to have occurred), Immediately upon such default, and without any further notice to You, You will pay to Us the following amounts: (i) the full, dollar value of all remaining Assigned Assets as they become due after the date of the default; All of the remedies specified under this section shall be cumulative with all of the remedies for default pursuant to 58, g, If You learn before or after the signing of this Agreement of the threat or actual beginning of any lawsuit or proceeding that bas anything to do with Our rights under this Agreement or the Assigned Assets, then You will immediately notify Us of that and You will give Us copies of all notices and other writings relating to it promptly after You receive them, h, If You receive any notice relating to any supposedly unpaid claim affeeting the Annuity or the Assigned Assets or to any other claim against the Annuity or the Assigned Assets, then You will promptly notify Us and will promptly give Us copies of all notices and other writings relating to it received by You promptly after You reeeive them, 5, RIGHT TO CANCELLATION. YOU MAY CANCEL THIS CONTRACT WITHOUT PENALTY OR FURTHER OBLIGATION WITHIN TWENTY-ONE DAYS FROM THE DATE YOU RECEIVE PAYMENT FROM 321 HENDERSON. In order for the cancellation to be effective, You musl mail a notice of eancellation by registered or certified U,S, mail, postmarked within twenty-one (21) days of receipt of the Purchase Price to Us, clo Yice President of Operations at 2215-B, Suite 5, Renaissance Drive, Las Vegas, NV 89119, Furthennore, in order for Your notice of cancellation to be effeclive, Your registered or certified U,S, mail package to us must include a bank or certified check for the full Purchase Price that We paid You under this Purchase Agreement. Any failure to comply with the above procedure shall be a waiver of Your right to cancel this transaction, 6, Your Further Promises. You agree that, from time to time, at Your expense, You will promptly sign and give to Us any and all documents to help Us realize our rights and benefits under this Agreement. This promise includes signing, filing or allowing Us to file financing or continuation statements, or amendments or assignments of those documents, You penn it Us or others acting for Us to sign our name and/or your name and file without Your signature such financing statements, if that is pennitted in Your state of residence, When You sign this Agreement, You will also sign and deliver to Us a "Special Irrevocable Power of Attorney" You must retain the services of an attorney and deliver an opinion of Your attorney about the sale of Assigned Assets to Us, in a fonn acceptable to Us, '"'''~- .. 6 @2005321 Henderson Recei"abJes Limited Partnership 7. Continuation or Representations, Warranties and Covenants, All or Your representations, warranties and promises made in this Agreement will conlinue 10 be relied on by Us after this Agreement is signed, 8, Event or Default. Your failure to eomply with any term or this Agreement or Your breach of any of Your representations in this Agreement will mean that YOll will be in default We refer to this as an "Event of Default." Ifthere is an Event of Default, We have the right to sue You in court to make You perform Your promises or to get money from You, Your failure to comply with any material terms of this Agreement will be a default. In Paragraph 4 (c ) You agree to give US at least thirty (30) days written notice after Your move to a new residence or change of Your legal address from the address in Paragraph 11 ofthis Agreement If we are purchasing from You certain lump sum payments, We will contact you at least 3 months before the scheduled payment is due to determine if the address change We have effected with the annuity company is in place and to determine if Your legal address has remained the same, If We cannot contact you because You have changed Your legal address or moved Your residence and failed to notify Us, We will consider such failure to notify Us to be an EVENT OF DEFAULT and We will exercise all of our legal rights under this Agreement, OUR RIGHT TO PROCEED AGAINST YOU UNDER THIS AGREEMENT SHALL BE SOLEL Y LIMITED TO WHEN YOU HAVE COMMITTED AN EVENT OF DEFAULT. WE SHALL NOT HAVE THE RIGHT TO SUiE YOU IFOR BECAUSE THE ANNUITY COMPANY IS NOT ABLE TO MAKE PAYMENTS 8lEcAUSE IT IS NOT FINANCIALLY ABLE TO DO SO. 9. Controlling Law, This Agreement shall be governed. construed and enforced in accordance with the internal laws of the State of Pennsylvania without regard for the conllicts of law rules thereof or elsewhere, (For Court Orders or Notice Transfers obtained in the following jurisdictions: AK, AR, AZ, CA, CO, CT, DE, FL, GA, lA, !D, IL, IN, KS, KY, LA, MA, MD. ME, MI, MN, MO, MS, MT, ~~~~~OO~~~~~m~~~~~~~~~~ jurisdictions shall be applied in Ihe event of a dispute regarding the transfer,) Your domicile is the proper place of venue to bring any action arising out of a breach of this Agreement 10, Responsibility for this Agreement This Agreement will hold responsible Your heirs, executors, successors and assigns and will benefit Our representatives, successors, beneficiaries and pcrmitted assigns, Nothing in this Agreement is intended to give anyone otlter than You or Us or each of OUf successors or assigns any benefits. 1 L Notices, All notices and other communications under this Agreement will be in writing and will be made by delivery by means by which the sender obtains a receipt of delivery from the carrier (including without limitation, certified mail return receipt requested or overnight courier services), addressed to the party to whom a request or demand is to be made, Such demand or notice or request shall be deemed given on the date which is one business day after the date sent by overnight mail or three days after the date sent by certified mail. The addresses of the parties are as follows: If to You: Joseph Clark 95 Wagner Street Carlise, PA 17013 ,"M gC _ .. 7 @200S 32l Henderson Receivables Limited Partnership If to Us; 321 Henderson Receivables Limited Partnership 22I5-B Renaissance Drive SuiteS Las Vegas, NV 89119 Attention: Vice President - Operations 12, Past Actions. Anything either You or We did or said before this Agreement was signed will not affect Your or Our rights under this Agreement in any way_ 13, Exeenses, Except as otherwise affirmatively set forth in this Agreement, You and We agree that we will each pay our respective costs and expenses in connection with the carrying out of this Agreement. 14, Headin2s, The section and subsection headings contained in this Agreement are for reference purposes only and will not affect in any way the meaning or interpretation of this Agreement \5. Counterearts. One or more originals of this Agreement may be signed with Your or Our signature, When put together they will make one agreement and the Agreement will be considered signed by all parties that need to sign, A facsimile signature will be considered an original. 16. Assi2ument. We and ar.yor,e to whom We assign this Agreement may assign Our right, title and interest in and 10 this Agreement, the Annuity and 1he Assigned Assets without Your approval. You and We agree that if there is an assignment by Us to someone else, We shall not be responsible to You, You must look only to the person or company that We assign this Agreement to for any payment (for example, of the Purchase Price) and performance of this Agreemenl, When asked by Us or any assignee, You will sign and deliver any such documents as We may require to perform this transaction, as assigned, '"""rt-- .. 8 @200S 321 Henderson Receivables Limited Partnership 17 , Your soouse. You and Your spouse are fully aware of Your rights in the Assigned Assets, You and Your spouse fully give up those rights. You and Your spouse understand that by selling the Assigned Assets to Us, You and Your spouse are not receiving the same amount of money as You would if You waited for all of the scheduled Payments of the Assigned Assets but, rather, are receiving a discounted value in return for receipt of the Purchase Price immediately, You and Your spouse have valid reasons for selling the Assigned Assets, You and Your spouse fully understand the terms of the Purchase Agreement and understand that the sale of the Assigned Assets is finaL You also understand that Your spouse gives up any property right he or she may have in the Assigned Assets that Your spouse could claim because of Your marriage, 18, Entire Aereement. This Agreement and the Exhibits and other doeuments You signed make up the entire understanding and agreement between You and Us about this Agreement. This Agreement replaces all prior agreements, whether written or oral, about this Agreement. This Agreement may not be changed unless in a writing signed by You and Us. 19, Limitation of Liability of Buyer. You understand that Our liability to You under this Agreement is strictly limited to the requirement to pay the Purchase Price and under no circumstances will We be responsible for consequential damages. 20, Court AooroyaL You understand that court approval is required for this transfer. You agree to cooperate with us to obtain such court approvaL , 2L Exhibits, Attached to this Purchase Agreement are the following Exhibits: Exhibit nA" List of What Payments We are Buying, Intending to be legally bound, You and We have signed this Agreement as of the date at the top of the first page of this Agreement. 321 HENDERSON RECElV ABLES LIMITED PARTNERSHIP <3IGN HERE I Spouse Sworn to and subscribed t!;. , before me this a day of lit. ( ,20ot c<h rlt--#'_q & i;?iV Notary NOtARIAl. SEAl. ANNETTE PERKINS Notary Public CAAf> HllllOROUGH, CUM!EIllANOCOUNIY My ComrnIsaIon exp<<.. JuI 22. 2009 9 @2005 32l Henderson Receivables Limited Partnership SCHEDULE 1 DISCLOSURE STATEMENT PLEASE BE ADVISED THAT THE PROPOSED TRANSACTION IS A SALE, NOT A LOAN, AND THAT YOU WILL BE SELLING ALL RIGHTS AND TITLE TO THE ASSIGNED ASSETS ONCE THIS TRANSACTION IS CONSUMMATED. PLEASE BE ADVISED THAT YOU MAY BE SUBJECT TO ADVERSE FEDERAL AND STATE INCOME TAX CONSEQUENCES AS A RESULT OF THE PROPOSED TRANSACTION. YOU SHOULD CONSULT YOUR OWN COUNSEL, ACCOUNTANT, OR FINANCIAL ADVISOR REGARDING ANY FEDERAL OR STATE INCOME TAX CONSEQUENCES ARISING FROM THE PROPOSED TRANSFER. YOUR PURCHASE PRICE WAS DERIVED ASSUMING A DISCOUNT RATE SIGNIFICANTLY HIGHER THAN THE PRIME INTEREST RATES CHARGED BY COMMERCIAL BANKS, THEREFORE, WE URGE YOU TO EXPLORE ALL FINANCIAL OPTIONS. WE WILL PURCHASE FROM YOU A) 1 payment of $50,000.00 on 3/11/2011 B) 1 payment of $75,000.00 on 3/11/2016 THE AGGREGATE AMOUNT OF THE PURCHASED PAYMENTS IS $125,000.00. THE DISCOUNTED PRESENT VALUE OF THE AGGREGATE PAYMENTS AT 5.60% IS $81,842.45. 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 IS $52,885.69. THE FOLLOWING EXPENSES ARE INCURRED BY THE SELLER (YOU) AND WILL BE DEDUCTED FROM THE PURCHASE PRICE: COMPLIANCE AND ADMINISTRATIVE FEE: $0.00 FILING AND RELATED EXPENSES FEE: $0.00 THE NET AMOUNT PAYABLE TO THE SELLER(YOU) IS $52,885.69. NO OTHER EXPENSES ARE INCURRED BY YOU. SCHEDULE 1. PAGE 2 THE DISCOUNTED PRESENT VALUE OF PAYMENTS SHALL BE . CALCULATED AS FOLLOWS: THE APPLICABLE FEDERAL RATE USED IN CALCULATING THE DISCOUNTED PRESENT VALUE IS 5.60%. THE EFFECTIVE ANNUAL DISCOUNT RATE FOR THIS TRANSACTION IS 12.00%. THE CASH PAYMENT YOU RECEIVE IN THIS TRANSACTION FROM US WAS DETERMINED BY APPLYING THE SPECIFIED EFFECTIVE ANNUAL DISCOUNT RATE, COMPOUNDED MONTHLY, TO THE TOTAL AMOUNT OF FUTURE PAYMENTS TO BE RECEIVED BY US, LESS THE TOTAL AMOUNT OF COMMISSIONS, FEES, COSTS, EXPENSES AND CHARGES PAYABLE BY YOU. THENETAMOUNT THAT YOU WILL RECEIVE FROM US IN EXCHANGE FOR YOUR FUTURE STRUCTURED SETTLEMENT PAYMENTS REPRESENTS 64.60% OF THE ESTIMATED CURRENT VALUE OF THE PAYMENTS BASED UPON THE DISCOUNTED VALUE USING THE APPLICABLE FEDERAL RATE. THE QUOTIENT OBTAINED BY DIVIDING THE NET PAYMENT BY THE DISCOUNTED PRESENT VALUE IS 64.60%. BASED ON THE NET AMOUNT THAT YOU WILL RECEIVE FROM US AND THE AMOUNTS AND TIMING OF THE STRUCTURED- SETTLEMENT PAYMENTS THAT YOU ARE TURNING OVER TO US, YOU WILL, IN EFFECT, BE PAYING INTEREST TO US AT A RATE OF 12.00% PER YEAR. THE NET AMOUNT PAID TO YOU (THE PAYEE) BY US (THE TRANSFEREE) REPRESENTS AN ESTIMATE OF THE FAIR MARKET VALUE OF THE FUTURE PERIODIC PAYMENTS TRANSFERRED UNDER THE STRUCTURED SETTLEMENT AGREEMENT. SCHEDULE 1. PAGE 3 NOTICE OF CANCELLATION RIGHTS: . YOU MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO 5:00 P.M. OF THE TWENTY-FIRST DAY FOLLOWING THE LATER OF THE EXECUTION OF THE PURCHASE AGREEMENT, OR THE DATE THE PAYEE BECOMES OBLIGATED UNDER THE PURCHASE AGREEMENT WITHOUT PENALTY OR FURTHER OBLIGATION. THIS CANCELLATION RIGHT CANNOT BE WAIVED IN ANY MANNER. TO CANCEL, YOU MUST PROVIDE WRITTEN NOTICE TO THE TRANSFEREE. WRITTEN NOTICE SHOULD BE MAILED OR DELIVERED TO THE ADDRESS BELOW BY 5:00 P.M. OF (THE TWENTY-FIRST DAY FOLLOWING THE TRANSACTION). IT IS BEST TO MAIL IT BY CERTIFIED MAIL" RETURN RECEIPT REQUESTED, AND TO KEEP A PHOTOCOPY OF THE SIGNED FORM AND YOUR POST OFFICE RECEIPT. ADDRESS TO WHICH CANCELLATION IS TO BE RETURNED: 321 HENDERSON RECEIVABLES LIMITED PARTNERSHIP 2215-B RENAISSANCE DRIVE SUITE 5 LAS VEGAS, NY 89119 ATTENTION: VICE PRESIDENT - OPERATIONS IMPORT ANT NOTICE: YOU ARE STRONGLY URGED TO CONSULT WITH AN ATTORNEY WHO CAN ADVISE YOU OF THE POTENTIAL TAX CONSEQUENCES OF THIS TRANSACTION. SCHEDULE 1. PAGE 4 . 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. THERE ARE NO BROKERS COMMISSIONS, SERVICE CHARGES, APPLICATION FEES, PROCESSING FEES. CLOSING COSTS, FILING FEES, ADMINISTRATIVE FEES, LEGAL FEES, NOTARY FEES AND OTHER COMMISSIONS, FEES, COSTS, EXPENSES AND CHARGES PAYABLE BY YOU OR DEDUCTED FROM GROSS AMOUNT OTHERWISE PAYABLE TO YOU OTHER THAN THE COMPLIANCE AND ADMINISTRATIVE FEE AND THE FILING AND RELATED EXPENSES FEE. IF YOU BELIEVE YOU WERE TREATED UNFAIRLY OR WERE MISLED AS TO THE NATURE OF THE OBLIGATIONS YOU ASSUMED UPON ENTERING INTO THIS AGREEMENT, YOU SHOULD REPORT THOSE CIRCUMSTANCES TO YOUR LOCAL DISTRICT ATTORNEY OR THE OFFICE OF THE ATTORNEY GENERAL. THE EFFECTIVE DATE OF THE TRANSFER AGREEMENT SHALL BE DEEMED TO BE THE DATE THAT THE AGREEMENT WAS SIGNED BY THE YOU (PAYEE). PLEASE BE ADVISED THAT PAYMENT TO YOU PURSUANT TO THE TRANSFER AGREEMENT IS CONTINGENT UPON COURT APPROVAL OF THE TRANSFER AGREEMENT. PLEASE BE ADVISED THAT PAYMENT TO YOU WILL BE DELAYED UP TO 30 DAYS OR MORE IN ORDER FOR THE COURT TO REVIEW AND APPROVE THE TRANSFER AGREEMENT. BY SIGNING BELOW YOU ARE CONFIRMING RECEIPT OF THIS DISCLOSURE AT LEAST 10 DAYS PRIOR TO RECEIPT OF THIS CONTRACT. <:3IGN HERE I Exhibit A Weare hereby purchasing from You under the Annuity: A) I payment of $50,000,00 on 3/11/2011 B) 1 payment of $75,000,00 on 3/1112016 <3IGN HERE I STATE OF fA- : cOUNTYOF CurYIbf,Ic.."[1. : On this ~ day of Ii /),,: I , 200~ before me, the above signed personally appeared before me, personally known to me to be the person w~ subscribed to the within instrument and acknowledged to me that he executed it. f/V1 n,dL ;1'/) /2t/~'-<J , Notary NOTAK~ SE:Al ANNETTE PERKINS Notor\;' Public CNIIP HIU BOROUGH. CUMBERlAND COUNTY My Com_ Ellpl'" Jul22, 2009 CERTIFICATE OF SERVICE I, Michael D. Rentschler, Esquire, do hereby certiry that, on the date stated below, I served a copy of the foregoing Petition and the attachments as required thereto upon the following by Certified Mail, return receipt requested and addressed to: First Colony Life Insurance Company 700 Main Street Lynchburg, VA 24505-1280 Attn: Structured Settlement Department Fireman's Fund Insurance Company 777 San Marin Drive Novato, CA 94998 Attn: Structured Settlement Department Date: -~~~~ Michael D. Rentschler, Esquire 28 N, 32nd Street Camp Hill, PA 170Il (717) 975-9129 PA Supreme Court ID # 45836 ~g-.. ~ ~ ~ 'It r; ~. ..t::. ~ --J 'W ~ f--), ~_::~ ---1 c_J :~2: ('", ,t cl IN THE MATTER OF JOSEPH CLARK : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : NO. 06-2081 CIVIL CERTIFICATION OF SERVICE I, MICHAEL D. RENTSCHLER, ESQUIRE, do hereby certify that I served a true and correct copy of the Petition for Approval of Lump Sum Payment of Structured Settlement Pursuant to the Structured Settlement Protection Act, and the necessary notices and information in accordance with the Act by USPS Express mail upon: Fireman's Fund Insurance Company 777 San Martin Drive Novato, CA 94998 ATTN: Structured Settlement Dept And First Colony Life Insurance Company 700 Main Street Lynchburg, VA 24505-1280 ATTN: Structured Settlement Department As evidenced by the attached USPS delivery confirmations Date: May 9,2006 ~~~ MICHAEL D. RENTSCHLER, ESQUIRE 28 N. 32"d Street Camp Hill, PA 17011 (717) 975-9129 Supreme Court ID# 45836 ,. "I ~III~I~' 111~11I1~ I~IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII I.. .. E,Q 1.5114Inb~? us I PO f'~7D'1 ( D., of D.",.., I Dete Accepted I Mo'1 "",I ") ,it I Time Accepted D DAM Noon )Ir-\('" ~ Militaf'l t ! l./ "","PM I F'!lIRIlWO or Weight JIbS. Lf OZS. Postage D_o.,y D3rdDaY $ \rrt'1 Alpha Country Code Acceptance Emp. Initials t' I" I FRO . (PLEASE PAINT) PHONE I I __~---.,__ ~;~LA?~. '-'41",.:.". VIO ~~'?-e ~e:;rtil~ ;;;fi- p. E9..-e :>cf '~"', ~ ;.) ~ A? / >.tJ// <;')_/ FOR PICKUP OR TRACKING v'" WWW..Usps.com _ __ ,-'5E.3.:$=-- -- C;111 1-800~222~1811 -~:;51~i3-- I I JlI[~~H~~I~JII.I~1 . . PO Z'(P. 918,\ l (' ':;. of Delivery Postage f U I ~ext cr;nd D2rdOel.Oay $ . Scheduled Date of Oeliv~ A turn R celpt F e0 Oot."",.ptb I... \ ' W i I" Month DaY/) $ Mo. t odv yJ.,/..... Scheduled e of Delivery CO lnsu ce Fee lime Accepted D - ./ $ lOAM Noon [}("PM \ 0 G ~M Military Total P tege Fees FJatRateDorWeight 02ndDay D3rdDay $ ou, FROM: ( E PRINT} PHONE ( l ~;l';.../"&?,4?~~ ,/' , K~~dP/(i'~ ';;>8',AJ.3B-..J2 $tf" I i~( c:;. C-r>~~ /?d// \\~Oj~~ ~EXPRESS - - '..,. MIJIL -- .------ Customer Copy Label 11-8, Marc:h2004 UNITED STOTES POST4LSERV,CE. Post Office To Addressee . . .. . DellveryAtternpt Tim. DAM Mo, D. DpM DelNeryAtt<mlpt Time DAM Mo, D. DpM DetllYeryDate Time DAM EmploYll8Signature Emp!oyeeSignature EmpfoyeeSignatul'El Mo. DB . PAYMENT illY ACCOUNT Express Mall Corporate Acct. No. federal Agency Acct. No. or Pom\ ServiCll Ac(:\. No. -'I \~""",,-~$ ~ ;Z:;$' /' 7(} 7?';/ .s;;J /-'?-<A!'rA-tJ;::.t::k~ C) <.J..".;'.. I .cA 4?nJ f 5'7~CJ~ ~-r ~'~r~~t~r:E]"D D c.......=:----- .~ j ---- -- ---- .---- ~ EXPRESS MIJ.IL -- Customer Copy' Label 11.S, March2004 UNITEDST.4TES POSTJJL SERVICEiKl Post OfficeToAddressee . OellveryAttempt TI~ Mo, D. Delivery Attempt Time Mo, Da DeltnryDatto TI~ EmployeeSIgn8l:unt Employee Signature Employee Signature Mo, "" . PAYMENT 8Y ACCOUNT Express Mall Corporate Accl No. Federal AgancyAoct. No. or postal Service Acct. No. ~.J<r':::;~cJ L-.5i::.:z;;" ""-VC7?7J ,'f'<f) ,/r-k/"v .sV~r , "'':6",,'C:) t/~ 1/lzAl: ~R<,<~~st:PKA"..r~ FOR PICKUP OR TRACKING - V", WWW.Usps.com __ _ Cd" 1,800,222,1811 --::;;gmff? --- ZIP: . 4jU.S. ADDRIESSES ONLY. DO NOT US! fOR FOREIGN POSTAL COOP.} [t] ~ [g 0 + [2] ~ [l] [QJ C""""OEmHA"_WR"""""""""_."ow, ~. .~.., ,j ._ __J USPS - Track & Confirm .... Page 1 of 1 . r------ .________ -a~.IG I HQ"ltili~ - Track &. Confirm CJ Search Results LabellReceipt Number; EQ15 8481 697U S Status: Delivered o Trac. .. Confirm o Enter LabellReceipt Number. 01 Your item was delivered at 11:38 am on April 14, 2006 in NOVATO. CA ~947. The item was signed for by S MELSBERRY, o ( I~ r ANIl...,,,..,,.> n--ItUll'&-"'>) n ~ OptiOlll Track & Confinn by email Get current event infonnation or updates for your item sent to you or others by email. (.. > ) Proof of Delivery Verify who signed for your item by email, fax, or mail. (s.>) c::::J . POSTAL INSPECTORS Preserving the Trust site map contact us government services jobs National & Premier Accounts Copyrlght@1999-2004 USPS. All Rights Reserved. Terms of Use Privacy Policy http://trkcnfcm1.smi.usps.com/PTSIntemetWeb/InterLabelInquiry.do 4/17/2006 USPS - Track & Confirm . Page 10f1 DJIIIiP1lIWE. 1I011!O I fI$jp TrIck,. Confirm Search Results LabellReceipl Number: EQ15 8481 706U S Status: Delivered Your ~am was delivered at 7:45 am on April 15, 2006 in LYNCHBURG, VA 24506 to FIRST COLONY LIFE, The nem was signed for by A HALL. Trac.' Confirm '\ < 111:1 Enter LabeVRec:eipt Number, I ( ( A.......,s.aIIII> ) ("... It ~".., > ) NoIificatioII Ol"ions Track & Confinn by email Get current event information or updates for your item sent to you or others by amail. (.. > ) Proof of Delivery Verify who signed for your nem by arnail, fax, or mail. (.. > ) . POSTAL INSPECTORS Preserving the Trust site map contact us government services jobs National & Premier Accounts Copyrighl@1999.2004USPS,AIIRlghtsRes.rved. Terms 01 Use Privacy Policy http://trkcnfrm1.smi.usps.com/PTSIntemetWeb/InterLabelInquiry .do 4/17/2006 (') ...., = 0 (- = -., < 0" -olV :::It ~fQ l1) cq > ~__ '0"" -< ~~E, I :B~ \D 0, ~~ ~~-~ -0 ~:t' ~~i :::It %.~ r:-i' z =-t ::;1 (.0.) ~ c:..:> IN THE MATTER OF JOSEPH CLARK : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PENNSYLVANIA : NO. 06-2081 CIVIL ORDER OF COURT '\~ AND NOW, to-wit this , day of M "'f , 2006, upon consideration of the Petition for Transfer of Structured Settlement Payments by Joseph Clark to 321 Henderson Receivables Limited Partnership and its nominees, successors and assigns pursuantto 40 P.S. 4001 et sea., and any response thereto, the Court hereby makes the following findings: 1. The transfer satisfies all statutory requirements of the Structured Settlement Protection Act. 40 P.S. 4001 et ~., and will not contravene any other applicable Federal or State statutes or regulations or order of any court or responsible administrative authority; AND; 2. Not less than ten days prior to the date on which the payee first incurred any obligation with respect to the transfer, the Transferee has provided to the Payee a disclosure statement as required by 40 P.S. 4003(a)(2); AND 3. The transfer is in the best interests of the Payee. taking into account the welfare and support of the Payee's dependents; AND 4. The Payee has received independent legal advice regarding the implications of the transfer, including considering the tax ramifications of the transfer, AND 5. Timely written notice of the Transferee's name, address and taxpayer identification number has been provided to the Annuity Issuer and Structured Settlement Obligor as required by 40 P.S. 4003(a)(6), neither of whom have objected to the transfer. 6. The Transferee shall be liable to the Structured Settlement Obligor and to the Annuity Issuer: a. If the transfer contravenes the terms of the structured settlement, for any taxes incurred by the Structured Settlement Obligor or the Annuity Issuer as a consequence of the transfer, and b. For any liabilities or costs, including reasonable costs and attorney's fees, arising from compliance by such parties with this order of the Court or arising as a consequence of the Transferee's failure to comply with the Act. The Structured Settlement Obligor and Annuity Issuer shall irrevocably change the beneficiary for the Transferred payments to the transferee, and no other individual or entity other than the transferee shall have the authority to change beneficiary for the Transferred Payments. Based on the foregoing findings, and being satisfied that the proposed transfer satisfies all applicable statutory requirements as set forth in 40 P.S. 4001 et~., and is in the best interests ofthe Payee, and that upon review and consideration ofthe pleadings on file and the argument of counsel, if any, and all evidence presented to the Court in this matter, the Court is of the opinion that approval should be granted of the transfer by Petitioner, Joseph Clark to 321 Henderson of the right of Annuitant to receive two (2) payments comprising the aggregate amount of $125,000.00; as follows: one (1) payment of $50,000.00 on March 11, 2011 and one (1) payment of $75,000.00 on March 11,2016, from structured settlement obligor as the party obligated by way of a Uniform Qualified Assignment to make such payment under a settlement agreement, and which obligation has been funded by its purchase of an annuity from Annuity Issuer bearing annuity contract number 0303344. IT IS THEREFORE ORDERED AND ADJUDGED that the assignment, per the terms of the transfer agreement denominated "Purchase Agreement" attached hereto as Exhibit A, by Joseph Clark to 321 Henderson of all his right, title and interest in and to the two (2) payments comprising the aggregate amount of $125,000.00; as follows: one (1) payment of $50,000.00 on March 11, 2011 and one (1) payment of $75,000.00 on March 11,2016 (the "Assigned Payments"), from Structured Settlement Obligor bearing annuity contract number 0303344 is hereby approved. IT IS FURTHER ORDERED AND ADJUDGED that Structured Settlement Obligor and Annuity Issuer be and are hereby directed to deliver the assigned payment, payable to Joseph Clark, at the following address: 321 Henderson Receivables Limited Partnership at P.O. Box 7780-4244, Philadelphia, PA 19182-4244. IT IS THEREFORE ORDERED AND ADJUDGED that 321 Henderson Receivables Limited Partnership, its successors or affiliated companies, shall hold harmless, indemnify and defend Structured Settlement Obligor and Annuity Company and Annuity Issuer and their successors and assigns, parents, affiliates, subsidiaries, and the underlying parties to the Settlement Agreement or to the Uniform Qualified Assignment, including without limitation, First Colony Life Insurance Company and Fireman's Fund Insurance Company ("Indemnitees") from any against any and all liability, claims, losses, damages, awards, penalties and judgments, including but not limited to claims which may be brought by Joseph Clark (including his heirs, beneficiaries, contingent beneficiaries, or personal representative), by any individual or entity to which 321 Henderson subsequently attempts to assign or transfer the payment or any portion thereof, or by any other individual or entity. IT IS THEREFORE ORDERED AND ADJUDGED that 321 Henderson will provide written notice of this Order to Structured Settlement Obligor within 30 days of the date of this Order. The Structured Settlement Obligor shall, within 30 days of receiving said notice from 321 Henderson of this Order, instruct the Annuity Issuer to redirect the transferred payment in accordance with the notice provided by 321 Henderson. IT IS THEREFORE ORDERED AND ADJUDGED that the Annuity Issuer, within 30 days of receiving said notice from Structured Settlement Obligor shall process the request and implement the change. IT IS THEREFORE ORDERED AND ADGUDGED, in conformation with 321 Henderson's acknowledgement and agreement that the resolution of this matter is premised upon the specific annuity file in issue, the specific language of the applicable underlying annuity documents and the governing law, and further that the resolution of this matter is case specific, that this Order and the resolution of this matter does not constitute waiver of any defenses or claims of the Annuity Issuer and/or Structured Settlement Obligor in other annuity transactions nor is it, nor shall it be used or cited to as, precedent or authority persuasive in any other proceeding regarding any other annuity contract, transaction, attempted transfer of structured settlement payments, or otherwise. IT IS FURTHER ORDERED AND ADJUDGED that Petitioner, Joseph Clark for herself and his assigns, heirs and administrators, or individuals or entities that may claim through his (the "Releasors"), hereby remise, release, and forever discharge the Annuity Issuer and the Structured Settlement Obligor and its directors, shareholders, officers, agents, employees, servants, reinsurers, successors, and assigns, and any parent, subsidiary, or affiliate thereof, and their directors, shareholders, officers, agents, employees, attorneys, servants, successors, and assigns, past and present (the "Releasees"), of and from any and all manner of actions and causes of actions, suits, debts, dues, accounts, bonds, covenants, contracts, agreements, judgments, settlements, damages, claims, and demands whatsoever, in law or in equity, arising out of, related to, or in connection with the Assigned Payment identified herein, or the Annuity Issuer and the Structured Settlement Obligor's compliance with this Order. IT IS FURTHER ORDERED AND ADJUDGED that, upon payment by the Annuity Issuer of the Assigned Payment identified herein and in conformity with this Order, Annuity Issuer and Structured Settlement Obligor's obligations with regard to the structured settlement payment will be forever and finally extinguished. IT IS FURTHER ORDERED AND ADJUDGED that Petitioner, Joseph Clark shall no longer have the power or authority to request changes of address or beneficiary designation relating to the Assigned Payment, and no person or entity other than 321 Henderson or affiliated companies shall have the power or authority to change the address for payment of the Assigned Payments. IT IS FURTHER ORDERED AND ADJUDGED that neither Structured Settlement Obligor nor Annuity Issuer shall change the payment address for the Assigned Payment except upon receipt of written notice from 321 Henderson or its affiliated companies to do so. IT IS FURTHER ORDERED AND ADJUDGED that any further attempted assignments, in whole or in part, by Joseph Clark, of any other structured settlement payments, must be submitted to this Court for approval, and neither Annuity Issuer nor Structured Settlement Obligor have waived or prejudiced their right to object to any such further assignments. IT IS FURTHER ORDERED AND ADJUDGED, as agreed to and understood by Petitioners, that in the event that 321 Henderson attempts to further assign the Assigned Payment to another person or entity, neither Structured Settlement Obligor nor Annuity Issuer ever will be obligated to re-direct or make payable the Assigned Payment to any such person or entity. If 321 Henderson is granted by Court Order approval to further assign the Assigned Payments, Annuity Issuer and Structured Settlement Obligor will remain obligated only to forward such Assigned Payment without change to 321 Henderson as per this Court Order, then 321 Henderson shall make payments pursuant to its approved further assignment and 321 Henderson shall continue to service the further Assigned Payments. IT IS FURTHER ORDERED AND ADJUDGED that any Structured Settlement or Assigned Payment that are distributed before the expiration of the Annuity Issuer's thirty- day notice of this Order as provided herein, extinguishes the Obligor and Annuity Issuer's obligations and liabilities with respect to the payment and it is solely 321 Henderson's responsibility to collect the funds. IT IS FURTHER ORDERED AND ADJUDGED that this Order shall in no way modify nor negate the ownership of the under1ying annuity contract number 0303344 issued by First Colony life Insurance Company and owned by Fireman's Fund Insurance Company. IT IS THEREFORE ORDERED AND ADJUDGED that the Transferee shall be liable to the Structured Settlement Obligor and to the Annuity Issuer: a. If the transfer contravenes the terms of the structured settlement, for any taxes incurred by the Structured Settlement Obligor or the Annuity Issuer as a . consequence of the transfer; and b. For any liabilities or costs, including reasonable costs and attorney's fees, arising from compliance by such parties with this order of the Court or arising as a consequence of the Transferee's failure to comply with Act. The Structured Settlement Obligor and Annuity Issuer shall irrevocably change the beneficiary for the Transferred payments to the Transferee, and no other individual or entity other than the Transferee shall have the authority to change beneficiary for the Transferred Payments. BY THE COURT, J. DISTRIBUTION: Prothonotary's Office Court Administrator's Office 321 Henderson Receivables First Colony Life Insurance Company Fireman's Fund Insurance Company Michael D. Rentschler, Esquire 2 ~ ~ "" 2\]~ ~ ~~ ~ -.;!' " I ~:b 9. ~;r ,.,p 0 r-C'" -'.,- ~:~~;:: .." ::C3j ::It 00 ~<..) <.? ts.f11 C "'I Z ~ -~ N -<. ,.,p