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COURT OF COMMON PLEAS
CUMBERLAND COUNTY
CIVIL DIVISION
No. C(,. - sll.. '1 e;oLL /&...~
~.
DOUGLAS E. MADE
1045 Eppley Road
Mechanicsburg, PA 17055
(717) 691-5624
Joint Petitioner, pro se
LAW OFFICES OF MICHAEL A. GREEN, P.c.
By: Michael A. Green, Esquire
LD. No. 73450
1831 Chestnut Street Suite 300
Philadelphia, P A 19103
(215) 972-5520
Attorney for Joint Petitioner Stone Street Capital, Inc.
IN RE: TRANSFER OF STRUCTURED
SETTLEMENT PAYMENT RIGHTS BY
DOUGLAS E. MADE
JOINT PETITION FOR COURT APPROVAL OF A
TRANSFER OF STRUCTURED SETTLEMENT PAYMENT RIGHTS
TO THE HONORABLE JUDGES OF THIS COURT:
Petitioners DOUGLAS E. MABE and STONE STREET CAPITAL, INC. hereby jointly
petition this Honorable Court for approval of a transfer of structured settlement payment rights
pursuant to the Pennsylvania Structured Settlement Protection Act, 40 P.S. ~ 4001 et. seq. (the
"Act"), and in support thereof state as follows:
1. Douglas E. Mabe (hereinafter "Mabe" or "Payee") is an adult individual who
resides at 1045 Eppley Road, Mechanicsburg, Cumberland County, PA 17055.
2. Stone Street Capital, Inc. ("Stone Street") is a Pennsylvania corporation, which
has a primary place of business at 7316 Wisconsin Avenue, Fifth Floor, Bethesda, MD 20814
and bears a tax identification number of23-2617276.
3. By the terms of a 1988 personal injury settlement (the "Settlement"), Mabe
became entitled to receive periodic payments.
Annuitv No. 1476007
-,
4. The structured settlement obligor is St. Paul Travelers Companies, Inc., successor
in interest to United States Fidelity and Guaranty Company ("St. Paul Travelers" or "Obligor").
5. Pursuant to the Settlement, the Obligor purchased two annuities to fund the
settlement: annuity contract numbers 1476007 and 1476008 (the "Annuities") from Fidelity and
Guaranty Life Insurance Company ("FGLIC" or "Annuity Issuer"), naming Mabe as annuitant.
6. Pursuant to the Annuities, FGLIC makes the Periodic Payments required of the
Obligor pursuant to the Settlement directly to the Payee.
7. Pursuant to the Settlement and Annuities, Mabe became entitled to receive the
following guaranteed Periodic Payments:
. $11,207.00 on February 1, 1993;
. $17,846.00 on February 1, 1998;
. $25,620.00 on February 1,2003;
· $36,780.00 on February 1,2008;
. $51,706.00 on February 1,2013;
. $70,179.00 on February 1,2018;
. $92,593.00 on February 1,2023;
· $119,304.00 on February 1,2028; and
. $150,102,00 on February 1,2033.
Annuitv No. 1476008
· $700.00 per month, beginning on February I, 1988, increasing at 3% per year
for life with forty years guaranteed;
(the "Periodic Payments.")
8. Mabe, desiring to receive a lump sum payment in lieu of a portion of the Periodic
Payments he would otherwise receive pursuant to the Settlement and Annuity, has agreed to
transfer to Stone Street and its successors and assigns the following Periodic Payments:
· All but One Thousand and 00/100 Dollars ($1,000.00) of monthly payments
of One Thousand One Hundred Ninety and 70/100 Dollars ($1,191.70)
increasing 3% each February beginning with the payment on November I,
2
2006 through and including the final payment on October 1, 2021 (from
annuity contract number 1476008);
. Thirty six thousand seven hundred eighty dollars and 00/100 ($36,780.00) due
and payable on February 1,2008 (from annuity contract number 1476007);
. Fifty one thousand seven hundred six dollars and 00/100 ($51,706.00) due and
payable on February 1,2013 (from annuity contract number 1476007); and
. Seventy thousand one hundred seventy nine dollars and 00/100 ($70,179.00)
due and payable on February 1,2018 (from annuity contract number
1476007).
-"
(sometimes the "Assigned Payments").
10. On July 27, 2006, Mabe executed a Periodic Payment Right Purchase Agreement
(defined as a "Transfer Agreement" under 40 P.S. ~ 4002) to effect the transfer of the Assigned
Payment. A true and correct copy of the Transfer Agreement and amendment thereto is attached
and incorporated as Exhibit A.
II. Stone Street timely provided to Mabe a Disclosure Statement, as required by 40
P.S. ~ 4003 (a)(2), more than ten days prior to the date on which the Payee was first to incur any
obligation with respect to the transfer. A true and correct copy of the Disclosure Statement and
amendment thereto is collectively attached and incorporated as Exhibit B.
12. The aggregate total of the Assigned Payments is: Two hundred fifty thousand six
hundred twenty one dollars and 93/100 ($250,621.93)
13. The gross payment to Payee is One hundred two thousand four hundred forty
seven dollars and 00/100 ($102,447.00).
14. The net payment to Payee is Nine hundred ninety nine thousand nine hundred
forty seven dollars and 00/100 ($99,947.00).
15. The Payee has been provided with the required "IMPORTANT NOTICE" in the
form and manner prescribed by 40 P.S. ~ 4003 (3)(b). A true and correct copy of the notice is
attached hereto and incorporated as Exhibit C.
3
19. The transfer complies with the requirements of 40 P.S. ~ 4001 et sea. and does not
-.
16. The Payee has duly executed a separate written acknowledgment which
acknowledges he has received independent legal advice regarding this transaction from Mark W.
Allshouse, Esquire. A true and correct copy of the acknowledgment is attached and incorporated
as Exhibit D.
17. Timely written notice of the transfer and the transferee's name, address, and
taxpayer identification number for each annuity was given to the Annuity Issuer and the Obligor.
True and correct copies of the Notices of Assignment are attached collectively and incorporated
as Exhibit E.1
18. Additionally, the Annuity Issuer and Obligor have also been timely provided with
a copy of the instant Petition, the exhibits hereto, and the proposed form of Order. See
Certificate of Service attached hereto.
contravene any other applicable federal or state statutes or the order of any court or responsible
administrative or govermnental authority or any applicable law limiting the transfer of workers'
compensation claims.
20. Mr. Mabe is umnarried and has one dependent, his daughter Brittany Mabe, aged 14.
21. The transfer is in the best interest of the Payee, taking into account the welfare
and support of his dependents.
I Stone Street has subsequently assigned its interest in this transaction to Stone Street Settlement Funding, LLC
("SSSF"), 39121 Treasury Center, Chicago, IL 60694-9100, tax identification number 20-3369290. The Stone
Street-SSSF transfer will not affect Mr. Mabe in any way.
4
<
WHEREFORE, having satisfied all applicable statutory requirements for the transfer of
the structured settlement payment rights identified in this Petition, Petitioners respectfully
request that this Honorable Court grant the instant Petition and enter the attached Order.
Respectfully submitted,
DOUGLAS E. MADE
k,,'-~ -~ ~
Douglas ~
Pro se
LAW OFFICES OF MI
P.C,
Michael A. Gree
Attorney for Petitioner Stone Street Capital, Inc.
5
.
VERIFICATION
I, Douglas E. Mabe, verify and state that the facts contained in the foregoing Joint
Petition for Approval of a Transfer of Structured Settlement Payment Rights and the exhibits
thereto are true and correct to the best of my knowledge, information and belief. I make this
Verification subject to 18 P A. C.S.A. 9 4904, relating to penalties for unsworn falsification to
authorities.
)~~ ~ vv-k
Douglas . abe
VERIFICATION
I, John Ryan, am President and Chief Operating Officer of the Structured Settlement
Division of Stone Street Capital, Inc. I am familiar with the file that Stone Street Capital, Inc.
maintains for Douglas E. Mabe and I am authorized to make this Verification.
I verify and state that the facts contained in the foregoing Joint Petition for Approval of a
Transfer of Structured Settlement Payment Rights and the exhibits thereto are true and correct to
the best of my knowledge, information and belief. I make this Verification subject to 18 P A.
C.S.A. 9 4904, relating to penalties for unsworn falsification to authorities.
Date: a/id
l!
7
CERTIFICATE OF SERVICE
I, MICHAEL A. GREEN, ESQUIRE, certify that I caused to be served a true and correct
copy of the foregoing Petition for Approval of a Transfer of Structured Settlement Payment
Rights, the exhibits thereto and proposed form of Order, this rday of 4vF~
2005, via certified mail, return receipt requested, upon the following:
Douglas E. Mabe
1045 Eppley Road
Mechanicsburg, PA 17055
Service of Process Coordinator
St. Paul Travelers Companies, Inc.
385 Washington Street, MC 515A
St. Paul, MN 55102
Fidelity and Guaranty Life Insurance Company
100 I Fleet Street
Baltimore, MD 21202
8
to
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. .S~~St~~
Amendment to Purchase, Transfer and Assignment Agreement
("Amendment")
On our about July 6, 2006, Douglas E, Mabe (referred to as "you" or "your"), executed a Purchase,
Transfer and Assignment Agreement (hereafter the "Agreement"), which is a contract between you and
Stone Street Capital, Inc. its successors and/or assigns ("Stone Street" or "we," "us", or "our"). a
Pennsylvania Corporation. After that time, you and Stone Street have agreed to amend certain key
tenns of the contract. The purpose of this Amendment is to set forth the new tenns under which you
agree to sell us your structured settlement payments. The Date of this Amendment is August 15,2006.
SUMMARY OF KEY TERMS:
Instead of the payments originally set forth in your Agreement, you agree to sell, and Stone Street agrees
to purchase the following payments:
All but One Thousand and 00/100 Dollars ($1,000,00) of monthly payments of One Thousand One
Hundred Ninety-One and 70/100 Dollars ($1,191.70) increasing 3% each February beginning with
the payment on November 1, 2006 through and including the tinal payment on October 1, 2021; plus
one (1) lump sum payment of Thirty-Six Thousand Seven Hundred Eighty and 00/100 Dollars
($36,780.00) due and payable on Febl1lary 1,2008; plus one (1) lump sum payment of Fifty-One
Thousand Seven Hundred Six and 00/100 Dollars (S51 ,706.00) due and payable on February 1,2013;
plus one (1) lump sum payment of Seventy Thousand One Hundred Seventy-Nine and 00/100 Dollars
($70,179.00) due and payable on February 1,2018 ("the Assigned Payments")
Instead of the payments originally set forth in your Agreement, you have agreed to accept the following
purchase price in exchange for the Assigned Payments:
$102,447.00 (the "Purchase Price")
Addendum to Disclosure Statement. Along with this Amendment, we have also provided you with a
copy of an Addendum to Disclosure Statement. Among other things, the Disclosure Statement describes
the fees that you will be responsible for at the time of funding. The tenns set forth of the Disclosure
Statement and the Addendum to the Disclosure Statement are considered a part of this Agreement. You
agree that you had the opportunity to read and review the Disclosure Statement and the Addendum to
Disclosure Statement, and that you agree to its tenns.
Other Terms of Your Al!reement. Other than changes to the Assigned Payments and the Purchase
Price as set for above, all other terms and conditions in your Agreement with Stone Street Capital shall
remain in full force and effect, and by signing below you represent and promise to Stone Street Capital
that you are not aware of any breach or violation of the Agreement as of the date hereof.
By signing below, the parties agree to be bound to the tenns of the agreement, including the provisions
set forth in the Terms and Conditions attached hereto and incorporated herein by reference.
SELLER:
f)r,~ ~~
Douglas Mabe
75 . ('8'16G
STONE~f\~ILTAL'I~C:
By: ~
David M. Lewis, Senior Vice President
.stonestreet
Capital
PuRCHASE, TRANSFER AND AsSIGNMENT AGREEMENT
This Purchase, Transfer and Assignment Agreement, which along with the Terms and Conditions
attached hereto is referred to herein as the "Agreement", is a contract between Stone Street Capital, Inc:
its successors and/or assigns ("Stone Street" or "we," "us", or "our"), a Pennsylvania Corporation, and
Douglas E. Mabe (referred to as "you" or "your'~. The purpose of this Agreement is to set forth the
terms of a legally binding contract where you agree to sell us your structured settlement payments.
SUMMARY OF KEY TERMS:
You agree to sell, and Stone Street agrees to purchase the following payments:
All but One Thousand and 00/100 Dollars ($1,000.00) of monthly payments of One Thousand One
Hundred Ninety and 70/100 Dollars ($1,190.70) increasing 3% each February bq;iuning with the
payment on November 1, 2006 through and including the final payment on October 1, 2021; plus one
(1) lump sum payment of Thirty-Six Thousand Seven Hundred Eighty and 00/100 Dollars
(536,780.00) due and payable on February 1, 2008; plus one (1) lump sum payment of Fifty-One
Thousand Seven Hundred Six and 00/100 Dollars (551,706.00) due and payable on February 1,2013;
plus one (1) lump sum payment of Seventy Thousand One Hundred Seventy-Nine and 00/100 Dollars
($70,179.00) due and payable on February 1,2018 ("the Assigned Payments")
You have agreed to accept the following purchase price in exchange for the Assigned Payments:
-+- hi"" <Ai c.kl!.c.:J( f<ir r'"I./t, :r~5
$102,447.00 (the "Purchase Price") . .11 I.}o-' I
ft..e~<.. c..",>JR.rS"\.'i-i~ c.i'\ ~J:;;t'-06 h..
Disclosure Statement. To comply with state and federal law, we gave you a Disclosure Statement that\-
explained the financial terms of this Agreement. Among other things, the Disclosure Statement
describes the fees that you will be responsible for at the time of fimding. The terms set forth of the
Disclosure Statement, including any later amendments to the document, are considered a part of this
Agreement. You agree that you had the opportunity to read and review the Disclosure Statement, and
that you agree to its terms.
Date of the Al!reement. The date of this Agreement is July 16,2006, and you have no obligation under
this Agreement before that date.
By signing below, the parties agree to be bound to the terms of the agreement, including the provisions
set forth in the Terms and Conditions attached hereto and incorporated herein by reference.
SELLER:
. ~o_~ o,,~
This foregoing ins ent was acknowledged before
me this ay of 200~ by Douglas E. Mabe,
who is ei (i) 0 wn m (ii) who
h pro
By:
<ro~rm~
David M. Lewis, Senior Vice President
otary Signature /J 1"1
Notary Public in and for the State of f/ /'7
My Commission Expires: -,:J
Page I
,
~
TERMS AND CONDITIONS
The purpose of this Terms Summary is to set forth additional terms of a legally binding contract where
you agree to sell structured settlement payments to Stone Street
Backgrouud
A. You (or someone acting on your behalf) settled a lawsuit or a claim sometime before the date
of this Agreement, and as a result of that settlement, you became entitled to receive payments
payable over time. The terms of that agreement are documented in a Settlement Agreement
or a similar document (the "Settlement Agreement"). The defendants or their insurers in
your lawsuit or claim assigned their obligation to make those payments to a third party, the
Settlement Obligor (the "Obligor"). The Settlement Obligor purchased an annuity (the
"Annuity") from an insurance company (the "Issuer") to make sure that you would receive
the payments according to the terms of the Settlement Agreement. You are entitled to
receive payments from the Annuity.
B. You have decided that receiving your payments according to the timetable set forth in the
Settlement Agreement does not satisfy your financial needs. After thinking about other ways
of addressing your financial situation, you have decided to sell some of your payments to
Stone Street in exchange for a cash payment.
1. The Sale and Purchase. You agree to sell the settlement payments identified as the "Assigned
Payments" on the Summary of Key Terms to which this Terms Summary was attached. Stone Street
agrees to pay you, and you agree to accept, cash in the amount identified as the "Purchase Price" stated
on the Summary of Key Terms to which this Terms Summary was attached
2. How the Purchase 'Price Will be Paid to You. We will pay you by any means you choose,
including an electronic wire transfer directly to your bank account or by check. If you elect an
electronic wire transfer, we will On1~~ payment to a bank account in your name.
PA-i 8j C.~L ~)
3 What Must HaDDen Beior Funifinl!:. Before the Assigned Payments are transferred to Stone
Street, a court must approve this Agreement. After court approval, there are additional conditions that
must be met before we can pay you your Purchase Price. First, the Issuer must acknowledge, in writing,
the receipt of a court order that: (a) directs the Obligor and Issuer to make the Assigned Payments to
Stone Street to the address and entity that we name; (b) makes all fmdings required by applicable law;
and (c) cannot be appealed. Second, we must confirm that all of your obligations under the Agreement
have been satisfied including providing us with all necessary documentation. Last, we must review the
transaction, the supporting documents, lien, judgment, bankruptcy and other searches to verify that there
is no right or condition that exists that would require us to terminate this Agreement. When these steps
are satisfied, your transaction will close and fund.
4. The PavmeDts We Do Not Buv. If you decided to sell us only a portion of your payments, this
Agreement does not affect the payments that you did not sell. You will continue to receive the unsold
portion of the payments unless those payments were previously sold, encumbered or subject to court
ordered garnishment or execution. In some cases, the court, the Obligor or the Issuer may require that
the entire structured settlement payment be paid to us, and, upon receipt, we shall remit the unassigned
portion of the structured settlement payment back to you. If such a circumstance arises in your
transaction, you agree to this payment servicing arrangement.
5. Other Documents. Stone Street will expeditiously and diligently work to get a court order
Page 2
approving this Agreement. To assist us in this process, you agree to execute additional documents that
may be required by the court, the Obligor or the Issuer. You agree to provide us with complete copies of
your Settlement Agreement and Annuity, and other documents necessary to complete the transaction.
6. You Own and Can SeD Your Pavments. We must establish that you own the payments that
you are selling to us, and that no one else could claim an interest in the Assigned Payments. Unless you
tell us in writing otherwise, you represent and promise to us that:
(a) You have the right to receive and sell the Assigned Payments;
(b) This Agreement does not conflict with any of your other obligations;
(c) The Assigned Payments are not subject to any community property or spousal rights of any
person;
(d) There is no dispute, lawsuit, or challenge relating to your right to receive the payments under
the Settlement Agreement;
( e) Neither you nor anyone else has sold, pledged or otherwise transferred the
Assigned Payments nor attempted to do so;
(f) No other person or business claims a security interest, lien, right, title, or interest of any kind
in the Assigned Payments;
(g) All applicable child support, alimony, and tax obligations are up to date;
(h) There are no unsatisfied judgments against you;
(i) You are not in bankruptcy; and
G) If one or more of these statements becomes untrue before the Purchase Price is paid to you,
you agree to notify us in writing. In all events, you authorize us to conduct credit checks,
judgment and lien searches, and criminal background searches to confirm that there are no
claims against the Assigned Payments.
7. Your Promises to Us. Stone Street is relying upon the statements you have made to us and the
documents you have provided regarding you, your situation, the payments you are receiving, and the
payments you are now selling, including the following:
(a) You completed and signed an application along with this Agreement, and the information
contained in the application is complete and correct;
(b) You believe that selling the Assigned Payments is in the best interest of you and your
dependents;
( c) You are 18 years of age or older, are of sound mind, not under the influence of drugs or
alcohol;
(d) You understand and agree that you are not considered a "consumer" in this transaction, and
that you waive the protection of various consumer protections laws;
(e) You understand that we are not assuming any of your obligations under the Settlement
Agreement, Annuity, Uniform Qualified Assignment or other related documents;
(f) You understand and agree to the terms of this Agreement;
(g) No one has forced you to sign this Agreement nor has anyone promised you anything other
than what is stated in this Agreement in an effort to persuade you to sign it.
8. IndeDendent Advisor. Before you sign this Agreement, you may wish to consult with an
independent advisor to seek legal, financial or other expert advise regarding the legal, financial,
and tax consequences of this Agreement. By'signing this Agreement, you acknowledge that Stone
Street has advised you of this right in writing.
9. Deductions from the Purchase Price. We will deduct from your Purchase Price any fees that
are set forth on your Disclosure Statement. In addition, you may have elected to sell payments to pay
off debts, liens, and past due obligations. If you owe back taxes, past due child support, or have
judgments or liens recorded against you or your assets, we may require that some of those debts, claims,
Page 3
.
or liabilities be paid at the time the transaction is funded. If it is reasonably necessary to pay certain
debts before funds are released to you so that the Assigned Payments are not subject to such debts, Stone
Street will pay those debts for your account and deduct the payment from your Purchase Price.
10. Payments Received Before FundiBl~. You acknowledge that it may take some time for the
Obligor and Issuer to receive and process the court order. Accordingly, you could receive payments that
were supposed to be sold to Stone Street. If you receive some payments before we pay you the
Purchase Price, the amount of payments received by you will be deducted from the Purchase Price.
11. Amount Heldback from Purchase Price. As set forth above, it may take the Obligor and
Issuer some time to process the court order. We may withhold an amount from the Purchase Price equal
to the amount of the payments to be paid within two to six months of the closing (depending upon the
insurer and its practices). When the Assigned Payments begin to be received by Stone Street, the
am?unt ~thheld will be released to yo~ less the amount of any payments Pai)over to you in error
whi).e the msurlWce company was proc~ssm~ the addres~ chanie. I ~(d' . v'At.. ~ ~
ret.. f'V\ /<-1 -:r "..,..t"J ND~ ,N'J ("..,Il/ 10 ~ re , <.> U ,,_.? iO -18 b
12. Receiyinl!: Payments In Error. The Obligor and Issuer may send an Assigned Payment to you
in error. In the event that you receive a payment that you have sold to Stone Street, you agree to hold
those payments in trust and immediately turn them over to Stone Street.
13. Limited Power of Attomev. Some insurance companies will continue to make the Assigned
Payments payable in your name after the transaction is closed. You hereby grant Stone Street, or its
successors, assigns or agents, an irrevocable limited "power of attomey" granting us the right to cash
these checks and to deposit the money into our collection account.
14. Chanl!:es in the Terms of your Structured Settlement by the Issuer. From time to time,
insurance companies have financial problems that cause them to be placed in receivership,
rehabilitation, liquidation or subject them to other similar proceedings. As a result, the payments paid
under your structured settlement could be reduced. If the payments are reduced, you agree that the
reduction is first taken from any payments that we did not purchase. Also, if there is a payment from an
insurance fund benefit to make up for the reduction, the payment is first distributed to make up for any
deficiency in the Assigned Payments so that Stone Street is made whole. After we are made whole, the
remaining insurance fund payment shall be attributed to payments that Stone Street did not purchase.
15. Grant of Securitv Interest. You intend to sell and Stone Street intends to purchase your rights,
title and interest in and to the Assigned Payments. This Agreement is not a loan. Subject to the court's
approval of the sale, you grant to Stone Street a security interest under Article 9 of the Uniform
Commercial Code in your rights and interest in the Assigned Payments. These rights have been
assigned to Stone Street as a payment intangible or general intangible under Article 9 of the Uniform
Commercial Code. This Agreement shall function as a security agreement, and the security interest
secures payment of the rights assigned and performance of your obligations under this Agreement. In
the event that the transaction is for any purpose characterized as a loan, a financing or extension of
credit or anything other than a true sale by any court, you grant us a security interest and all rights of a
secured party lender under the Uniform Commercial Code. We may file a UCC-I financing statement or
continuation statement evincing and perfecting our rights in the jurisdictions that we deem appropriate.
16. Testamentary Al!:reement. If you should die prior to the due date of the last Assigned Payment,
Stone Street will continue to receive the Assigned Payments on the dates set forth in the Summary of
Key Terms. You are giving up your rights to the Assigned Payments, and the rights of your heirs,
successors, beneficiaries, and/or any other person claiming by, through or under you. Accordingly, this
Agreement is a Testamentary Agreement in which you irrevocably agree to name Stone Street or its
Page 4
assigns as the party that will inherit the Assigned Payments upon your death. You understand that you
no longer have the power to amend, modify, alter or otherwise change this beneficiary designation.
Also, you agree to sign a form designating Stone Street as the sole beneficiary under the Annuity during
the term of the Assigned Payments.
17. Restrictions on Assilmment. Your Settlement Agreement may contain language prohibiting
your right or power to accelerate, defer, increase, decrease or assign your payments. You hereby waive
and release any such restriction if your Settlement Agreement or the Annuity contains this or similar
language, As such, you understand and agree that you will never claim or assert that the payments you
are now selling were not transferable, or that this language renders this Agreement void.
18. Arbitration. Any claim or dispute ("Claim") by either you or us against the other, or against the
employees, agents, successors or assigns of the other, arising from or relating in any way to this
Agreement or any prior agreement (whether under a statute, in contract, tort, or otherwise and whether
for money damages, penalties or declaratory or equitable relief) including Claims regarding the
applicability of this arbitration clause or the validity of the entire Agreement or any prior agreement,
shall be resolved by binding arbitration. The arbitration shall be conducted by National Arbitration
Forum (''NAF'') under the Code of Procedure in effect at the time the Claim is filed. NAP Rules and
forms may be obtained and Claims may be filed at any NAP office, www.arb-forum.com. or at PO Box
50191, Minneapolis, Minnesota 55405, telephone (800) 474-2371. We or you may, upon approval of
the other, substitute another nationally recognized, independent arbitration organization that uses a
similar code or procedure. This arbitration agreement is made pursuant to a transaction involving
interstate commerce, and shall be govemed by the Federal Arbitration Act, 9 U.S.C. ~~ 1-16 ("FAA").
Any arbitration award shall be final, and judgment upon the award may be entered in an court having
jurisdiction. No Claim submitted to arbitration is heard by a jury, and no Claim may be brought as a
class action or as a private attorney general. You do not have the right to act as a class representative or
participate as a member of a class of claimants with respect to any Claim. I KNOWINGLY,
INTENTIONALLY AND VOLUNTARILY WAIVE MY RIGHT TO A JURY TRIAL UNDER TIllS
AGREEMENT.
19. Construction of this Aereement. All of the headings contained in this Agreement are for
convenience only. They are not part of this Agreement, and that shall not affect its meaning,
construction or interpretation. This Agreement, the Disclosure Statement, and the attached exhibits
make up the entire agreement between you and Stone Street and replace all prior arrangements and
understandings, written or spoken. If we amend this Agreement, the terms of the amendment shall
control over terms that set forth herein.
20. Severabilitv. Should any provisions of this Agreement is held to be invalid, illegal,
unenforceable or in conflict with the law of any jurisdiction, that provisions shall be deemed to be
modified to the extent necessary to render it lawful and enforceable. If such a modification is not
possible, that provisions shall be severed from the Agreement and shall not in any way affect or impair
the validity, legality and enforceability of the remaining provisions in this Agreement.
21. Future Assil!Dment Bv Stone Street. Stone Street (and any future assignee) may assign all of
its right, title, and interest in and to this Agreement, the other related docwnents, the Annuity, and the
Assigned Payments either before or after the closing and without any requirement of prior consent from
or notice to you.
22. Annlicable Law. Except as otherwise required by applicable statutory law, this Agreement shall
be governed by and interpreted in accordance with the law of the jurisdiction where we sought court
approval of this Agreement.
Page 5
AUTHORIZATION TO RELEASE INFORMATION
To Whom It May Concern:
You are hereby authorized to release any information which I am entitled to
receive regarding my structured settlement annuity. This authorization specifically
applies to any insurance company who is the issuer or owner of the structured settlement
annuity from which I currently receive certain periodic payments.
This authorization also applies to any attorney, law firm, settlement broker, court
clerk or insurance company that may have copies of any settlement agreement, release or
similar document that I executed, or was executed for my benefit, that is related to the
above referenced structured settlement annuity.
This authorization also applies to all creditors, including any child support
agency, taxing authority, and structured settlement purchasing company, to whom I am
currently indebted or have been indebted to in the past. This authorization specifically
authorizes those creditors to discuss and/or divulge in writing any outstanding debt I owe.
This authorization is for the specific use by Stone Street Capital, Inc. with its
principal place of business at 7316 Wisconsin Avenue, Suite 500, Bethesda, Maryland
20814, its successors and assigns.
A photocopy of this authorization shall be considered as the original.
~o~t, '- "'~
Douglas E Mabe
Acknowledgement
The above person, known to me to be the person whose name is subscribed to this
instrument, personally appeared before me and acknowledged to me that he/she has read
this instrument and that the instrument has been executed by himlher. Given under my
hand this _ day of ,200_.
Notary Public
State of
Print Name Here:
My Commission Expires:
.
Douglas E. Mabe
To Whom It May Concern:
Please change your records to show the Estate of Douglas E. Mabe as the
beneficiary after my death under the above referenced annuity contract. Please confirm
this beneficiary change in writing at your earliest conveni~ce.
""'" yon ro.y"''''_ ''''':=>'1' Q ~
. ljc~T s
Acknowledllement
The above person, known to me to be the person whose name is subscribed to this
instrument, personally appeared before me and acknowledged to me that he/she has read
this instrument and that the instrument has been executed by him!her. Given under my
handthis~dayof J;L/f./ ,20oiL.
J}(l//$
lil otary Public
State of fft
Print Name Here: 8alhe flJJ3hoflSe.-
My Commission Expires: ,j-.2'I-,J()'Jfj
OF
NalarIIIs.I
SIIIe~lIha_p"~
c.nou ........
My CommIIIlon EllIlhS M8r. .2008
ADDENDUM TO DISCLOSURE STATEMENT
This Addendum to the Disclosure Statement dated August 15, 2006 (hereinafter
"Addendum") is made by and between STONE STREET CAPITAL, INC. ("Stone Street") and
Douglas E. Mabe ("Mabe").
RECITALS
WHEREAS, Mabe executed a Disclosure Statement on or about July 6, 2006 (hereinafter
"Disclosure Statement"); and
WHEREAS, the parties have mutually agreed to modify the tenns of the Disclosure
Statement by the execution of this Addendum;
NOW, THEREFORE, in consideration of the mutual promises set forth herein as well as
other valid consideration, the receipt and sufficiency of which is hereby acknowledged, the
parties agree as follows:
1. The recitals set forth above are hereby incorporated into this Addendum and made
a part hereof
2. Paragraph No. I of the Disclosure Statement pertaining to the amounts and due
dates of payments transferred is hereby corrected to read as follows:
I. Amounts and Due Dates ofPavments to be Transferred. You will
assign to Stone Street all of your right, title and interest in and to all
but One Thousand and 00/100 Dollars ($1,000.00) of monthly
payments of One Thousand One Hundred Ninety-One and 70/100
Dollars ($1,19..70) increasing 3% each February beginning with the
payment on November 1,2006 through and including the final
payment on October 1,2021; plus one (1) lump sum payment of
Thirty-Six Thousand Seven Hundred Eighty and 001100 Dollars
($36,780.00) due and payable on February 1, 2008; plus one (1) lump
sum payment of Fifty-One Thousand Seven Hundred Six and 001100
Dollars ($51,706.00) due and payable on February 1,2013; plus one
(1) lump sum payment of Seventy Thousand One Hundred Seventy-
Nine and 00/100 Dollars ($70,179.00) due and payable on February 1,
2018 out ofthose certain payments due under the Settlement
Agreement and Release.
3. Paragraph No.2 of the Disclosure Statement pertaining to the aggregate amount of
payments transferred is hereby corrected to read as follows:
J19171,OI
4. Gross Amount Pavable. The gross amount payable to you in
exchange for the transferred payments is One Hundred Two
Thousand Four Hundred Forty-Seven and 00/100 Dollars
($102,447.00).
2. Al!l!ret!:ate Amount of Pavments Transferred. The aggregate amount
of the payments to be transferred to Stone Street totals Two
Hundred Fifty Thousand Six Hundred Twenty-One and 93/100
Dollars ($250,621.93).
4. Paragraph No.3 of the Disclosure Statement pertaining to the Internal Revenue
Service Discounted Present Value is hereby corrected to read as follows:
3. Internal Revenue Service Discounted Present Value. The Internal
Revenue Service discounted present value of the payments to be
transferred is One Hundred Fifty-Nine Thousand Eight Hundred
Fifteen and 56/100 Dollars ($159,815.56) determined by discounting
the future payments to be transferred using a rate most recently
published for determining the present value of an annuity by the
Internal Revenue Service, which rate is 6.0%. This is a calculation of
the current value of the transferred structured settlement payments
under federal standards for valuing annuities. THIS IS NOT THE
RATE USED TO CALCULATE YOUR PURCHASE PRICE. It is
also not the market rate for transfers of annuity payments of
structured settlement payments.
5. Paragraph No.4 of the Disclosure Statement pertaining to the gross amount
payable is hereby corrected to read as follows:
6. Paragraph No.6 of the Disclosure Statement pertaining to the net amount payable
is hereby corrected to read as follows:
6. Net Amount Pavable. The net amount payable to you in exchange
for the transferred payments is Ninety-Nine Thousand Nine
Hundred Forty-Seven and 001100 Dollars ($99,947.00).
7. Paragraph No.7 of the Disclosure Statement pertaining to the quotient is hereby
corrected to read as follows:
31')17)01
7. Quotient. The quotient (expressed as a percentage) obtained by
dividing the net payment amount by the discounted present value of
the payments is 62.54% (#6 divided by #3).
By
David . Lewis, Esq.
Its General Counsel
o c-p- '7-~
Douglas E. Ma e '8 - {~ - 06
319173.01
DISCLOSURE STATEMENT
This Disclosure Statement is being provided by Stone Street Capital,
Inc. ("Stone Street") to you, Douglas E. Mabe, on July 6, 2006 in
connection with your agreement to transfer and assign to Stone Street
Capital, Inc. or its assigns certain structured settlement payment rights.
1. Amounts and Due Dates ofPavments to be Transferred. You
will assign to Stone Street all ofyonr right, title and interest in
and to all but One Thousand and 00/100 Dollars ($1,000.00) of
monthly payments of One Thousand One Hundred Ninety and
701100 Dollars ($1,190.70) increasing 3% each February
beginning with the payment on November 1,2006 through and
including the final payment on October 1, 2021; plus one (1)
lump sum payment of Thirty-Six Thousand Seven Hundred
Eighty and 00/100 DoIlars ($36,780.00) due and payable on
February 1,2008; plus one (1) lump sum payment of Fifty-One
Thousand Seven Hundred Six and 00/100 Dollars ($51,706.00)
due and payable on February 1, 2013; plus one (1) lump sum
payment of Seventy Tbousand One Hundred Seventy-Nine an
001100 Dollars ($70,179.00) due and payable on February 1,
2018 out of those certain payments due under tbe Settlement
Agreement and Release.
2. Mf!'reeate Amount of Payments Transferred. The aggregate
amount oftbe payments to be transferred to Stone Street total
Two Hundred Fifty Thousand Six Hundred Twenty-One and
93/100 DoUars ($250,621.93).
3. Internal Revenue Service Discounted Present Value. The
Internal Revenue Service discounted present value of the
payments to be transferred is One Hundred Fifty-Nine
Tbousand Eight Hundred Fifteen and 561100 Dollars
($159,815.56) determined by discounting the future payments
to be transferred using a rate most recently published for
determining the present value of an annuity by the Internal
Revenue Service, which rate is 6.0%. This is a calculation of
the current value of the transferred structured settlement
payments under federal standards for valuing annuities. TH S
Jj~^v\
(Initial here)
IS NOT mE RATE USED TO CALCULATE YOUR
PURCHASE PRICE. It is also not the market rate for
transfers of annuity payments of structured settlement
payments.
4. Gross Amount Payable. The gross amount payable to you in
exchange for the transferred payments is One Hundred Two
Thousand Four Hundred Forty~Seven and 00/100 Dollars
($102,447.00). -t j r(;C','~ ch.ec.J( P.<::I"'a.. ,JI'>
Cl-N>lil.;'<.J,..;oJ o~ b - ~(, . alL() ~
5. Good Faith Estimate of Fees and Expenses. Y 00 will be -.:. Ii
responsible for paying the following commissions, fees,
expenses, charges, and costs in connection with the closing of
this transaction: Legal fees of $2,500.
5
6. Net Amount Pavable. The net amount payable to you in
exchange for the transferred payments is Ninety~Nine
Thousand Nine Hundred Forty~Seven and 00/100 Dollars
($99,947.00). + '$ (CD,~. C~i( (J<,r, ~fl... 5,
C ""..J va U"'~l"',j ON (, -'<;>b . \1,(.
7. Quotient. The quotient (expressed as a percentage) obtained
by dividing the net payment amount by the discounted present
value of the payments is 62.54% (#6 divided by #3).
r
~~
8. Breach of Contract. The amount of any penalty and the
aggregate amount of any liquidated damages (inclusive of
penalties) payable by the payee in the event of any breach of
the transfer agreement by the payee shaD be: None.
By signing this Disclosure Statement where provided below, you
acknowledge and agree that you have read and fully understand e
foregoing Disclosure Statement, that you have been advised by
Stone Street to discuss the Disclosure Statement and the details 0
the proposed transaction with your financial advisors and attome s
and have been provided an opportunity to do so.
~~
~
-
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(Initial here)
RECEIVED, AGREED AND ACKNOWLEDGED:
~.~
(, -',:; 7 -0i.
Date
c
D
Choose one:
~
I have received independent professional advice from \
an Attorney, Licensed inancial PI et, CPA) whose office is locatesl at
I (I phone number @JSfQ -'} ()IJi.
regarding e I al, tax and financial implications of the transfer of my structured
settlement payment rights.
ST ATE~NT ON INDEPENDENT P~QFESSIONAL ADVICE
Stone Street Capital, Inc. is required by law to advise you of your right to consult
with an independent professional advisor regarding the legal, tax and financial
implications of the transfer of your structured settlement payment rights.
Acknowledl!ement
I, Douglas E. Mabe understand that I may consult with an independent
professional advisor and acknowledge that Stone Street has informed me of that right.
-OR-
o I have knowingly and voluntarily chosen not to consult with an independent
professional advisor and hereby expressly waive the right to do so.
I am aware of the legal, tax and financial implications of the proposed transfer
and I desire to have the court approve the transfer of structured settlement payment rights
as described in the Purchase, Transfer and Assignment Agreement.
":00..0 ~J
Douglas E. ~
DOUGLAS E. MABE
1045 Eppley Road
Mechanicsburg, P A 17055
(717) 691-5624
Joint Petitioner, pro se
LAW OFFICES OF MICHAEL A, GREEN, p,c.
By: Michael A. Green, Esquire
J.D. No. 73450
1831 Chestnut Street Suite 300
Philadelphia, PA 19103
(215) 972-5520
Attorney for Joint Petitioner Stone Street Capital, Inc.
IN RE: TRANSFER OF STRUCTURED
SETTLEMENT PAYMENT RIGHTS BY
DOUGLAS E. MADE
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
CIVIL DIVISION
No.
NOTICE OF ASSIGNMENT
Transferor:
Transferee:
Annuity Owner:
Douglas E. Mabe
Stone Street Capital, Inc. and its successors and assigns
St. Paul Travelers Companies, Inc., successor in interest to United States
Fidelity and Guaranty Company
Fidelity and Guaranty Life Insurance Company
1476007
Annuity Issuer:
Annuity Numbers:
Pursuant to Section 4003 of the Pennsylvania Structured Settlement Protection Act, 40
P.S. ~ 4001 et seq. (the "Act"), notice is hereby given that the above-referenced transferor has
entered into agreements with the above-referenced transferee to transfer all of his right, title, and
interest in certain payments due under the above-referenced annuity in exchange for
consideration. The transferred payments are as follows:
· $36,780.00 on February 1,2008;
· $51,706.00 on February 1,2013; and
· $70,179.00 on February 1,2018.
The Transferee's taxpayer identification number is 23-2617276.
Neither the Annuity Issuer nor the Annuity Owner is being asked to honor the transfer at
this time. Pursuant to the Pennsylvania Structured Settlement Protection Act, the Transferee and
Transferor will be seeking court approval of the transfer in the Court of Common Pleas of the
County in which the Annuitant resides and will provide both the Annuity Owner and the Annuity
Issuer with a copy of the court's order.
While neither the Annuity Issuer nor Annuity Owner is required to appear or participate
in the court approval proceedings, the Annuity Issuer and Annuity Owner are entitled, under the
Act, to support, oppose, or otherwise respond to the Petition, either in person or by counsel, or by
submitting written comments to the court or by participating in the hearing. Any such written
comments or objections must be filed with the Court and served upon the undersigned counsel
for Petitioners within twenty (20) calendar days from the date of this Notice.
Under Section 4004 of the Act, upon entry of an order by the court approving the
transaction, the Annuity Issuer and Annuity Owner will both be released from all liability for
making the payments which are the subject of the assignment to all parties except the Transferee.
The form of order submitted to the court will also provide that nothing in the order shall be
interpreted to negate, impair or modify the ownership or control over the annuity contract by the
Annuity Owner or Annuity Issuer.
LAW OFFICES OF MICHAEL A. GREEN,
P.C.
"~
~ichael A. n
Attomey for Petitioner Stone Street Capital, Inc.
.
CERTIFICATE OF SERVICE
I, MICHAEL A. GREEN, certify that I caused to be served a true and correct
copy of the foregoing Notice of Assignment this 'W~ay of tJv1 lJf r ,2006 via certified
mail, return receipt requested, upon the following:
Douglas E. Mabe
1045 Eppley Road
Mechanicsburg, PA 17055
Service of Process Coordinator
St. Paul Travelers Companies, Inc.
385 Washington Street, MC 515A
St. Paul, MN 55102
Fidelity and Guaranty Life Insurance Company
100 I Fleet Street
Baltimore, MD 21202
.
DOUGLAS E. MADE
1045 Eppley Road
Mechanicsburg, P A 17055
(717) 691-5624
Joint Petitioner, pro se
LAW OFFICES OF MICHAEL A, GREEN, P.C.
By: Michael A. Green, Esquire
I.D. No. 73450
1831 Chestnut Street Suite 300
Philadelphia, P A 19103
(215) 972-5520
Attorney for Joint Petitioner Stone Street Capital, Inc.
IN RE: TRANSFER OF STRUCTURED
SETTLEMENT PAYMENT RIGHTS BY
DOUGLAS E. MABE
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
CIVIL DIVISION
No.
NOTICE OF ASSIGNMENT
Transferor:
Transferee:
Annuity Owner:
Douglas E. Mabe
Stone Street Capital, Inc. and its successors and assigns
St. Paul Travelers Companies, Inc., successor in interest to United States
Fidelity and Guaranty Company
Fidelity and Guaranty Life Insurance Company
1476008
Annuity Issuer:
Annuity Numbers:
Pursuant to Section 4003 of the Pennsylvania Structured Settlement Protection Act, 40
P.S. S 4001 et seq. (the "Act"), notice is hereby given that the above-referenced transferor has
entered into agreements with the above-referenced transferee to transfer all of his right, title, and
interest in certain payments due under the above-referenced annuity in exchange for
consideration. The transferred payments are as follows:
· All but One Thousand and 00/100 Dollars ($1,000.00) of monthly payments of One
Thousand One Hundred Ninety and 70/100 Dollars ($1,191.70) increasing 3% each
February beginning with the payment on November I, 2006 through and including the
final payment on October I, 2021.
The Transferee's taxpayer identification number is 23-2617276.
,
Neither the Annuity Issuer nor the Annuity Owner is being asked to honor the transfer at
this time. Pursuant to the Pennsylvania Structured Settlement Protection Act, the Transferee and
Transferor will be seeking court approval of the transfer in the Court of Common Pleas of the
County in which the Annuitant resides and will provide both the Annuity Owner and the Annuity
Issuer with a copy of the court's order.
While neither the Annuity Issuer nor Annuity Owner is required to appear or participate
in the court approval proceedings, the Annuity Issuer and Annuity Owner are entitled, under the
Act, to support, oppose, or otherwise respond to the Petition, either in person or by counsel, or by
submitting written comments to the court or by participating in the hearing. Any such written
comments or objections must be filed with the Court and served upon the undersigned counsel
for Petitioners within twenty (20) calendar days from the date of this Notice.
Under Section 4004 of the Act, upon entry of an order by the court approving the
transaction, the Annuity Issuer and Annuity Owner will both be released from all liability for
making the payments which are the subject of the assignment to all parties except the Transferee.
The form of order submitted to the court will also provide that nothing in the order shall be
interpreted to negate, impair or modify the ownership or control over the annuity contract by the
Annuity Owner or Annuity Issuer.
Michael A. Gre n
Attorney for Pe . 'oner Stone Street Capital, Inc.
.
CERTIFICATE OF SERVICE
I, MICHAEL A. GREEN, certify that I caused to be served a true and correct
copy of the foregoing Notice of Assignment this ~daY of JJv;; v (r, 2006 via certified
mail, return receipt requested, upon the following:
Douglas E. Mabe
1045 Eppley Road
Mechanicsburg, PA 17055
Service of Process Coordinator
St. Paul Travelers Companies, Inc.
385 Washington Street, MC 515A
St. Paul, MN 55102
Fidelity and Guaranty Life Insurance Company
1001 Fleet Street
Baltimore, MD 21202
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DOUGLAS E. MABE
1045 Eppley Road
Mechanicsburg, PA 17055
(717) 691-5624
Joint Petitioner, pro se
RECEIVED
SEP 0 6 2006
BY:
, .
LAW OFFICES OF MICHAEL A. GREEN, P.e.
By: Michael A. Green, Esquire
LD, No, 73450
1831 Chestnut Street Suite 300
Philadelphia, PA 19103
(215) 972-5520
Attorney for Joint Petitioner Stone Street Capital, Inc,
IN RE: TRANSFER OF STRUCTURED
SETTLEMENT PAYMENT RIGHTS BY
DOUGLAS E. MABE
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
CIVIL DIVISION · L'-t-
No. C:J.- -5/1..7 (!'OL I~
RULE
AND NOW, this I J.-/j. day of ~ 2006 upon consideration of the
Joint Petition for Court Approval of the Transfer of Structured Settlement Payment Rights by
Douglas E, Mabe ("Mabe") to Stone Street Capital, Inc. and its successors and assigns
(collectively "Stone Street") pursuant to 40 P.S. g 4001 et. seq., a Rule is hereby issued upon
Mabe and Stone Street to show cause why the relief requested in the Petition should not be
granted.
RULE RETURNABLE and to be heard the 5-4:JL day of O~'\. , 2006 at
I 0'.00 a.m./p.m. in Courtroom ~ .
BY
J,
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IN RE: TRANSFER OF STRUCTURED: IN THE COURT OF COMMON PLEAS OF
SETTLEMENT PAYMENT RIGHTS BY CUMBERLAND COUNTY, PENNSYLVANIA
DOUGLAS E. MABE
06-5167 CIVIL TERM
AND NOW, this
ORDER OF COURT
~ day of October, 2006, following a hearing, the
joint petition for court approval of a transfer of structured settlement payment rights, IS
DENIED.1
~chael A. Green, Esquire
1831 Chestnut Street Suite 300
Philadelphia, PA 19103
For Stone Street Capital, Inc,
~UglaS E. Mabe
1045 Eppley Road
Mechanicsburg, PA 17055
:sal
1 We find that the payee has not established that the transfer is in his best interest
or the best interest of his dependent daughter. The cost at a 13.02% nominal
discount rate is not warranted given the payee's stated purpose of seeking to
secure funds now that will enable him to purchase a home. The next periodic
payment on Annuity No. 1476007 in the amount of $36,780 will be made on
February 1, 2008. It is in the payee's best interest and the best interest of his
daughter to wait until that time to secure funds for a down payment that will
enable him to obtain a mortgage at a market rate,
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