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HomeMy WebLinkAbout06-2344 . . IN THE COURT of COMMOM PLEAS of CUMBERLAND COUNTY, COMMONWEALTH ofPENNSYLV ANIA In Re: SCOTT A. HADBA VNY, Petitioner No. 0(,,- ::{3CfL/ {I(;"'i l l'VLi Petition for Transfer of Structured Settlement NOTICE of PROPOSED TRANSFER PURSUANT to 40 Pa CSA 4004 Petitioner SCOTT A. HADBA VNY, above captioned hereby furnishes this Notice to Nationwide Insurance and its assignees and 321 Henderson Receivables, LP and any other interested party of the purposed Partial Transfer of Structured Settlement, as more fully set forth in the attached Petition. The purpose of this Notice is to provide full opportunity to support, oppose, or otherwise respond to my above client's Petition, either in person or through counsel by submitting written comments or attending and participating in a hearing. You will be further notified of the time and place of the hearing, which will not occur sooner than twenty (20) days hereof. Esquire t. I : 23933 132-1 ut Street Harrisburg, A 17101-1612 (717) 238-5515 Counsel for Petitioner n.ted f 1'1.& } 0 0 By: . . IN THE COURT of COMMON PLEAS of CUMBERLAND COUNTY, COMMONWEALTH of PENNSYL VANIA In Re: SCOTT A. HADBA VNY, Petitioner No.O/"- ;;{:Nlf (?lul:r~[ Petition for Transfer of Structured Settlement To: The Honorable Judges of Said Court: Petition for Partial Transfer of Structured Settlement Pursuant to Structured Settlement Protection Act, 40 Pa. CSA 4000 et seq. AND NOW thiJ(g~y of ftfJH 1,2006 comes Petitioner SCOTT A. HADBA VNY, by and through his attorney John M. Glace, Esquire and respectfully petitions this Honorable Court for Partial Transfer of his Structured Settlement and, supports thereof, presents the following: I. Petitioner SCOTT A. HADSA VNY is a adult, single individual who resides 155 Salem Church Road, Lot # 22, Mechanicsburg, Cumberland County, Pennsylvania. 2. Petitioner is the residuary beneficiary of a annuity owned by Nationwide Insurance Company. Petitioner is the son of Susan Otto, the wife who predeceased her husband Donald J. Otto, step-father of Petitioner. Donald J. Otto and Susan Otto were the named beneficiaries of a February 16, 1999 structured settlement from Nationwide Insurance Company. Said Settlement Agreement is attached en toto as Exhibit "A" and made part hereof. 3. Said Settlement Agreement, in addition to immediate and/or prior payments provides at paragraph IllS for periodic payments of $995.00 per month commencing March 24, 1999 until February 24,2014. 4. At the death of Donald J. Otto who was the widower of Susan Otto, Daniel M. Hadbavny, brother and only sibling of the Petitioner, had been designated as the primary beneficiary of the structured settlement, above described. Thereafter Daniel Hadbavny . . designated his brother, Petitioner Scott Hadbavny as his primary beneficiary on September 22, 2002 and amended that designation on February 24, 2004 by naming his father Mike Hadbavny as a contingent beneficiary with succeeding interest to the Petitioner. Those designations to Nationwide Insurance are attached hereto in the aggregate as Exhibit "B" and made part hereof. 5. On October 13, 2005 tragically Daniel Hadbavny was killed as a result of a motor vehicle accident in Silver Spring Township, Cumberland County, Pennsylvania while returning to his residence in that township. A true and correct copy of his death certificate is attached hereto as Exhibit "Coo and made part hereof. 6. By virtue of Petitioner's brother's tragic accidental death, Petitioner became by appointment the primary beneficiary of the aforesaid structured settlement and has been receiving the designated monthly stipend. 7. Petitioner proposes to enter into a purchase agreement with 321 Henderson Receivables Limited Partnership ( "Buyer" or Transferee"), its nominees, successors, or assigns, doing business in Pennsylvania at 40 Morris Avenue, Bryn Mawr, Pennsylvania, 190 I 0, who will purchase the balance owned of the structured settlement. Petitioner will receive $30,000.00 in a lump sum payment for a final payout of $45,000.00; but with a discounted present value of $36,904.37 on March 1,2006. This Purchase Agreement with Exhibits is attached hereto as Exhibit "D" ad made part hereof. 8. Pursuant to 40 Pa. CS Section 4003, Buyer furnished the Petitioner a Disclosure Statement ( attached to this Petition's Exhibit "D", the Purchase Agreement) at least ten 910) days prior to Petitioner's contracted agreement to sell. 9. The Buyer has served written notice, including its name, address and tax identification number to Nationwide Insurance Company, the structured settlement obligor, and has served written notice upon all interested parties pursuant to 40 Pa. CS Section 4004; none of whom have tendered objections to said transfer. True and correct copies of said notices are attached in aggregate as Exhibit "E" ad made part hereof. 10. Petitioner's best interest would be optimally served by grant of the requested relief in order to permit him to pay outstanding bills, purchase a dependable vehicle in order to maintain employment, and to have access to funds for a down payment for a residence. . . WHEREFORE Petitioner SCOTT A. HADBA VNY respectfully requests that this Honorable Court enter a Rule upon Nationwide Insurance Company to show cause why the sale and transfer of the structured settlement herein described to 321 Henderson Receivables Partnership Limited, its nominees, successors or assigns should not be approved. Respectfully submitted, The Law Office 0 ohn M. Glace V\..- ce, 9fIuire 10: 'l--1Jq~:) nut Street Harris ,PA 17101-1612 (717) 238-5515 . . Txhibit "51" . . RELEASE AND SETTLEMENT AGREEMENT This Release and Settlement Agreement ("Agreement") is made and entered into among Donald J. Otto and Susan Otto, individually and as husband and wife; Glenn E. Eaves and Jean Eaves, individually and as husband and wife and Alan Fogle; and Nationwide Mutual Insurance Company ("the Parties"). The "Claimant" shall collectively mean Donald J. Otto and Susan Otto, individually and as husband and wife, their respective heirs, executors, adminjstrators, personal representatives, successors and assigns; the "Insured" shall collectively mean Glenn E. Eaves and Jean Eaves. individually and as husband and wife and Alan Fogle; and the "Insurance Company" shall mean Nationwide Mutual Insurance Company. 1. RECITALS A. On or about December 12, 1996, at or near Route 15, Adams County, Pennsylvania, Donald J. Otto claims to have sustained physical injuries as a result of the alleged conduct of the Insured (the "Incident"), In connection with the Incident, the Claimant has asserted a claim against the Insured based upon tort or tort type claims, B. The Insurance Company and the Insured have entered into a liability insurance contract which provides that the Insurance Company shall defend the Insured against any claim or suit for damages arising from the Incident, has <ll!thnrity to settle any such claim or suit on behalf of and as agent for the Insured, and shall insure the Insured for such liability subject to the limits set forth in the contract. . . C. The Parties desire to enter into this Agreement to provide, among other things, for considerations in full settlement and discharge of all claims and actions of the Claimant for damages which allegedly arose out of or due to the Incident, on the terms and conditions set forth in this Agreement. NOW, THEREFORE, it is agreed as follows: II. RELEASE A. Release and Discharl!e. In consideration of the cash payment(s) referred to in Paragraph IlLA. and the promise to make the periodic payments referred to in Paragraph IlLB. ("Periodic Payments"), the Claimant hereby complete~~ i7e.Ieases and forever discharges the "'-J:.:<~: Insured, the Insurance Company. and any and all other persons,JirIllsr:o~ corporations from any "'._",.",- ;&"" - ,~ and all past, present, or future claims, demands, actions, damages, Cl)sts, expenses, loss of services, and causes of action of any kind or character, whether based on tort, contract, or other theory of recovery, whether known or unknown, including any and all claims for loss of marital services and consortium which have arisen in the past or which may arise in the future, whether directly or indirectly, caused by, connected with or resulting from the Incident, except for the claims, demands, actions, causes of action, damages. costs, expenses and loss of services specifically reserved herein. This release and discharge shall be a fully binding and complete settlement among all Parties to this Agreement, and their heirs, assigns, and successors. Except as to the Insured and the Insurance Company, Claimant reserves their continuing and future claim for first party benefits and benefits paid or payable as Workers' Compensation wage, indemnity or medical benefits. 2 . . The Claimant acknowledges and agrees that this release and discharge is a full and final release of Glenn E. Eaves and Jean Eaves, individually and as husband and wife; Alan Fogle; and Nationwide Mutual Insurance Company. The Claimant expressly waives and assume, the risk of any and all claims for damages and expenses which exist as of this date, but of which the Claimant does not know or suspect to exist, whether through ignorance, oversight, error, negligence, or otherwise, and which, if known, would materially affect the Claimant's decision to enter into this Agreement. The Claimant further agrees that the Claimant has accepted the considerations set forth in Paragraphs III. A. and B. as a complete compromise of'matters involving disputed issues of law and fact. The Claimant assumes the risk that the facts or law may be other than the Claimant believes. It is understood and agreed to by the Parties that this settlement is a compromise of a doubtful and disputed claim, and the payments are not to be construed as an admission of liability on the part~ii,he Insured, by whom liability is expressly tZ ~ , denied.''';'' B. Iniuries Known and Unknown. The Claimant fully understands that the Claimant may have suffered personal injuries that are unknown to the Claimant at present and that unknown complications of present known injuries may arise, develop or be discovered in the future, including, but not limited to, subsequent death or disability. The Claimant acknowledges that the consideration received under this Agreement is intended to and does release and discharge the Insured and the Insurance Company from any claims for, or consequences arising from, the injuries which allegedly arose from the Incident; and the Claimant hereby waives any rights to assert in the future any claims not now known or suspected even though, if such claims were known, such knowledge would materially affect the terms of this Agreement. 3 . . C, Parties Released. This release and discharge shall also apply to the Insured's and the Insurance Company's past, present, and future officers, directors, stockholders, attorneys, agents, servants, representatives, employees, subsidiaries, affiliates, reinsurers, partners, predecessors and successors in interest, heirs, executors, personal representatives, and assigns and all other persons, firms or corporations with whom any of the former have been, are now, or may hereafter be affiliated. m. PAYMENTS TO CLAIMANT. PAYEE. AND/OR BENEFICIARY A. Pavment at Settlement (and Amounts Previouslv Paid). The Insurance Company and the Insured have paid One Hundred Twenty Three Thousand Seven Hundred Sixty Nine Dollars and 12/100 ($123,769_12) to the Claimant, and Counsel for Claimant, Timothy Shollenberger, receipt of which is acknowledg~Q.0fn;~ition, the PMA Group has received "~Wf;' tl1J,,/~Y":,':' Seventy Six Thousand Two Hundred Thirty DOllars- arlt!t 8'S1199"($76,230.88) to satisfy a workers compensation lien, receipt of which is acknowledged. These payments include, but are not limited to, all out of pocket expenses, attorney fees, all medical liens, all rights of recovery, all medical subrogation claims, all worker compensation subrogation claims, known and unknown, and claims for general damages. B. Periodic Payments. The Insurance Company, on behalf of the Insured, agrees to pay or cause to be paid the following Periodic Payments: (1) To Donald J. Otto ("Payee"), the sum of Nine Hundred Ninety Five Dollars ($995) to be paid on or about the twenty fourth (24th) day of each and every month beginning on or about March 24. 1999. guaranteed to be paid for a period of one hundred eighty (180) months, with the last payment to be made on or about February 24, 2014. 4 . . ,.. V" I I (2) Should Donald J. Otto die before February 24, 2014, then any remaining guaranteed Periodic Payments set forth in Subparagraph m.B.(I) shall instead be paid, subject to the provisions of Subparagraph m.B.(3) below, as they become due, to Susan Otto while living; otherwise to Daniel Michael Hadbavny ("Beneficiary"), with the last guaranteed Periodic Payment to be made on or about February 24, 2014. Should Susan Otto and Danie~ Michael Hadbavny both die before the remaining guaranteed Periodic Payments are made as set forth in Subparagraph IlI.B.(I), then all remaining guaranteed Periodic Payments will be made subject to the provisions of Subparagraph IlI.B.(3) below; as they come due, to the estate of the last to die of Donald J. Otto, Susan Otto and Daniel Michael Hadbavny, with the last payment to be on or about February 24, 2014. (3) The Payee shall have the right to SUb~~~,*\~st to change the Beneficiary by filing ''';'~,,;,. '~i', a written request with the owner of the Annuit;\e@~~a~t:.. The change will be effective , :;.;..-,;.. when approved by both the owner of the Annuity Contract. and the Annuity Issuer. Any change in the Beneficiary shall not in any way affect or alter any of the provisions of this Agreement. IV. RESPONSIBILITY AND FUNDING FOR FUTURE PERIODIC PAYMENTS A. ResDonsibilitv for Pavments. The Parties understand and agree that the Insurance Company will be directly and solely responsible for making all furore Periodic Payments set forth in Paragraph m.B. of this Agreement. 5 . . I '''.1 II iUVV." B. Annuitv Funding. The Parties understand and agree that the Insurance Company may fund its obligation to make the Periodic Payments by purchasing an annuity contract (the "Annuity Contract") from Employers Life Insurance Company of \Vausau (the "Annuity Issuer"), If such Annuity Contract is purchased, the Insurance Company shall be the owner of the Annuity Contract and shall have and retain all rights of ownership in the Annuity Contract. For its own convenience, the Insurance Company may direct the Annuity Issuer to make all the Periodic Payments directly to the respective Payees and/or Beneficiaries designated in Paragraph III.B. Each Payee and Beneficiary designated in Paragraph III,B. shall be responsible for maintaining his current mailing address with the Annuity Issuer. ?i'.? ',.~, The obligation to make each Periodic Paymli{n,~~WUk;,pe fully discharged upon the mailing ;;,,; ",,"" of a valid check or electronic funds transfer in the amount of such p<o/ment on or before the due date to the last address on record for the Payee or Beneficiary with the Annuity Issuer. If the Payee or Beneficiary notifies the Insurance Company that any check or electronic funds transfer was not received, the Insurance Company shall direct the Annuity Issuer to initiate a stop payment action and, upon confirmation that such check was not previously negotiated or electronic funds transfer deposited, shall have the Annuity Issuer process a replacement payment. C. Status of Claimant. Pavees, and Beneficiaries. The Claimant, each Payee and each Beneficiary, as applicable, shall, at all times, remain a general creditor of the Insurance Company and shall have no rights in the Annuity Contract nor in any other assets of the Insurance Company. The Insurance Company shall not be required to set aside sufficient assets 6 . . r "... I. ,VVV I" or secure its obligation to the Claimant, each Payee, or each Beneficiary, in any manner whatsoever. V. NO CHANGES IN PERIODIC PAYMENTS The Claimant acknowledges and agrees that all, some, or any part of the Periodic Payments cannot be accelerated, commuted, transferred, deferred, increased or decreased by the Claimant or by any Payee or Beneficiary and that the Claimant or any Payee or Beneficiary shall not have the power to sell, mortgage, encumber, or otherwise anticipate all. some, or any part of the Periodic Payments by assignment or otherwise. VI ENTIRE AGREEl\iffiNT This Agreement contains the entire agreement between the Claimant, the Insured, and the Insurance Company with regard to the matters set forth in it. There are no other understandings or agreements, verbal or otherwise, in relation to the Agreement, between the Parties except as expressly set forth in it. This Agreement is intended to conform with the requirements of Internal Revenue Code Sections 104(a)(2). All provisions of this Agreement should be construed in a manner so as to effectuate that intent. 7 . . VII. READING OF AGREEMENT II' pn'~r!n~ il'!" this Agret>m~nt, the Claimant represents that the Claimant has completely read all of its terms and that such terms are fully understood and voluntarily accepted by the Claimant. The Claimant has been represented by counsel of the Claimant's choice. VIII. FUTURE COOPERATION All Parties agree to cooperate fully, to execute any and all supplementary documents, and to take all additional actions that may be necessary or appropriate to give full force and effect to the terms and intent of this Agreement which are nO! inconsistent with its terms. IX. DRAFfING OF DOCUMENT AND RELIANG.E,BY CLAIMANT This Agreement has been negotiated by the respective Parties through counsel. The Parties to this Agreement contemplate and intend that all payments set forth in Section III constitute damages received on account of personal injuries or sickness, arising from the Incident, within the meaning of Section 104(a)(2) of the Internal Revenue Code of 1986, as amended. However. the Claimant warrants, represents, and agrees that the Claimant is not relying on the advice of the Insured, the Insurance Company, anyone associated with them, including their attorneys and the insurance broker placing the Annuity Contract, as to the legal and income tax or other consequences of any kind arising out of this Agreement. Accordingly, the Claimant hereby releases and holds harmless the Insured, the Insurance Company, and any and all counselor consultants for the Insured and the Insurance Company from any claim, cause of action, or other 8 . . .-. .. ,... "'.. .... rights of any kind which the Claimant may assert because the legal, income tax or "t1:!~~ consequences of this Agreement are other than those anticipated by the Claimam. The Parties signing this Agreement, and each of them, warrant and represent that no promise, inducement or agreement not expressed in this Agreement has been made to them and that this Agreement constitutes the entire agreement between the Parties and that the terms of this Agreement are contractual and not mere recitals. The Claimant represents and agrees that he/she has read the Agreement and fully understand it, and have been advised by counsel of their own choosing as to the propriety and legal effect of executing it, and neither the Agreement nor the compromise and settlement recited in it were induced by fraud, coercion, compulsion or mistake, nor is this Agreement nor the compromise and settlement made in reliance upon.,wwstafe,rpent or representation of any of the Parties released by this Agreement, or their representatives, agents or attorneys. X. WARRANTY OF CAPACITY TO EXECUTE AGREEMENT The Claimant represents and warrants that, with the exception of contingency fee contracts and any agreements which may exist between the Claimant and his/her counsel relative to the reimbursement of litigation expenses, no other person or entity has, or has had, any interest in the claims, demands, obligations, or causes of action referred to in this Agreement, and that the Claimant has the sole right and exclusive authority to execute this Agreement and receive the sums specified in it and that the Claimant has not sold, assigned, transferred, conveyed or otherwise disposed of any of the claims, demands, obligations or causes of action referred to in this Agreement. 9 . . . ,....' . I ,"IVy 1'1 XI. COURT APPROVAL The Parties agree that the Claimant will file petitions for all necessary court approvals, that all such petitions and orders shall be in a form satisfactory to all Parties, and that this Agreement will not be effective until such approvals have been obtained. XII. CO~TROLLING LAW This Agreement shall be construed and interpreted in accordance with the laws of the Commonwealth of PelU1Sylvania. Dated: J- /J, -9Cf _D~J()\~ Donald J. Otto, i ividually and as husband, Claimant Dated: J-/:?t-qq \ Otto.~divl uallyand as wife, Claimant ( Dated: ,:)/11.11 Ie; '1 . - Duly thori ed Represefftative for Nationwide Mutual Insurance Company Approved as to Form and Content: "] -(6- '11 Dated: Jt(I!t~~ Ti t Y ShOI~nbe g , t: unant APPLICABLE TO PK!liNSYLVANIA ONLY: For your protection, Pennsylvania requires the following to appear on this form: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. 10 . . Txfiibit "'E" . . C:EP " ,. 'IOn" ...1 lj:, t... :/li;~ REQUEST FOR CHANGE OF BENEFICIARY STRUCTURED CLAIM SETTLEMENTS N\"VL-C~:;'~:: ~,- -....,,-( D............. . . ,- .-" :::",*, I ay. 11-.:;:~: 11:;'" -I';:;~~;-"'~'" ._.-... ,.W: Instructions for com letion on reverse side Contractholder Payee Name: Daniel M. Hadbamy Nationwide Mutual Insurance Company Soc Sec #: - cC- -s ( . 'r 7 Birth date: I,) - . The undersigned Payee hereby re\'okes all pre\'ious beneficiary designations with respect to proceeds to the Payee by way of a structured settlement agreement. Check ami com lett! nl' Ile 0 tile items numbered 1- 3 tl,ell si II 'bOll, Po 'ee ""tl U';tIlCS.'i tll tile hottom fI this orm. f~.1- -77 2. ( ) SPOUSE PRIMARY BENEFICIARY Souse'. Full Name and Address Sodal Seeuritv Number Date of Birth CHlLD(REN) CONTINGENT BENEFICIARY(IES) Child(reu)'s Full Name aud Address Social Security Number Date of Birth In tbe event no primary or contingent beneficiary(ies) designated in 1 or 2 abo\'e survive the Payce. the rcmaining guaranteed payments shall be paid, as they become due, to the Estate of the Payee. 3. ( ) PAYEE'S EST ATE - The executor or administrator of the Payee. \0,- (month),2002 One N.ltionwide MilL,l Columbus, OH '" 321 5 - 2120 7' (~' FOR OFFtCE USE ONLY: " "\..J.k.-, ././-,(1 '7,1 ~ RECIEVED AND RECORDED o~[-'111l1 r:u- :JV. jlf. : , . . ;;~~.'li I"~ ..~ 5 7-7 ~ I 12'4'- /X~rrt( r <'ill) s-co-r7CJ,5 yeef f,_/t.... f,o?,-I'.; I )''<:'(1/,4 VJIM'l^ bev ~,r fir,...... Ii.,] . b~;,,~-0c; "7 '--ff,,) L,~ (. s / L\'~ Irc <;..:'\ t.A- -1(,!.. -h., ~- ....L J v,5 t (' eat'- let ,r /1,JIh.;';'1 1>C"t:.;;~I'C" '~J \('C+/ A/kf' /frt dl V!"'~1, d'd ( fY...",(:j C. aJ' L"':-'-I Ap:1# .;c Y ) /~rr,sh((y) / j'lH. /711/ }i;CIC'. ( )CCv., L /'7.). - S-e - fJI ~ \. ) \.J.e..(',) ;) - n - T( . ~-~ 1-' .., ~" t.1 1..., -.- '--;-'1', [ ~"j: l; l...... - <.' ,.' ')~ "- "'."\ ;,~~5) r.,;rc<,~.rl( 0C11t:C,{/~~l~7-'~ It /C'd-c~1 Ov~n- ,,,,: -- 'N 41? " f: K 1/' I) . ""-lU~"'-- -- ~-J=""",->:.~~~~i.;1b I I lye '--It.S (jJ7.y/e/y 5 j,~nek/ci"7 n,~f'/J.- ('v/c) Ilk-ex .52>/1 < /bY'JrC"~; A. /f,t tii~ cl,~ck. Ii.)' L)(~I'tI.( I J.ICid/J:iL,jLf C L. ?S7 J- /C.(. (' h / lit:) ~J J. i)..../t,s, /)!J, c' . II ') /c.:(" ~ . . " ~'\ r l _- _ . ". ') .,-;-) I" _ LQUMl ;~K C~ALGE ~;~E~E;;~IARY STRUCTURED CLAIM SETTLEMENTS hL'VL.l. '\' .DJ" j ~\ ,; c'" (! (" - 'I \ . " - ') i / ( ~!"); Iti~ MnR 0 1 2C04 NWL-Cor.~ra::;~ 2.1cl F3.yme,lt Adrn:nis:; 2..~ion (Jnsiru~tions for comnletion on reverse side) Contractholder Payee Name: Daniel Hadbavny l"ationwide Mutual Insurance Company Soc Sec #: 206-56-99741 Birth date: 12127/1976 The undersigned Payee hereby revokes all previous beneficiary designations with respect to proceeds to the Payee by way of a structured settlement agreement. lid com tete 0111 one 0 the items /lumbered 1 - 3 tlren si " 'botll Pa ee and JYitne ~ at tile bottom 0 II1;s orm. Sochd Security Number ,()- 58- 8;;;1,,> Date of Birth "J-1l-7p! Date of Birth ~, . 3c '~G 2. ( ) SPOUSE PRIMARY BENEFICIARY Spouse's Full Name and Address Social Security Numher Date of Birth CHILD(REN) CONTINGENT BENEFICIARY(IES) Child/ren"s Full Name and Address Social Security ,,"umber Date of Birth In the event no primary or contingent beneficiary(ies) designated in I or 2 above survive the Payee, the remaining guaranteed payments shall be paid, as they become due, to the Estate of the Pa~'ee. 3. ( ) PAYEE'S ESTATE - The executor or administrator of the Payee. FOR OFFICE USE ONLY: RECIEVED AND RECORDED 01" \\ \. . ~ \, \~_\. 's-~\ fA (City/State), this ~~ 'I \ \ BY: . Ont' N.Hionwide PlaziI Columbus, OH 43215.2220 '\Jlfonwide Insurance '\Jtionwid;:: Financial , , -\-. CUi'" . . "'€d\;c'<;", tc.{ Cn6.."j" (', fJ\:'f'\:.T1CiCV, .S +p,,,, (~\I'e d. '- IC;.,." 5.: {.\ 1<: "'to. l 4 1 ~,<. +'(J""_', ,J-eJ ihq -!-(,o", \ Ij:,,sVlf {.,.,(e G:'''('~JI7 0u')'~ I It) fk,J k,,',,'( .)c., G.-- 5 ~ - 'f'j 7'1 jJ ..~ 7 - 7/:; (U.,-hI'\S{''\ t- {JtlJ L-hC iC~'\.l o( ~J((dl F;;'Cb,t,ll 15'(.lf Cc /ckh (~f'",c.. ,J., Ihe:s:yO\.Ic IX 7)' i "i1 50(,(,/.5tCO.. i 1..[ dC 7 -"1& -t;-q~':J tf" 'll)~i.<'k. .J . d S':"S8 <'YJll ~d ;;;cc: ~ I!;<:;.;~ ~",' ~) u +- O",I)"S / ,J A~" C;,i,',s'))/iti\ 0 t:. )~ Sf rhli,k~/ ~h" l/e .. srfC'.7t'-<" L ))(.H~(/ /M~<u.:;;/ "~jn"..f......\:. <;.[ h -h't&"S' 'A (J..-rLhu:-~ ,r:. .. .-"..-U;<..:rV:-:- r--; {;oJI11iff,/il/lk:l,fF. 1M, tJ: l,h!-~U1~CI, ;d~o; / \.S~ba ~ ?IJ.:< (h1-6t: J- 6F :J.. . . Txhibit "e" ".. ~,,"- c.' ,-- . ":"~ _. --'~:-~"",:,;".'?':~"' 'wut'" , ~~~~~ct-=-. 11101 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (Coroner) S IOH KlNOOF ~"tr...al~~u~~ ., Unemployed ~MAlUHG lS1tnt.CiIyI1bwn.Slete,ZipCOdeI 155 Salem Church Road, Lot '.. Mechanicsburg, PA 17050 'RMER'SN.wE(FQL.........LoIrlJ a...~.t...,I8o.-....., .12(0-121 """........... scx:IAL l5l!!CURm' NUUBER DIlf"EOFO&RH~o...,. v-) .. October 13, 2005 I AMECFDE jRrst, .LasI) Daniel ~(laIlBkthc:llyl UHDE'AlveAA ..... - M Hadbavny OAl'EOFBIFrTH (MorIlh.o.y,"'" Dec.27,1976 . 206-56-9974 "NO.." DAY .... -- BIl'ITHPI.Aa:(QIyend SIallIotFotelgnCounllYl =.~ 28 VII. "" ..... Cumber land CnY. Silver Spring 1, Irwin, PA FN::lUNNAME{lInalinIblulIOn.gInI*<<IIendlU'llber) 6746 Carlisle Pike .. ... vm~~sf ...0 ""C5I( ~SEDUCRlON White SUR\IIVWG SPOUSE (llwi1e.givernakllln/llll'Ml ...,..,.",... """"'- 2~ M...._ 17a.SIalw PA ... ,... Cumberland 1111.0 ~~= uorHER'SNAMEp:ftl.Midcle.UllidDIISuPwne) ... INFOI'IMAHT'SIUJlJNB ~CIIyflbwn,~.ZIp~ 155 Salem Cburch Road Lot 22 Mec a a ur P -.~ ~ orou..... Cremation Society of Cremato Harrisbur NAMEANDAl:JDMS8OffilaUfYAuer Metp.ol'ial Services Inc. Harr1Sbur "'" N ,. ~HAMEcr)'pll/Pnnl) Michael Hadbavn Michael Hadbavn BurIlltO ~t1( Re...-lb'lllllS&DO """'- -....-..-.pIMclby _who~~ OF prx. .. 12:25 A." ~.JllUtTI: e...lM--.tnjurletorCl;llllCllicaliwtlldlClt&ed"'~Donol"""''''''-flldylng.auc:fI..c:ardlcor~''''''.-''odc'''NarfIallln. l.hlIanlyONl_lIIl.-dl..... (MClI'lIt>.D8y.Y8arl October' 13, 2005 RE ",,0 .... -......... ..".......ac.~ ....EnIIrUNDEflt.YlNII =--CO--OIlrpy .-- tNingindealhllAST Multiple Traumatic Injuries DUE1O(QRASACONSEOUENCE OF): Motor Vehicle Crash D\JE1O(OFlASACONSEOUENCE Of): ... 1-' ,-- j_anddMlb ...~ PARTn: Olhtr.,lIeanlllCll'lClllclM-*IIlUI!ngtDcMlIIb,buI IlOIresuIlI"lIIn,,*~CIIlII8g1118nlnPARTl -.....- ~orc:andilion ~in~_ OUE1OIQRASACONSEOUENCE OF): ....1I1tlPSV """"""" _MlIOPSY S M8\llA8LEPfIlORTO ~""c.wss ""....., MANNiA OF DEArH TlMEOfINJUl'lV Aprx. s- OReOFINJURV (MonlIl.Oay.'4Ur) o __ 0 Oct. 13,2005 >01 ... __ ~ _,_ 0 2:25 A. ... 0 NGtp. ... 0 No ~ 0 0 PlACEOF'NJUFl'h'lhonlt.........!adoIy.ofIkllI ... ~ ~ CQQldnolb..,......... ~.IiIC..~ Highway ~.:=e:"'~{F'tlysidencerlfying_Oldellh'liltlllnlll'Cllh8rphY*ll/l""proI'IOIn:eddedllnlCP'Jlpllled'*"23) To...loeMoI""~.__InId.ru.Io..--c:II)....__-..d'......._....____....... --- .="...:::,~=~==~::.rc::oo::=-.~oI=...--................. 0 'IIEIllCAL""""""'" Ia.~'::::-.::,~.~~~~~:~r:'!.~~~:~~~~~..~:~.~~:~.~~~~~.~ }Ct 12. um~"7?~-: 1...7/toll/I/1 . . Txhi6it "'D" . . PURCHASE AGREEMENT This is a Purchase Agreement. The date of this Agreement is . 200_. Scott Hadbavny is the Seller. 321 Henderson Receivables Limited Partnership, a Nevada Limited Partnership, its successors and/or assigns is the Buyer. In this Agreement, Scott Hadbavny is referred to as "You" or "Your" and 321 Henderson Receivables Limited Partnership or its nominee, is referred to as "We", "Us" or "Our". BACKGROUND OF THIS AGREEMENT I. 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 (the "Annuity") issued by Nationwide Life Insurance Co F/kIa Employers Life Insurance Company OfWausau (the "Annuity Company"). 3. A list ofthe Payments being sold under this Agreement is attacbed to this Agreement as Exhibit "At!. 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 I (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 ahove. b. The Gross Purchase Price is Thirty Thousand Dollars and 00/100 Cents ($30,000.00). The Net Purchase Price payable to You is $30,000.00 (the "Purchase Price"). The Net Purchase Price will be paid to You when both You and We sign this Agreement and We have completed Our internal process. 2. Acknowledl!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 nccess8IY or proper to carry out this Agreement. b. When You and We sign this Agreement, You will also deliver to Us: (I) a letter addressed to the Annuity Company directing that all payments of the Assigned Assets after Your death shall be sent directly to Us, and (2) a Change of Beneficiary Form changing the beneficiary of the Assigned Assets, after Your death, to "321 Henderson Receivables Limited Partnership., as sole beneficiary [(I) and (2) above are referred to as the Change of Beneficiary Form]. The Change of Beneficiary Form will state that the instructions may never be revoked and that no change may be made in the instructions or ._",.1 . A J.J ~ @200S321 HendeBon Receivables Limited Partnersbip . . in the payments (including as to the payee or the manner or place of making such payments) without Our prior written consent. You will also, when this Agreement is signed by You and Us, deliver to Us, addressed as We may require, 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 Scott Hadbavny, as primary beneficiary of the Assigned Assets, of the terms of this Agreement. Scott Hadbavny will agree that they are not entitled to any rights to any of the Assigned Assets. d. You agree to sign a1l 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 determine whether this transaction will resuh 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 Reoresentations 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, Jiens, 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 a1l 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 performance 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; iii. 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. ,.,,;.1 .A 1L 2 ~ @200S321 Henderson Receivables Limited Partnership In;';ol' j /J. . . d. You understand the terms and provisions of this Agreement and You have been represented by tax and accounting advisors and a lawyer in the signing of this Agreement. e. Neither You nor anyone else have to do anything else for (I) the proper signing and performance 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 connection with this Agreement or in any agreement required by this Agreement, is inaccurate or contains any untrae 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 a. 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. Yon 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 @200S 321 Henderson Receivables Limited Partnership . . I. Your right to the Assigned Assets is not affected by any mortgage, pledge, lien, charge, security interest, encumbrance, restriction or adverse claim of any nature. You understand that any violation of any of Your representations in this agreement wUl result in an ad of fraud hy You whieh 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 descnlled 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. o. As of the date of this Agreement, You are oflegal age in the state noted as Your address in Section II 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 financial 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, finder, 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 fur the sole purpose of buying the Assigned Assets. Initial: Jl1 _ ~ 4 @200S 321 HendeJSon Re<eivab1es Limit<d Partnenhip . . 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 CIDLD 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 We are 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. ,"",.. J Ji L- 5 @2oo5 321 Henderson Rea:ivables Limited Partnenhip . . 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 checka, funds or other form 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 from Us, as determined by Us in our reasonable discretion, directly or indirectly on account of any act or omission by You or any person acting for Yon, 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 S8. g. If You learn before or after the signing of this Agreement of the threat or actual beginning of any lawsuit or proc:ecoding that has 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 affecting 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 receive them. 5. RIGHT TO CANCEI.I.ATTON. YOU MAY CANCEL TIllS CONTRACT WITHOUT PENALTY OR FURTHER OBLIGATION WITHIN TWENTY-ONE DAYS FROM THE DATE YOU RECENE PAYMENT FROM 321 HENDERSON. In order for the cancellation to be effective, You must mail a notice of cancellation by registered or certified U.S. mail. postmarked within twenty-one (21) days of receipt of the Purchase Price to Us, c/o Vice President of Operations at 2215-B, Suite 5, Renaissance Drive, Las Vegas, NV 89119. Furthermore, in order for Your notice of cancellation to be effective, 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 AgJeement. This promise includes signing, filing or allowing Us to file financing or continuation statements, or amendments or assignments of those documents. You permit 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 permitted in Your state of residence. When You sign this Agreement, Yon 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 form acceptable to Us. In;.;.', J jJ ~ 6 @200S 321 Henderson Receivables Limited Partnership . . 7. Continuation of Renresentations. Warranties and Covenants. All of Your representations, warranties and promises made in this Agreement will continue to be relied on by Us after this Agreement is signed. 8. Event of Default. Your failure to comply with any term of this Agreement or Your breach of any of Your representations in this Agreement will mean that You will be in default. We refer to this as an "Event of Default." If there is an Event ofDefaull, 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 II of this 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 railed to notify Us, We will consider such failure to notify Us to be an EVENT OF DEFAULT and We will exercise aU of our legal rights under this Agreement. OUR RIGHT TO PROCEED AGAINST YOU UNDER THIS AGREEMENT SHALL BE SOLELY LIMITED TO WHEN YOU HAVE COMMITl'ED AN EVENT OF DEFAULT. WE SHALL NOT HAVE THE RIGHT TO SUE YOU IF OR BECAUSE THE ANNUITY COMPANY IS NOT ABLE TO MAKE PAYMENTS BECAUSE IT IS NOT FINANCIALLY ABLE TO DO SO. 9. Controlling Law. This Agreement shall be governed, constnJed and enforced in accordance with the intema1laws of the State of pennsylvania without regard for the conflicts of law roles thereof or elsewhere. (For Court Orders or Notice Transfers obtained in the following jurisdictions: AI(, AR, AZ, CA, CO, CT, DE, FL, GA, IA, m,lL, lN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, ~~~~~~~~~~~m~~~~~~the~~~ jurisdictions shall be applied in the 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. Resnonsibilitv for this AllreeIIlent. This Agreement will hold responsible Your heirs, executors, successors ~ assigns and will benefit Our representatives, successors, beneficiaries and permitted assigns. Nothing in this Agreement is intended to give anyone other than You or Us or each of Our successors or assigns any benefits. II. ~. 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: Ifto You: Scott Hadbavny 155 Salem Church Road. Lot 22 Mechanicsburg, PA 17050 ,,,;ri.,1111 7 ~ @2005 321 Henderson Receivables Limited Pannership . . Ifto Us: 321 Henderson Receivables Limited Partnership 221S-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. Exnenses. Except as otherwise atftrmatively 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. Beadinl!s. 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. IS. Counteroarts. 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. Assitmment. We and anyone to whom We assign this Agreement may assign Our right, title and interest in and to this Agreement, the Annuity and the 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 Agreement. 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. '_"'.'. ,J u L- 8 @200S 321 Henderson Reeeivablcs Limited Parbtership . . 17. Your SDOUse. 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 saDIe 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. Yau and Your spouse fully understand the terms of the Purchase Agreement and understand that the sate 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 As!reement. This Agreement and the Exhibits and other documents You signed make up the entire understanding and agreement between Yau 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 Buver. 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 AooTOval. You understand that court approval is required for this transfer. You agree to cooperate with us to obtain such court approval. 2\. Exhibits. Attached to this Purchase Agreement are the following Exhibits: Exhibit "A" 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 RECEIVABLES LIMITED PARTNERSHIP ~IGN HERE I Spouse .... Sworn to and su~ibed before me this ~ day of ~c~, 200U2.. Notary F PENNSYL\\ NolBriaI SeIlI 1lIIInny J. M~.t::;.=rblic ..r-;"~~RYnireRJune'~ 9 @2OGS 321 Henderson Receivables Limited Partnership . . Exhibit A We are hereby purchasing from You under the Annuity; A) 90 Monthly payments ofSSOO.OO each, beginning on 3/24/2006 and ending on 8/24/2013 S~y~ ~IGN HERE I STATEOF Y\=\ : COUNTY OF~~~W: On this ~day of N\9-rC'" , 200k, before me, the above signed personally appeared before me, personally known to me to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed it. '-~~ Notary ~ENNS~'V~1A G NobIria1 SoaI ,... J. ~oIIIyPub\k: ~'~~7 ~. PennSy\VlIlII8 Ass<Jclo1Ion 01 N_ . . SCHEDULE 1 DffiCLOSURESTATEMENT 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 TIDS 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) 90 Monthly payments of $500.00 each, beginning on 3/24/2006 and ending on 8/24/2013 THE AGGREGATE AMOUNT OF THE PURCHASED PAYMENTS IS $45,000.00. THE DISCOUNTED PRESENT VALUE OF THE AGGREGATE PAYMENTS AT 5.40% IS $36,904.37, 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 $30,000.00. 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 $30,000.00. NO OTHER EXPENSES ARE INCURRED BY YOU. . . SCHEDULE 1. PAGE 2 mE DISCOUNTED PRESENT VALUE OF PAYMENTS SHALL BE CALCULATED AS FOLWWS: THE APPLICABLE FEDERAL RATE USED IN CALCULATING mE DISCOUNTED PRESENT VALUE IS 5.40%. THE EFFECTIVE ANNUAL DISCOUNT RATE FOR mIS TRANSACTION IS 11.80%. THE CASH PAYMENT YOU RECEIVE IN mIS TRANSACTION FROM US WAS DETERMINED BY APPLYING mE SPECIFIED EFFECTIVE ANNUAL DISCOUNT RATE, COMPOUNDED MONTHLY, TO mE TOTAL AMOUNT OF FUTURE PAYMENTS TO BE RECEIVED BY US, LESS mE TOTAL AMOUNT OF COMMISSIONS, FEES, COSTS, EXPENSES AND CHARGES PAYABLE BY YOU. THE NET AMOUNT THAT YOU WILL RECEIVE FROM US IN EXCHANGE FOR YOUR FUTURE STRUCTURED SETTLEMENT PAYMENTS REPRESENTS 81.30% OF THE ESTIMATED CURRENT VALUE OF THE PAYMENTS BASED UPON mE DISCOUNTED VALUE USING mE APPLICABLE FEDERAL RATE, THE QUOTIENT OBTAINED BY DIVIDING THE NET PAYMENT BY mE DISCOUNTED PRESENT VALUE IS 81,30%. BASED ON THE NET AMOUNT THAT YOU WILL RECEIVE FROM US AND THE AMOUNTS AND TIMING OF mE STRUCTURED- SETTLEMENT PAYMENTS mAT YOU ARE TURNING OVER TO US, YOU WILL, IN EFFECT, BE PAYING INTEREST TO US AT A RATE OF 11.80% PER YEAR. THE NET AMOUNT PAID TO YOU (mE PAYEE) BY US (THE TRANSFEREE) REPRESENTS AN ESTIMATE OF mE 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. WRI'ITEN 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 WIDCH CANCELLATION IS TO BE RETURNED: 321 HENDERSON RECEIVABLES LIMITED PARTNERSHIP 2215-B RENAISSANCE DRIVE SUITE 5 LAS VEGAS, NY 89119 ATTENTION: VICE PRESIDENT - OPERATIONS IMPORTANT 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. JL~ <lION HERE I . . Txhibit "T" . . 321 HENDERSON RECEIVABLES LIMITED PARTNERSHIP March 17, 2006 Nationwide Life Insurance Co F/k/a Employers Life Insurance Company OfWausau P.O. Box 182290 Columbus, OH 43218-2290 Attn; Legal Department/Structured Settlements Nationwide Mutual Insurance Company One Nationwide Plaza Columbus, OH 43215 Attn; Legal Department/Structured Settlements RE: Notice of Sale/Assignment of Payment Rights Your Contract #; 000001874 Payee: Scott Hadbavn SS #: 222-62-8751 Dear Insurer; Please be advised tbat 321 Henaemf1 Receivables Lintited Partnershipandlorits successors ~d assigns, have entered into a transaction with the abo~ annuitant who is seeking to @ transfer certain ofhislher 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 h.....!", statute. Pursuant to the statute, please note the fullowing information about the Purchaser: \ ) 321 Henderson Receivabfes Liprit'id)'~CJship 40 Morris Ave Bryn Mawr PA 19010 Tax ID #88-0513164 ~ASE NOTE; No payments under this ammity should be held until the courts have entered a . finaI order and we have forwarded this order to you. . Very truly yours, 321 Henderson Receivables Limited Partnership ~ . "" "."'" r.......Q... 2215-B RENAISSANCE DRlVE . suite 5 . LAS VEGAS, NV 89119 PHONE: 800-454-9368. FAX: (215) 567-7525. E-MAIL: TGWiIllTGWFlJNDING.COM WRR flTTF.. WWW Tr.W1>1l1\JT)TNr.. rnu - . VERIFICATION I verifY that the statements made in the foregoing Petition for Partial Transfer of Structured Settlement are true and correct to the best of my understanding and belief. I understand that false statements herein are made subject to the penalties provided by 18 Pa. CSA, Section 4904, relating to unsworn falsification to authorities. Date: L('0'Oy, ~uu Scott A. Had~ ~ . CERTIFICATE OF SERVICE I HEREBY CERTIFY that thi~~ay of April, 2006 I have served a true and correct copy of the foregoing Petition for Partial Transfer of Structured Settlement, by first class mail, return receipt requested, upon: Nationwide Life Insurance Company P.O. Box 182290 Columbus Ohio 43218-2290 Attn: Structured Settlements (annuity issuer) Nationwide Mutual Insurance Company One Nationwide Plaza Columbus, OH 43215 Attn: Legal Department! Structured Settlements (settlement obligor) 321 Henderson Receivables Limited Partnership 40 Morris Avenue BrynMawr,PA 19010 ( transferee) LAW OFFICES of JOHN M. GLACE . lace, Esquire Walnut Street s ,PA. 17101-1612 717) 238-5515 tification No. 23933 Counsel for Petitioner fZ) '6q It 10 Crj '--- vt ' " ~ --.) D -- r P:! 1: --'-!:- -- c' ~ v, r Q, . ,~ ~~, e . ) IN THE COURT of COMMON PLEAS of CUMBERLAND COUNTY, COMMONWEALTH ofPENNSYLV ANIA In Re: SCOTT A. HADBA VNY, Petitioner : No. die - ;).31-1'1 C'ul'L Y ~ Petition for Transfer of Structured Settlement RULE t\\ AND NOW this , day ofl'\~'t ~ 2006, upon due consideration of the attached Petition for Partial Transfer of Structured Settlement Pursuant to the Structured Settlement Protection Act, 40 Pa. C.S.A. Section 4000, et seq., a RULE is hereby issued on Nationwide Insurance Company and its assigns and 321 Henderson Receivables, LP to show cause why said petition should not be granted. RULE RETURNABLE FOR HEARING the C{" 'tI-. day of ~ ' 2006 at 1\ :VD lLM in Courtroom Number..s of the Cumberland Co ty Courthouse, I Courthouse Square, Carlisle, Pennsylvania17013. BY THE COURT: ~ /"'." VlN\f^lASNN3d MNnm r'''1\f1H:::8~'-lno L +J :6 W~ g- AVW 900Z AtNl.ONOHl08d 3Hi :lO 3::ll:J:\o-G311:l ~ IN THE COURT of COMMON PLEAS of CUMBERLAND COUNTY, COMMONWEALTH ofPENNSYLV ANIA In Re: SCOTT A HADBA VNY, Petitioner No. 2006 - 2344 CIVIL TERM Petition for Transfer of Structured Settlement Order "t'" AND NOW this 1.. ~ day of :r -.J f\ t... , 2006, after due consideration of e Petition of Scott A. Hadbavny for transfer of structured settlement payments p uant to Act 200-1 ( 40 Pa Cs 4000 et seq.), makes the below findings and issues the bel w Order. The interested parties to this Action as defined by 40 Pa CS 4002 are as foll ws: 1. Scott A. Hadbavny (succeeding his deceased brother Daniel Hadbavny) 155 Salem Church Road, Lot # 22 Mechanicsburg, P A 17050 2. tructured Settlement Obligor: Nationwide Insurance Company One Nationwide Plaza Columbus, OH 43215 Attn: Structured Settlements 3. 321 Henderson Receivables Limited Partnership 40 Morris Avenue Bryn Mawr, PA 19010 This oUIt hereby makes the following findings: 1. The transfer sought to be approved complies with the requirements of the Structured Settlement Protection Act, 40 Pa CS Section 4000 et seq. and will not contravene any applicable law; and 2. Not less than ten (10) days prior to the date<)n which Petitioner first incurred ~ any obligation with respect to the Transferee, 321 Henderson Receivables Limited Partnership, said Transferee has provided to Petitioner Scott A. Hadbavny a dis- closure statement as required by Pennsylvania Statute at 40 Pa CS 4oo3(a)(2); and 3. The transfer does not contravene any Federal or state statute or the Order of any Court or administrative authority; and 4. The best interests Scott A. Hadbavny are served by grant of this Petition; and 5. 321 Henderson Receivables Limited Partnership has served written notice including its name, address, and tax identification number to the structured settlement obligor and has served written notice as required by Pennsylvania Statute 40 Pa CS 4004 upon all interested parties, none of whom has tendered objection to the transfer. BASED on the foregoing findings, it is hereby ORDERED and DECREED that transfer of the structured settlement payment rights, as described in the purchase ent attached to this petition is hereby approved and no other party to this eeding shall hereafter refuse to honor this approved transfer. Nationwide Insurance Company, Structured Settlement Obligor, is hereby orized to remit the assigned payments payable to Scott Hadbavny to the following ss: 321 Henderson Receivables Limited Partnership 40 Morris Avenue BrynMawr,PA 19010 The Transferee shall be liable to the Structured Settlement Obligor and Annuity Iss er: 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 eficiary for the transferred payments to the Transferee and no other individual or other than the Transferee shall have the authority to change beneficiary for the ferred Payments. . This Order is entered without prejudice to Nationwide Insurance Company and the Court makes no finding relative to any enforceability of any nonassignment . sion(s) contained in the original settlement agreement or related documents. This er in no way modifies or negates the ownership or control of the underlying contract tionwide Insurance Company. By the Court: \i~dt M.L. Ebert, Jr. , J. ~ G-- ~ ~ l'\- ~~ ~i 1 () ~~ .--:.,; r-__1 ~~::::;) '-<.:~) c.,"~ C) -n .... fl"1:D r-- r", (j-, " '.' - .. N c..< 1.- .....,.. IN THE COURT of COMMON PLEAS of CUMBERLAND COUNTY, COMMONWEALm ofPENNSYLV ANIA : In Re: SCOTI' A HADDA VNY, Petitioner No. (I(i - 2344 CML TERM . . Petition for Transfer of Structured Settlement Order '"' AND NOW this 'l.' day of 1",) \ 'f ' 2006, after due consideration of the Petition of Scott A. Hadbavny for transfer of structured settlement payments pursuant to Act 200-1 ( 40 Pa Cs 4000 et seq.), makes the below findings and issues the below Order. The interested parties to this Action as defined by 40 Pa CS 4002 are as follows: 1. The Payee: Scott A. Hadbavny (succeeding bis deceased brother Daniel Hadbavny) 155 Salem Church Road, Lot # 22 Mechanicsburg, P A 17050 2. Structured Settlement Obligor: Nationwide Insurance Company One Nationwide Plaza Columbus, OH 43215 Attn: Structured Settlements 3. Transferee: 321 Henderson Receivables Limited Partnersbip 40 Morris Avenue BrynMawr,PA 19010 This Court hereby makes the following findings: 1. The transfer sought to be approved complies with the requirements of the Structured Settlement Protection Act, 40 Pa CS Section 4000 et seq. and will not contravene any applicable law; and 2. Not less than ten (10) days prior to the date on which Petitioner first incurred any obligation with respect to the Transferee, 321 Henderson Receivables Limited Partnership, said Transferee has provided to Petitioner Scott A. Hadbavny a dis- closure statement as required by Pennsylvania Statute at 40 Pa CS 4OO3(a)(2); and ~. ~ - .. 3. The transfer does not contravene any Federal or state statute or the Order of any Court or administrative authority; and 4. The best interests Scott A. Hadbavnyare served by grant of this Petition; and 5. 321 Henderson Receivables Limited Partnership has served written notice including its name, address, and tax identification number to the structured settlement obligor and has served written notice as required by Pennsylvania Statute 40 Pa CS 4004 upon all interested parties, none of whom has tendered objection to the transfer. BASED on the foregoing findings, it is hereby ORDERED and DECREED that the transfer of the structured settlement payment rights, as described in the purchase agreement attached to this petition is hereby approved and no other party to this proceeding shall hereafter refuse to honor this approved transfer. Nationwide Insurance Company, structured settlement obligor is hereby authorized to remit the following: ninety (90) monthly payments of five hundred ($500.00) dollars each, beginning on March 24, 2006 and ending on August 24, 2013 being the assigned partial payments payable to Scott Hadbavny to the following address: 321 Henderson Receivables Limited Partnership P.O. Box 7780-4244 Philadelphia, PA 19812-4244 This Order is entered without prejudice to Nationwide Insurance Company and the Court makes no finding relative to any enforceability of any nonassignment provision(s) contained in the original settlement agreement or related documents. This Order in no way modifies or negates the ownership or control of the underlying contract of nationwide Insurance Company. By the Court: \ ~ lk\~ ... , M. L. Ebert, Jr. ,J. \ -Ot, ("\ -.3 0"1