HomeMy WebLinkAbout06-6095
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
PENNSYLVANIA
CIVIL DIVISION
INRE:
PETITION OF ROBERT E. GOLOFSKY
TO TRANSFER STRUCTURED
SETTLEMENT PAYMENT
RIGHTS
No. Ol.. -"O~ (!LO;tr~
PETITION TO TRANSFER STRUCTURED
SETTLEMENT PAYMENT RIGHTS
Petitioner, ROBERT E. GOLOFSKY, brings forth the following Petition to Transfer
Structured Settlement Payment Rights pursuant to, and in compliance with, the Structured
Settlement Protection Act, 40 P.S. SS 4001-4009, and in support states as follows:
1. The Petitioner is ROBERT E. GOLOFSKY, by his Attorney-in-fact, LINDA S.
GOLOFSKY, an adult individual whose date of birth is March 4, 1980. Mr. Golofsky is
currently incarcerated in SCI - Camp Hill located in Cumberland County, Pennsylvania, and
therefore he is now domiciled in Cumberland County.
2. This Court has venue pursuant to the Structured Settlement Protection Act,
because the Petitioner is domiciled in Cumberland County, Pennsylvania.
3. As a result of his incarceration, Mr. Golofsky has appointed his mother, Linda S.
Golofsky, as his Attorney-in-fact to act on his behalf in this and other matters. A true and correct
copy of a Power of Attorney executed by Robert E. Golofsky, appointing Linda S. Golofsky his
Attorney-in-fact is attached as Exhibit "A."
4. On or about August 21, 1981, the Petitioner suffered personal injuries as a result
of a dog bite accident. Thereafter, on or about February 6, 1987, the Petitioner, by and through
his parents and natural guardians, Richard and Linda S. Golofsky, entered into a Settlement
Agreement and Release with Lumbermens Mutual Casualty Insurance Company. The Agreement
provided that the Petitioner would receive lump sum payments on December 30 in the following
years and in the following amounts: 1998 - $12,000.00; 1999 - $13,000.00; 2000 - $15,000.00;
2001 - $20,000.00; and 2020 - $50,000.00. The Agreement further provided that Petitioner
would receive 228 monthly payments of $884.00, commencing January 30, 2002, through and
including December 30, 2020. A true and correct copy of the Settlement Agreement and Release
including confirmation of the benefits schedule is attached as Exhibit "B."
5. Lumbermens Mutual Casualty Company is the Structured "Settlement Obligor" as
defined by 40 P.S. g 4002. Lumbermens Mutual Casualty Company is located at One Kemper
Drive, Long Grove, IL 60049.
6. As authorized by the terms of the Agreement, Lumbermens Mutual Casualty
Company funded the obligation by purchasing an annuity from First Colony Life Insurance
Company, the "Annuity Issuer." Id. First Colony Life Insurance Company is located at 3100
Albert Lankford Drive, Lynchburg, VA 24501.
7. On October 3, 2006, Petitioner executed an Absolute Assignment and UCC
Article 9 Security Agreement (the "Transfer Agreement"), a true and correct copy is attached
and incorporated herein as Exhibit "C." The Transfer Agreement provides for the assignment of
Petitioner's right and interest in receiving: 48 monthly payments each in the amount of $884.00
commencing on January 30, 2017, through and including December 30, 2020; and one lump sum
payment of $20,000.00 due on or about December 30, 2020 (the "Assigned Payments"), to
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Settlement Funding, LLC (the "Transferee"). Settlement Funding, LLC d/b/a Peachtree
Settlement Funding ("Settlement Funding") is a Georgia Limited Liability Company with its
principal place of business at 3301 Quantum Boulevard, Boynton Beach, FL 33426.
8. The Transfer Agreement was executed by the Transferee on October 4,2006.
9. The Petitioner shall retain all right and interest in receiving the remaining balance
not assigned of: a partial lump sum payment of $30,000.00 due on December 30, 2020 (the "non-
assigned payment").
1 O. Additionally, as set forth in further detail in the Affidavit dated October 3, 2006,
attached and incorporated herein as Exhibit "D," Petitioner avers that:
a. He desires to sell the Assigned Payments to Settlement Funding, LLC.
b. The transaction contemplated by the Transfer Agreement is in his best
interest, it will improve his standard of living, and he has thoroughly
considered all of the ramifications of the transaction.
c. He will use the proceeds from this transaction to re-pay obligations
incurred for raising his bail and attorney fees.
d. He has been advised to obtain, but has declined independent professional
advice from an attorney or other professional.
11. Petitioner has been provided, and has acknowledged receipt at least 10 days prior
to receipt of the Transfer Agreement, of the "Transfer Disclosure" required by 40 P.S. 9 4003
(a)(2) attached and incorporated as Exhibit "E." As set forth in greater detail in the Transfer
Disclosure, the following terms have been disclosed to the Petitioner:
a. The amounts and due dates of the structured settlement payments to be
transferred are: 48 monthly payments each in the amount of $884.00
commencing on January 30, 2017, through and including December 30,
2020; and one lump sum payment of $20,000.00 due on or about
December 20, 2020.
b. The aggregate amount of the structured settlement payments to be
transferred is $62,432.00.
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c. The discounted present value of the payments transferred using the most
recently published applicable federal rate for determining the value of an
annuity is $29,145.67.
d. The federal discount rate used to determine the discounted present value is
the effective annual rate of 6.0% as of 9120/06.
e. The gross amount payable to Petitioner in exchange of the transferred
payments is $9,088.78.
f. The good faith itemized listing of all broker's commISSIOns, service
charges, legal fees, notary fees, costs etc. deductible from the gross
amount otherwise payable to the Petitioner is: Legal Fees of $2,000.00 and
processing fee of $200.00.
g. The net amount payable to Petitioner after deduction of the above
commissions, legal fees, etc., is $6,888.78 minus any advances made to
Petitioner against the amount payable to Petitioner.
h. The quotient is 23.64%.
1. The amount of penalty and aggregate amount of any liquidated damages
inclusive of penalties payable by the Petitioner in the event of any breach
of the transfer agreement by the Petitioner is: NONE.
12. Petitioner has been provided, and has acknowledged receipt, at least 10 days prior
to receipt of the Transfer Agreement, of the written "Important Notice" in bold print 12-point
type required by 40 P.S. S 4003 (b). A true and correct copy of Petitioner's acknowledgement of
the receipt ofthe S 4003 (b) notice is attached as Exhibit "F."
13. Petitioner has been advised to obtain but has waived independent legal advice
regarding the implications of the transfer, including tax ramifications of the transfer, as set forth
in the acknowledgement attached as Exhibit "G."
14. On January 24, 2002, "The Victims of Terrorism Tax Relief Act," PL 107-134,
115 Stat. 2427, was enacted, which in part, amends the Internal Revenue Code of 1986. The Act
amends 26 U.S.C.A. 9 5891 and now provides for favorable tax treatment of "structured
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settlement payment factoring transactions" that are approved in advance by a qualified court
order approving the transaction. 26 U.S.C.A. S 5891 (b)(l). A "structured settlement payment
factoring transaction" is defined as "a transfer of structured settlement payment rights (including
portions of structured settlement payments) made for consideration by means of sale,
assignment, pledge, or other form of encumbrance or alienation for consideration." 26 U.S.C.A.
S 5891 (c )(3)(A) (parentheses in original). A "structured settlement" is defined as an
arrangement established by "agreement for the periodic payment of damages excludable from the
gross income of the recipient under [Internal Revenue Code] section 104 (a)(2)..." and under
which the periodic payments are "of the character described in subparagraphs (A) and (B) of
section 130(c)(2)." A true and correct copy of 26 U.S.C.A. S 5891 is attached hereto as Exhibit
"H. "
15. 26 U.S.C.A. S 5891 (d)(l) was also added by the Act and provides:
[I]f the applicable requirements of sections 72, 104(a)(l), 104(a)(2), 130,
and 461 (h) were satisfied at the time the structured settlement involving
structured settlement payment rights was entered into, the subsequent
occurrence of a structured settlement factoring transaction shall not
affect the application of the provisions of such sections to the parties to
the structured settlement (including an assignee under a qualified
assignment under section 130) in any taxable year.
(Emphasis added).
Accordingly, a favorable tax result is in effect at the time the Payee and the Transferee
propose to enter into the Transfer Agreement.
16. Since a favorable tax result is in effect, approvals of the Settlement Obligor and
the Annuity Issuer to the proposed transfer are not required. 40 P.S. S 4003 (a)(5)(i)(A).
17. The structured settlement did not arise out of a workers' compensation claim.
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18. Petitioner has seriously contemplated this transaction, and due to his personal
circumstances and needs, believes that this assignment is in his best interests, taking into account
the welfare and support of Petitioner's dependents.
19. Petitioner acknowledges that counsel, Jones, Gregg, Creehan & Gerace, LLP has
not been engaged to render professional advice with respect to the advisability, or the
implications of the transfer, including the tax ramifications of the transfer. Counsel has been
engaged solely to prepare and present the within Petition, based upon Petitioner's independent
determination and/or professional advice obtained from others, with respect to the advisability
and ramifications of the transfer.
WHEREFORE, Petitioner prays that this Honorable Court schedule a hearing as set forth
in 40 P.S. ~ 4004, to consider this Petition to Transfer Structured Settlement Payment Rights.
Respectfully submitted,
Jones, Gregg, Creehan & Gerace, LLP
By:
/~.
,
7d;;--p~
Robert L. Monks
P A LD.# 52760
411 Seventh Avenue
Suite 1200
Pittsburgh, P A 15219
412-261-6400
Counsel for Petitioner, Robert E. Golofsky,
by his Attorney-in-fact, Linda S. Golofsky
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VERIFICATION
I, Robert E. Golofsky, by his Attorney-in-Fact Linda S.
Golofsky, have read the foregoing Petition to Transfer Structured
Settlement Payment Rights and hereby aver that the statements
contained therein are true and correct to the best of my
knowledge, information and belief.
This Verification is made subject to the penalties of 18
Pa. C. S. A. Section 4904 relating to the unsworn falsification to
authorities.
Dated: !o-!3-r;,/}t
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Gl':NERA.I. DURABLE POVVER OF ATTORNEY
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NOTICE
'11IB PURPOSE OFTlIIS PO~ OF A'lTORNEYlS TO GI:VB THE PERS01VYOU DESIGNATE
(l'O(JR "AG.8NT7 BROADPoWF.RS TO HANDLE YO.lJR P.ROPER~ WHr01 MAY l:.VCT..UDE
POWERS TO SELX OR OT1mRW'ISE l'J.o,;POSE OF ANY Rlt4L OR l"El.l..ClOJ'V.-1L l!ROPERn:
W1Tl10ur ADVANCF.N017(."E TO YOU ()RAPPROV~ 8YyoU.
THIS POweR OF.ATTORNEY DOP.:SNOT IMf>OSE A DllTYONU~URAGP.NT TO f;}.{ERClS.rz
OR4l.'n'DPOWlrRS, BCJ'1'W1:lEN J't,)WERSAllE 1::XERcrSElJ, l'OlJRltUENT .MUST US.E.OW!
CARJ.; 1"0 ACT FOR VO~ BENEFIT ANn L.V ACCORDANCE ""-T711 TfflS POWER OF
AnUAN~~ '.
lVC1RA'GB'lrrlfLl1' .nERt'}~1{7~ POWI'-:Bs GiW lIERE 77mOlTGHOtlT i"ovx
UFBTlJt.lll. EVEN AF1'ER YOU BELU1UE lNCAPACITA77JD. UNLEss YOU E..YPRE.9..<lLY I.lMIT .
7'1:1H DURAnON OF T1fESE POH-'XRS OR. YOU REVIJKB TH.B8f! POWER..~ OR A CO Vltr
ACTING ON YOU1lBF..1LU.F T.RRM.l:N'AT.Es l"OURAGEm"SAV771()Rt.f.Y.
YDURAGEN1'MUsT KEEP YOV'R ~s ~ARAm FROM YOUR AG.f.:NT"S FllNDS.
A COtIJIT C.tNTAREA iV.4Y.77.rB POWF.RS OF youR AG'ENT.IF rr FINDs YOUR A.GE1'v71S
NOTActJ:NG'PjUJPERT..l.... . . . . .
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'1'1ie: rowlm~;ANll Dm7:CS OF AN AGENT UiVDERA PO"WER OF Ar:roRNF.y ARE
EXP1..MNEDMOR.13~YIN:;lOP~....c...CJ. C11..5~: .' . .
IFTHE:R.l! IS",ilVYmlNG AR0l.1TTH18 FORMUt'1 Tl'OCroo NOT ffND1-:RSTA..V.O, 'ltnJ
SlIOU1.J.?~JC4. L..nl...~:cR OJ" }'OVR OH-N CHOOSLVGTOl1rcPL.UN1T TO I'DV'.
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a tl!Sidont of Itf') ~m 'L\A., · a.'M:)t~<'(city/tQwn). Pennsylvanhl J;>.4~(~ip code), .
. dO,a.uthoriZl! and designate ~Y.\k~' (, ~ --' WhOSll ~ddrllss :lIthe Lime ('If !his
W'ntmg is knowlI to be 31 0 .,......,~.rl M~(oe.v~,~__... (diy/town),
Pennsylwmia ~!.~ (zip code), a~ my true nlld lawful Agent. I ftnther Blttborb:e nlY Agent
to appear Or) IlIY.behalf, and sign my rlLlm~ to any document Q.!l if I Wi:ls present. I flll'ther .
cmjl'()wcr my Agent to do' n05 of the al1tho~~ed dllri~s assig.ned according t~ 20 P~:L.~.s.A. Ser.tionil
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I. Exhibit A ]
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, , 1:h-e powers Kl1lnted to Illy Agent ':.tre limited to the d'ur:ltion (If my incarCc::!ratioll jn:the
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AIlegh'en)',County 33 if and sb..n tl~rOljnatc at the t!OlI! O(.fOY ~elet1.se:', I.furt!ull' state thilt I retltin
the tight to terminate thilj power 'Of attorney Jlt any tilne by notifying my Agent in Wfitin~ of nlY
Intention.
The dutieo.s aha n include:
1. Power to make l~ired gifts in my nanlc.
2. Power to r.l'eate a trust for my benefit.
,3. Power 10 make ndditions to an exio;ling trust for my benefit.
4. Power to engage in real property .tranSO(:nollS inr.{uding the colJ~tiOI\ of reTlt or
m~rlg~gP.s OW~Jp ,D:le., . ,', ',:. ',... _'" ',,' ..~ ,_ ~.,: .:. ._:- ._: ,_. " ,
Pow." ;.. .~g.., in b"king .nd fi"'ncio1t&""ioo". incl.dl.g 'h. ,;""1",, or eh"'b,
draft<; or money' ordeJ:S, make withdrawal.,; from my savings and eheCking accOullts,
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deposit monies into Jlnyof my ~cePllnt.~, pay just debt~, including taxes, medical bills, etc:,
,Power to authorize admission ~I) a medIcal faCility and to llUthorize medical prOCedllres.
,7~: ,~ ~\)wCJ t9 e!,lter;;uu.: safe dep(lsit,~ox beld In my,nerine, but does Dot authorize ~e AgelJt to
place his/het name on $aId box lIS a joil1t owner, , ,
.1 rult.., .~ my Ag.n, .to h... po""" to .du .'1)'thing th., 1 might do u.nO!
descril?cd herein.
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, . 'I hl:!tebj- s\'{(!cu th~t I ha~'e cre:-tterl this Genel'al Durable .Power of Attorney document as
an apticm of In}' OWn free "ill and decision. ! further ~tate tllll.t r bay!:: not been tIlI'e3telll~d Or
,coerced to the sa Ine,
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Social Security NtlD1~r
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I,", d.y wirn._ U.. slguing 0' thl. Co..tal Durahi. Powe", """"'.y doe''''''n! nnd ''''''i'
thntthc Pl"incipnl siglledofhis OWt] o'ee.vill and lIt:cot'd. " ~
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W;'n"""'d and 'igned this _~__ dayor_~ .
~' ~ /~~.... . .,' '., SYLVAN
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ary'public ',' '- , . NclfQISeaI ,
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ACKNOWLEDGEMENT
I, Linda Golofsky. have read the attached power of attorney and am .he
person identified as the agent for the prtndpal. I hereby acknowledg. I that
in the absence of a specific provision to the contrary In the power of
attomey or in 20 Pa.C.S. when I act as an agent:
1 shall exercise the powers for the benefit of the principal.
1 shall keep the assets of the principal separate from my assets.
I shall exercise reasonable caution and prudence.
I shall keep a full and E-:JCCUrate record of all actions, receipts and
disbursements on behalf of the principal.
~~~~
(Si eel
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(Date)
STATE OF ~ YI nsy Ilia 4"'f I 'e....
COUNTY OR CITY OF A / lei A IhvJ
On the 9 f4 day of Oe..f{)h~ . in tbe year 2.aJ6 before me, the
undemigned, persooally appand Linda Golof'sky, personally known to me or proved "me on
the basis of satis&ctoty evidem:c to be the iDctividuaI(a) whose DilIIII:(s) is (are) mbscri.1: ~ to the
within instnlment, and acJtn<.wleclged \10 mo that hclshdtbcy _=utcd the same in his !len'their
capacity(ies), and tbt by ~ sipature(s) on tho iostnlmcnt, the iDdividuaJ(. . or the
p.nO"_b_ofvlO<h~__')_~~
Notary
My Commission expires on __7 -/ 'f' - ;:u.o~
COMMONWEALTH OF PENNSYLVANIA
NoIariaI Seal
George J.l<oIbakes. Notary PubDc
MurrysvlIle BOlO. WesM1a8Iand 0cUIIV
My CornmIssicn Expires July 14. 2008
Member p,.nnl'ylv..ola Assodlltion Of Notarie.
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412 623 4810 P.B2
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SETTLE NT AGUBHEJllJ'
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This Settleanent Agreement lease (t'Settlement Agreement h
'is 1I4de and entered illto thiS It. 'i "y of UU~ ' · 1981,
,by and bet"eell. ROKllT GOrrPSKY. a m1n~: b his parent~. GhCKM\O t.
GOLOFSKY and LINDA S. GOLOPSXY, his ~ard anS. and RICHARD E., GOL01SX!
and LINDA S. GOf.,OPSKY, hi~ wi! e t (lIPla1nt rrs ") and THOMAS WINSTON
I II
and DOf{OTHY IJINS'rON. his w1fe, ('IDefendan S").
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A, The plaintlffs flled a eomplain asainet the defenda~~.
in the Court of Co~on Pliee of A1ie~enY County at No. GD 83-l273b
which complaint arose out or certain tnju ies and damages allegedly
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suUered by the Plaintifff e. the r"1le f 8J\ ine1dent "hieh oceurred
on or about Augu6t 21, 19 l. in or abQut he premises ~hen owned b~
the cJefen~ant8.
9. The part1ea des re4 to ent.~ 0 this Settlement Agreementj
order eo prbvi~e for cer~ln payments\1n Ul1 .ettlement and dl~eharge
of all c18.1ms which are 01 misht have I bee the subject of the complain
,UP,on the terms and cond1 t one let ror~h h reirt.
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Agreement. The partieS here,to
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and their i surer. and the1
8arvants, r presentat1v~S.
oth8~ perso St firms, or co
c.
agree as follows:
entrs ealleci for
'1 c.omple1;e11
e the derendan~$
attorneys. egents,
nd assign$ and all
poration8, of and
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Exhibit B
t-O)-17-2003 15:08
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412 623 4819
P.03
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from any a~ all paat,jpresent or f~t~re
claims, de ndl, cb111.~1~ns, aotion8J eaU5&9
of action, wrons!ul1 d,at~ elalms, r1shtsJ.
dama&ee, C 6tS. 10.s of iserv1ces, e~p.nse8 and
compensat1on or an, natur~ whatsoever, whether
based on 1.1 tort. c'ontr~C'1; or other theol'Y of
Z'.oovery. and whether for ~ompenlatlon or., '
pun1t1ve ~~male8, wh1ch.the pla1nt1ffs now ha~e,
or ~h1ch j~Y hereafter'acrue or otherwise be
acquired, on a~eount ot~ or in any vay irow~ng
ou~ of, Ortl ~h1cb are th~ subje~t ot, the
com~la1nt (and all rela~ed Pleadings), tncluding,
~1thout 1 m1tat1on;. any and all known or u~known
claims to bo"1,11 and personal injury to the,
plaintifr or any rutur. wrongful 4eath cla1ms,
whiCh hav relulted o~ ~a.y ~e5ult trom the
all.sed a t5 or om1ss1bns of the defendante.
1his rele se, on ~he ~art of the. pla~nt1fts shall
be a fully 1nd1ng anc1 complete 8et~leE:lent bet\fleen
the plainiiffs ana th~ d.!endants and 1naurers
of the de endants. the1~ &ss1gns and 8ucce6sors~
&~Ve only the exeoutorYI~rov1$1onB of th1&
settleme", asreement. ~e plaint1!fs hereby
, agree to etendj inde~n~!y and hold the defendants
and their in8urers harmless from and against all
such 01&1 5, demands. !o~lisations, aet1on~~
causes of aotion. damagts, coste and expens.s.
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In eons1deration ot t~~'telea6e set forth above,
the de{en~ants and th+ir 1nsurer hereby agree to
pay the followinl sums in the tollowinc manner:
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Please reter to IISchedule A" attaehed hereto.
Pl&intlCrl. Rl~t to pa~~nt:
The de!en~bants and/o~:1~s~r.rs shall not segregate
or set aSide any of their assets to tund the .
payments to the plaintiffs ~equired h.~e1nl 1t
be1ng un erstood thatlp~aint1rf' arean4 shall
be lener 1 cred1tol"S ;to'the defendan1:& and/or '
the insu~er. Said payments canno~ ~e aecelerateo~
deferred, increased or ~eQrea.ed b~ ~h. pla1ntiffa and
no part of the payme~t~ called for herein or any
assets 0 defendants and/or the in6urer is to be .
sUbjee~ 10 ex.cut1ono~~ any lesal process for an~
. ~~ligat1on 1%1 any__mann.er, .~or Iha11 the pl~1nt1!r6
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2. .Payment&:
~-17-2003 15:B8
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412 623 4910
P.04
have ~he p wer to sell or'mortgag. a~ encumber
same, or a y part thereof, nor anticipate the
same, or I Y part tberec!t~. bV assignment: or
otherwise.
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Il. 1'1 ht to P chase U\ Mn:u," t
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The defend nt. and their ~nsurer reaerVQ tne
right to f~d the l1ab~~ity" ~o make periodic
P&7ments t oUSh the p~~ehas. of an ennu1ty
pol'.cy fro the First F~lo"n1 L1felnsurance
Co~pan,. ~h. d.rendanlt~ or the1r 1nsurer
shall be ~. owner of t~e annuity policy,
and shall have all ris'hts of ownership,
'!'he defe" ants and th811xt insurer may have the
annu1ty 0 rr1er, the ~1~$t Colony LiCe Insurance
company, a11 payment~ ~1~ect17 to the plaintiffs.
The plain 1fts shall ~e!re$ponS1ble for maintaininl
the curre cy of their prdper mailing ad4~eB. and
mortal1ty 1ntormat1on tQ:the First Colony Life
Insurance Company. I
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Pla1nt1ft t Senet1elar, ~
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Any payme ts to be ma~e;.rter the death of
Robert Go oriky, a miner.. purs\lant to tbe teroms
of this s ttlement'agr.eemerit shall be made to
such perl n or entitJla~:shall be des1~at.d 1n
writing b the guardla.nio~ guardians of Robert
Golof$ky, a minor. I~ n9 person O~ entity 15 .
80 deSisn~ted~ such p.y~ent shall ~e made to the
Estate oflRobert Golofs~y. a"minor. No sueh
de611nat1 n or any revo~atton thereof shall be
effective unless it 18 1n wr1t1ns.
D1schar e or Ob11 &t1&ni
The Oblig t10n of th.lc5~re~dants and the:ir 1nsurer
tc make e eh installat,iQP payment shall be dlscharged
upon the 11ing of a vt11d check in the amount
of 8uch p yment to ~h, .~dress designated by the
party ~e ho~ the payment 11 requlred to be made
under. th1 settl.men~1 &$reement.
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General
,.The :pJ.a1
the rele
s.eneral
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se let forth! 1n Paragraph 1 hereof is a
,lease and ~he~ Curther expressly ~a~v.
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and assume tbe risk of! .rlY 0 and all cla1
for damages which ex1It:a~ ot this date
~hich the ~la1nti!!s dD;n~t kno~ or SUI
exist. Whe~'her th~c~h ~8n~rance, overs
'negl1Sence, or otherwise) .nd. which. 1t
~ou14 mate tally atfect[tbt plaintiff.'
to enter ~to thlS 8ett~ern~~~'a8reement
~lalnt1rt6 further alr~, tn1t t~eY have
payment 0 the .\lIftS sp.ecir~.l~d. here1n as
cotnPl'orn1s4j of matters I1nvolv.1ng d1sp\lte
or law an~ fact and t~e1 &$!ume the r1s
the Xacts or law mal 'be otherwise then
believe. lIt is understooa and alr.ed b
that this settlemen~ 18,& co~prom1se of
and 41sputed ela1~ end the patments.are
construedlas an adm~laion or liab111tJ
part of t~t deCendants#1 by whom l1a~111
expreSSlY denied. .
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DeliverY ~f cert1!1Caie~ of Settlement
and D1scoat1nuance: 1 I
Conc~rr~n"11 with the:e~ecution of tb1s
agreement~ counsel for ~he Plai~tlfCs h
to the eounlel for the ~efen4an~S a Cer
of settlebent and Discontinuancl': or the
aet10n dotedbG in ..ee~tal "An above.
Warranty ~r Capacity ~~ Execute Alreement:
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The Pla1~1!f8 repres~nl: and warriant that no other
per.~n 0 ent1t7 has ~~ hie had any interest in
cla1ms~ emanch~ obl11~t1ona or causes or action
referred to in this &e~tlement &Kreement accept
as othe~ile eet forth ~er.1n and that they have
the sol~.lr1&ht and eiclus1ve a.uthl~ritY to execute
thiB sett1emen~ agreement and receive the Bum
5pecif1ec' in it; and t~at they'have not sold,
8aeisnedl transferred, conveyed or otherwise
d1spoaed or any ot the !claim', demands, obligations,
or causel of aetion referred to in th1$ settle~en~
agreernen~ . Ii:
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This set lement .agreement contains '~ne entire .
agreemen~ between th~ plaint1ffs, tr.e defendanta,
and th~1f insure~ w1~h'reSard to the matter set
forth herein and sha111,be. ."o-inding upcJ:l al')o "n.":1r.e O' . .
to .the bre!i.t of t~ i"ecuto.... a4Jllin,1.t....to....
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presentative,'.!. :he1ra, l~cce$SDrSJ and
each.
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10n of Comp~ehen&10n ot Document:
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into this ~e~tlement alreement,
the plaint ffB ~eprese"t. that theJ bave relied
upon the 1 gal adv1ce ~~:~h.1r attornera who
is their a tcrne1 of cboice an4 that the terms of
this settl ment agre~m+n~,have been completelY
read and e pla1ned to ~~em b7 thi8 attorney,
and those erm8 are Culliy understood and
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vol~ntar11 accepted by .them.
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Governing aWl: I \
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This settl ment agreem$nt' shall be construed
and interp, eted in accp~dance with the lawS ot
the Comzno 'ea.lth or Pennsylvania.
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This.sett ement agree~enti shall be~om. effective.
Collowlna exeeutlon.o1 ~:l oC the following:
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The dafan<lantj and ~hdr +,lirer. the LUJIlbe","",," Mutual
Ca!Ualty Insurance .coa,np,n1. agree t1 1&1(8 the followinc payments
with1n thi!'ty' (30) days 01' execution ~y i the pla1ntl!fl or the .
, SettlemEnt Agreement ane Release:
1. Richard E OoloCsky and; L1J'14s $.. Oolofsky
$~O J 000. ot ; I '
2. Robert S. Ad~s. Esqu~r.. $16.000.00.
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Defendants anc the1r 1nsuner the Lumbermens Matual
Casualty Insurance Comp~ny agree tolma~e the fOllOWing future
, payment. to Robert OOlotek7: I
1. December ~o, 1998 - $12~OOO.OO
2. Decembe~ 30. 1999 - $13jOOO.OO
3. December fO. 2000 - $1S!OOO.oo
". Deeember ~o. 2001 - $~O~OOO.OO
5. December JOi 2020 ~ $50~OOO.OO
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C~qmencins on January 3D,/2?02t an4 continuing monthly
thereafter for a term ot nineteen rears certa1n. the Gum ot
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$884.00 per Month. At fhe con01U8i~iot this nineteen 1ear ter~,
no further payments of lny nature whatsoever will be due ana owing.
.,
ABSOLUTE ASSIGNMENT AND uee ARTICLE 9 SECURITY AGREEMENT
(THE II AGREEMENT")
September 30, 2006
I, Linda S. Golofsky as Power of Attorney for Robert E. Golofsky, ("I", "Me" or "Assignor") residing at
110 Tyrolia Dr, Monroeville, PA 15146-3734 am entitled to 228 monthly payments each in the amount of
$884.00 commencing on January 30, 2002 through and including December 30, 2020, and one lump sum
payment of $50,000.00 due on December 20, 2020 (the "Periodic Payments") on account of the settlement
of a certain personal injury claim, the settlement of which is memorialized in that certain settlement
agreement dated February 6, 1987 (the "Settlement Agreement"). The Periodic Payments are due to me
from Lumbermens Mutual Casualty Company (the "Settlement Obligor") under the terms of the
Settlement Agreement and are being funded by an annuity issued by First Colony Life Insurance
Company (the "Annuity Issuer") bearing annuity contract number 0440986.
A. I hereby sell, assign and convey to Settlement Funding, L.L.C. (the "Assignee") or its assigns all of
my rights to and interest in and to the following payments due or to become due under the Settlement
Agreement:
48 monthly payments each in the amount of $884.00 commencing on January 30,
2017 through and including December 30, 2020. One lumpsum payment of
$20,000.00 due on or about December 20,2020 (the "Assigned Payments").
In consideration for this assignment, Assignee shall pay to me the sum of: $9,088.78 (the "Assignment
Price").
B. I hereby make the following unconditional representations, warranties and promises:
1. No one other than me has any interest or claim of any kind or nature in, to or under the
Assigned Payments I am assigning hereunder.
2. I am not indebted to anyone that would affect in any way either the assignment of the
Assigned Payments referenced above or Assignee's absolute rights to receive same.
3. I agree to conduct my affairs so as to ensure that Assignee obtains all of the benefits of the
assignment contemplated hereby.
C. I agree that the fOllowing shall be considered an event of default by me under this Absolute
Assignment Agreement:
1. The representations set forth in Paragraphs B 1 and B 2 above are at any time n,ot true.
2. Failure by me to perform the promise set forth in Paragraph B 3 above.
3. Failure by the Settlement Obligor or the Annuity Issuer to make anyone or more of the
Assigned Payments as a result of any act by me, my estate or any of my heirs.
4. Failure by the Settlement Obligor or Annuity Issuer to forward one or more Assigned
Payments to Assignee as a result of any act by me, my estate or any of my heirs.
5. Failure by me to forward promptly to Assignee any Assigned Payment received by me from
the Settlement Obligor or the Annuity Issuer.
6. Failure by me to fulfill any other obligation of mine under this Agreement.
D. The following are conditions precedent to Assignee's obligation to pay me the Assignment Price:
1. Assignee shall be satisfied, in its sole discretion, that there are no claims or interests of any
kind or nature whatsoever that do or may affect Assignee's rights to or interest in the
Assigned Payments and Assignee's ability actually to receive same on the dates and in the
amounts set forth herein.
2. Assignee shall have received a final non-appealable court order, or a signed
acknowledgment from Settlement Obligor and the Annuity Issuer satisfactory to Assignee
in its sole discretion (such court order or acknowledgement together are hereinafter
referred to as the "Order"), authorizing the transfer by assignment of the Assigned
Payments (which may continue to be made out to my name) to Assignee, and directing that
the Periodic Payments due on or after the day of the Order be forwarded, or authorizing the
forwarding of the Periodic Payments, directly to Assignee.
E. Under this Agreement and only to the extent permitted by law Assignee and I intend to create a
security interest under Article 9 of the U r- "'" rr-' of the state designated in Paragraph F
below, in my rights to and interest in pa Exhibit C e Settlement Agreement, which rights
have been assigned to Assignee as General Intangibles under Article 9 of the Uniform Commercial Code
of the state designated in Paragraph F below. This Agreement shall also function as a security agreement.
This security interest secures payment of the rights assigned and performance of my obligations under
Paragraph B above. Assignee may direct any account debtor, obligor on an instrument, including, without
limitation, the Settlement Obligor or Annuity Issuer, to make periodic payments directly to Assignee as
contemplated by the Uniform Commercial Code. Assignee may file a UCC-1 financing statement to perfect
its rights hereunder.
F. Except as otherwise required by applicable statutory law, this Agreement shall be governed by and
interpreted in accordance with the law of the state of residence of the Assignor on the date of this
Agreement.
ARBITRATION
Any and all controversies, claims, disputes, rights, interests, suits or causes of action arising out of or
relating to this Agreement and the negotiations related thereto, or the breach thereof, shall be settled by
binding arbitration administered by the American Arbitration Association. The demand for arbitration shall
be filed in writing with the other party to this Agreement and with the American Arbitration Association
offices in your state of residence. The arbitration shall be held in the largest city in your state of residence.
The arbitration shall be held before a single arbitrator selected in accordance with the Commercial
Arbitration Rules of the American Arbitration Association in effect at the time that the demand for arbitration
is filed. Discovery, specifically including interrogatories, production of documents and depositions shall be
at the discretion of the arbitrator and to the extent permitted shall be conducted in accordance with, and
governed by the Federal Rules of Civil Procedure.
A demand for arbitration shall be made within a reasonable time after the claim, dispute or other matter in
question has arisen. In no event, shall the demand for arbitration be made after the date when institution
of legal or equitable proceedings based on such claim, dispute or other matter in question, would be barred
by the applicable statute of limitations.
No arbitration arising out of or relating to this Agreement shall include, by consolidation or joinder or in any
other manner, an additional person or entity not a party to this Agreement, except by written consent of the
parties hereto, containing a specific reference to this Agreement and signed by the entity sought to be
joined. Consent to arbitration involving an additional person or entity shall not constitute consent to
arbitration of any claim, dispute or other matter in question not described in the written consent or with a
person or entity not named or described therein. The foregoing agreement to arbitrate and other
agreements to arbitrate with an additional person or entity duly consented to by parties to this Agreement,
shall be specifically enforceable in accordance with applicable law in any court having jurisdiction thereof.
The award rendered by the arbitrator shall be final, and judgment may be entered upon it in accordance
with applicable law in any court having jurisdiction thereof. Such arbitrator shall identify the substantially
prevailing party and shall include legal fees and expenses for the substantially prevailing party.
This provision does not apply to the extent inconsistent with applicable state law regarding the transfer of
structured settlement payments. In such case any disputes between the parties will be governed in
accordance with the laws of the domicile state of the payee and the domicile state of the payee is the
proper venue to bring any cause of action arising out of a breach of the agreement.
G. I hereby grant to Assignee an Irrevocable Power of Attorney with full powers of substitution to do all
acts and things that I might do regarding the Assigned Payments and any and all rights I have under the
Settlement Agreement, including, without limitation, the power to endorse checks, drafts or other
instruments, the power to alter, edit and change payment instructions and/or beneficiary designations and
any other act which, in the sole discretion of Assignee as my Attorney-in-Fact is necessary or expedient for
it to obtain all of the benefits of the bargain contemplated by this transaction. This power of attorney is
coupled with an interest and shall survive my death or disability.
H. In the event that prior to the consummation of the transaction contemplated hereby I receive any of
the Assigned Payments, or any portion thereof, the Assignment Price shall be reduced in like amount and
the terms of this Agreement regarding the payments to be assigned shall be deemed to be adjusted
accordingly. In the event Assignee receives or otherwise comes into possession of any of the Periodic
Payment(s) or portion(s) thereof which are not included in the payments being absolutely assigned to
Assignee hereunder, Assignee shall forward such amount(s) to me at the address set forth above within
seven (7) days of receipt of such amount(s).
I. Assignee shall be entitled to discharge any adverse claims against Assignor or any of the Assigned
Payments whether or not such adverse claims are disclosed. Assignee may, provided Assignee furnishes
prior written notice to Assignor, pay any and all amounts necessary or, if the Assignment Price has been
deposited into an escrow account, instruct the escrow agent to pay any and all amounts necessary to
discharge such liens or other adverse claims, and the Assignment Price shall be reduced by the amount of
any such payment. Adverse claims may include disclosed amounts to be deducted by Assignee from the
Assignment Price to pay Assignee, as servicer for Peachtree Finance Company, LLC, to enable Assignor
to obtain Peachtree Finance Company, LLC's release of its encumbrance on a portion of the Assigned
Payments, which portion of Assigned Payments relate to prior transfer transaction(s) consummated prior to
the effective date of the applicable transfer act( s) which encumbrance must be released for the transaction
contemplated herein to be consummated.
J. I know that it will take some time for the Settlement Obligor and the Annuity Issuer to receive and
process the court order once it is granted. I would like to receive the Assignment Price or a portion thereof
as soon as possible thereafter. Accordingly, I hereby request Assignee to pay me a portion of the
Assignment Price as soon as possible after the court order is granted and authorize Assignee to hold in
escrow an amount it deems necessary or advisable from the Assignment Price (the "Escrow Amount") until
all conditions precedent have been satisfied, including, without limitation, the receipt by Assignee of the
Settlement Obligor and the Annuity Issuer's acknowledgment of the terms of the court order in writing and
their agreement to honor and comply with same. At such time or earlier as Assignee may determine, I
understand that Assignee will send the Escrow Amount to me minus any Assigned Payments that the
Annuity Issuer and/or Settlement Obligor sent to me while the Settlement Obligor and the Annuity Issuer
were processing the court order.
K. This Agreement shall take effect on the date it is signed by me (the Assignor) or on such later date
prescribed by applicable statutory law.
L. All disclosure statements are a material part of this Agreement and shall be read in pari materia
herewith.
In witness whereof I hereunto set m
Linda S.
Q I \
STATE OF ~ eJ.1Yl5yIVarll~
COUNTYO CITY of Allefhpu1 ~lIo--t-f-J
On the :5 ~ day of Oc ~ ~ ,in the year 2aJG before me, the undersigned,
personally appeared Linda S. Golofsky as Power of Attorney for Robert E. GOlofsky,
personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose
name(s) is (are) subscribed to the within instrument, and acknowledged to me that he/she/they executed
the same in his/her/their capacity(ies), and that by hislher/their signature(s) on the instrument. the
individual(s), or the person upon behalf of which the individual(s act ecuted t e instru nt.
My Commission expires on
7 - / y-
6:J C7 g- PLEASE DO NOT SIGN THIS
DOCUMENT UNTIL 09/30/2006
COMMONWEALTH OF PENNS'I VANIA
Nolarial Seal
George J. Korbakes, Nolary PIIUllv
Murrysville Bore, Westmoreland Ccxr\ty
My Commission Expires July 14. 2008
Memo'" Ponn<:vlvanj.. Association Of Notaries
Accepted:
Settlement Funding, L.L.C.
\ fMJ . JJL,^ .
Title:\ ,:9'
Date: JDJ4/clo
I I
Authorization For Deductions
Pursuant to the terms of the Agreement, Assignee may deduct from the Purchase Price the full amount due to
any and all third party creditors, judgment holders, holders of child support obligations, the holder of any other
outstanding lien or claim (collectively the "Judgments/Claims") including life insurance policy payment(s) or any
attorney fees in connection with the consummation of this transaction.
If Assignee is able to satisfy in full the Judgments/Claims for less than the full amount due, Assignee shall be
entitled to keep the difference between the amount deducted and the amount actually paid.
Authorization to Conduct Credit and Criminal Backaround Checks
I, Linda S. Golofskyas Power of Attorney for Robert E. Golofsky residing at 110 Tyrolia Dr, Monroeville, PA
15146-3734, hereby authorize Settlement Funding or any of its agents or designees, to conduct any and all
criminal background reports, searches or checks and any and all credit history reports, searches or checks
which it in its sole discretion and judgment deems necessary or advisable.
Authorization to Release Information
I, Linda S. Golofsky as Power of Attorney for Robert E. Golofsky, hereby request and authorize Lumbermens
Mutual Casualty Company, First Colony Life Insurance Company, or any of their successors, assigns,
designees, agents or administrators, or my attorney to disclose, or any other parties that may possess any
information deemed necessary by Settlement Funding, or any of its agents or designees to be disclosed, make
available and furnish to Settlement Funding, or any of its agents or designees any and all information pertaining
to my personal injury settlement as set forth in a certain Release dated February 6, 1987 or any other
documents deemed necessary by Settlement Funding, or any of its agents or designees. I specifically direct that
Lumbermens Mutual Casualty Company, First Colony Life Insurance Company, or any of their successors,
assigns, designees, agents or administrators or any other person or entity that this authorization is given to,
cooperate with Settlement Funding or any of their agents or designees regarding disclosure of information
pertaining or related to my settlement or other required documentation. Please provide copies via fax or
otherwise of any and all documents requested by Settlement Funding or their agents or designees regarding my
settlement.
Dated/tJ d-tJ b
~ 11 )
STATE OF e.. AS' ,I 4-.
COUNTY OR CI~ OF Y rjZ; /u~J1
On the "3.)t day of Oc-f(}h~, in the year 2..tJo' before me, the undersigned,
personally appeared Linda S. Golofsky as Power of Attorney for Robert E. Golofsky,
personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose
name(s) is (are) subscribed to the within instrument, and acknowledged to me that he/she/they executed the
same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or
the person upon behalf of which the Individual{s) acted, ~
My Commission expires on 7 -I V- ? CI 0 ~
C0MMONWEAL TH OF PE!',,'r.". ""'I
..\oJ I ...\'("'!-.~ t. A
Notarial Seal
~ J. Korbakes. Notary Public
Murrys\lille ~~. Westmoreland County
My CommISSlOl1 Expires July 14, 2008
Member, Pennsy/vaniaAssOciafJon Of Notaries
AFFIDAVIT
I, Linda S. Golofsky as Power of Attorney for Robert E. Golofsky, of full age, being duly sworn according to law,
upon my oath depose and say:
1. I, Linda S. Golofskyas Power of Attorney currently reside at 110 Tyrolia Dr, Monroeville, PA
15146-3734.
2. I, Linda S. Golofskyas Power of Attorney am the recipient of certain guaranteed payments
under a structured settlement approved by court on February 6,1987. The entity presently obligated to make
the payments due under the structured settlement is Lumbermens Mutual Casualty Company. In order to fund
its payment obligations under the structured settlement Lumbermens Mutual Casualty Company purchased an
annuity contract 0440986 from First Colony Life Insurance Company.
3. I, Linda S. Golofskyas Power of Attorney voluntarily entered into an Absolute Assignment and
UCC Article 9 Security Agreement (the "Agreement") dated September 30,2006 with Settlement Funding, LLC
d/b/a Peachtree Settlement Funding ("Peachtree"). Under that Agreement, I agreed to sell and assign to
Peachtree the following payments due to Robert under the structured settlement:
48 monthly payments each in the amount of $884.00 commencing on January 30, 2017
through and including December 30, 2020. One lumpsum payment of $20,000.00 due on
or about December 20,2020 (the "Assigned Payments").
4. I, Linda S. Golofsky as Power of Attorney understand I will forego receipt of the Assigned
Payments under the Agreement. I understand that Robert's beneficiaries/heirs and Robert will no longer receive
any of the Assigned Payments or any portion of the Assigned Payments. I understand that all of the Assigned
Payments will go to Peachtree or the assigns of Peachtree.
5. I, Linda S. Golofskyas Power of Attorney also understand that this Affidavit is submitted for use
in the court approval process initiated by Peachtree and myself to seek court approval of the transfer of
payments to Peachtree.
6. I, Linda S. Golofskyas Power of Attorney also received from Peachtree a Disclosure Statement
detailing the terms of the Agreement, which I signed and returned to Peachtree. I carefully reviewed the
Disclosure Statement and fully and completely understand all terms of the Disclosure Statement.
7. In the Disclosure Statement, Peachtree advised me to seek professional advice regarding the
Agreement from an attorney, accountant or other professional of my choice.
[
Exhibit D
]
~s: I chose not to retain or consult with such a professional. I understand that
at all times, including at the time I entered the Agreement and received the Disclosure
Statement, and for all times, I knowingly waive the right to seek or obtain for myself
independent professional advice regarding the Agreement.
_ Initials: I chose to retain or consult with an attorney, accountant or other licensed
professional advisor of my choice.
8. Robert E. Golofsky is currently incarcerated and not employed. I, Linda S. Golofskyas Power
of Attorney for Robert S. Golofsky am employed with Dialysis Clinic earning $14,400.00 annually. In addition I
receive $1,000.00 per month from VA. Therefore, I have other sources of income other than the structured
settlement payments that I wish to transfer and assign to Settlement Funding on Robert S. Golofsky's behalf.
9. I, Linda S. Golofskyas Power of Attorney for Robert S. Golofsky have thoroughly considered
this transaction, his alternatives and the use to which I will put the proceeds of this sale. I have considered the
impact of this transaction on Robert. Robert will be able to improve his present standard of living if I am
permitted to transfer and assign his right to receive the Assigned Payments to Settlement Funding as described
in this Affidavit. After considering these factors I believe that this transaction is in Robert's best interest.
10. I, Linda S. Golofskyas Power of Attorney for Robert S. Golofsky intend to use the proceeds I
receive from Peachtree under the Agreement to pay Robert's bail bond and to hire an attorney. Robert is
currently incarcerated and awaiting trial. Therefore, I would like to use $500.00 of the proceeds from this
transaction to pay for Robert's bail bond so that he can be released and focus on getting back on his feet.
Being able to afford better legal representation could have a dramatic impact on the outcome of
Robert's situation. Therefore, I wish to use the remaining funds, approximately $6,300.00, to pay for the
expenses associated with legal representation, so that Robert can improve his chances of being released and a
productive future. I, Linda S. Golofsky as Power of Attorney am not in a position to hire a defense attorney, and
as such Robert is at a disadvantage. The proceeds of this transaction will enable me to overcome this obstacle.
Without the proceeds from this transaction, I lack the financial wherewithal from my current finances to
accomplish the aforementioned.
11 . I will not be using any portion of the proceeds from the Agreement for day-to-day expenses. I
have never assigned, sold or pledged any of the structured settlement payments that I am proposing to transfer
and assign herein to any party or entity. In addition, Robert S. Golofsky has no dependents. I do not believe
A.
B.
that approval of this transfer will negatively affect his standard of living or harm him in any way. Therefore, I
have determined that the proceeds from the Agreement with Peachtree is in Robert's best interest and will
improve his quality of life.
Linda S.
STATE OF ~'4-';}.~~/'1ftt! "-
COUNTY OR ell',' OF /I 1 kl/f~
On the 3~ day of a--C-d~, in the year 2el/G"efore me, the undersigned,
personally appeared Linda S. Golofsky as Power of Attorney for Robert E. Golofsky,
personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose
name(s) is (are) subscribed to the within instrument, and acknowledged to me that he/she/they executed the
same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or
the person upon behalf of which the individual(s) acted, ~~
Notary
My Commission expires on
J ~ ~ Y'~ l....tf'v~
.
PLEASE DO NOT SIGN THIS
DOCUMENT UNTIL 09/30/2006
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
M George J. Korbakes, Notary Public
lIn'ySviUe ~~, WeslmoreJand County
My CommlsslOl1 Expires July 14, 2008
Member, Pennsvlval1ia ~~~ncia!!on Of Notaries
PENNSYLVANIA TRANSFER DISCLOSURE
Payee: Linda S. Golofsky as Power of Attorney for
Robert E. Golofsky; resident of: P A
A. Amounts and due dates of the structured settlement payments to be
transferred: 48 monthly payments each in the amount of $884.00
commencing on January 30, 2017 through and including December
30, 2020 and one lump sum payment of $20,000.00 due on or about
December 20, 2020.
B. Aggregate amount of such payments: $62,432.00
C. (1) Discounted present value of such payments: $29,145.67.
(2)The discount rate used in determining such discounted present
value: 6.00 percent as of September 20, 2006.
D. Gross amount payable to the Payee in exchange for such payments:
$9,088.78
E. Itemized listing of all brokers' commissions, service charges,
application or processing fees, closing costs, filing or administrative
charges, legal fees, notary fees and other commissions, fees, costs,
expenses and charges payable by the Payee or deductible from the
gross amount otherwise payable to the Payee: Legal Fees: $2,000.00;
Processing Fee: $200.00.
F. Net amount payable to Payee after deduction of all commissions,
fees, costs, expenses and charges described above: $6,888.78 minus
any advances made to Payee against the amount payable to Payee.
G. The quotient, expressed as a percentage, obtained by dividing the
net payment amount by the discounted present value of the
payments: 23.64%
H. 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: NONE
I Exhibit E 1
I. Payee acknowledges receipt of, and acknowledges to have read and
understood, the above disclosure statement and information required
to be ~ by Payee's applicable state statute(s).
Initials:
By signing below you are confirming that you received a copy of this
disclosure at least 10 days prior to receipt of this contract.
/fJ"?7J (,
Date
NOTICE (fA}
Payee: Linda S. Golofskyas Power of Attorney for Robert E. Golofsky.
IMPORTANT NOTICE: You are strongly urged to consult with an
attorney who can advise you of the potential tax consequences of this
transaction.
I aCknowledge receipt of the above notice.
By signing below you are confirming that you received a copy of this
disclosure at least 10 days prior to receipt of this contract.
;j#f~/~W
ower of Attorney for Robert E. Golofsky
('
IO~3-tk
Date
ExhibitF" ....,
ACKNOWLEDGEMENT (eAl
Payee: Linda S. Golofsky as Power of Attorney for Robert E. Golofsky
(Please Initial one of the following statements which applies to you)
I have received independent legal advice regarding the implications of
the transfer, including considerations of the tax ramifications of the
transfer.
(Initials)
I expressly waive independent legal advice regarding the implications of
the transfer, including considerations of the tax ramifications of the
tr sfer.
I have waived independent legal advice but I have received independent
professional advice regarding the implications of the transfer, including
considerations of the tax ramifications of the transfer.
/JtJ~4f rc:~
as Power olAttorney for Robert E. Golofsky
/(J ~ :S --l~
Date
I ----........- --~.......
,
Exhibit G
]
26 USCA ~ 5891
26 U.S.C.A. ~ 5891
Page 1
I.R.C. ~ 5891
UNITED STATES CODE ANNOTATED
TITLE 26. INTERNAL REVENUE CODE
SUBTITLE E--ALCOHOL, TOBACCO, AND CERTAIN OTHER EXCISE TAXES
CHAPTER 55--STRUCTURED SETTLEMENT FACTORING TRANSACTIONS
Copr. ~ West Group 2002. No claim to Orig. U.S. Govt. Works.
Current through P.L. 107-136, approved 1-24-02
~ 5891. St11lctured settlement factoring transactions
(a) Imposition of tax.--There is hereby imposed on any person who acquires directly or indirectly structured
settlement payment rights in a structured settlement factoring transaction a tax equal to 40 percent of the
factoring discount as determined under subsection (c)(4) with respect to such factoring transaction.
(b) Exception for certain approved transactions.--
(1) In generaI.--The tax under subsection (a) shall not apply in the case of a structured settlement factoring
transaction in which the transfer of structured settlement payment rights is approved in advance in a qualified
order.
(2) Qualified order.--For purposes of this section, the term "qualified order" means a final order, judgment, or
decree which--
(A) fmds that the transfer described in paragraph (1)--
(i) does not contravene any Federal or State statute or the order of any court or responsible administrative
authority, and
(ii) is in the best interest of the payee, taking into account the welfare and support of the payee's dependents, and
(B) is issued--
(i) under the authority of an applicable State statute by an applicable State court, or
(ii) by the responsible administrative authority (if any) which has exclusive jurisdiction over the underlying action
or proceeding which was resolved by means of the structured settlement.
(3) Applicable State statute.--For purposes of this section, the term "applicable State statute" means a statute
providing for the entry of an order, judgment, or decree described in paragraph (2)(A) which is enacted by--
(A) the State in which the payee of the structured set:tlement is domiciled, or
(B) if there is no statute described in subparagraph (A), the State in which either the party to the structured
settlement (including an assignee under a qualified assignment under section 130) or the person issuing the funding
asset for the structured settlement is domiciled or has its principal place of business.
(4) Applicable State court.--For purposes of this section--
(A) In generaI.-- The term "applicable State court" means, with respect to any applicable State statute, a court of
Copr. ~ West 2
". TT ~ r.. t. Works
Exhibit H
L_
26 USCA ~ 5891
26 U.S.C.A. ~ 5891
Page 2
the State which enacted such statute.
(B) Special rule.--In the case of an applicable State statute described in paragraph (3)(B), such term also includes
a court of the State in which the payee of the structured settlement is domiciled.
(5) Qualified order dispositive.nA qualified order shall be treated as dispositive for purposes of the exception
under this subsection.
( c) Definitions.-- F or purposes of this section--
(1) Structured settlement.-- The term "structured settlement" means an arrangement--
(A) which is established byn
(i) suit or agreement for the periodic payment of damages excludable from the gross income of the recipient
under section 104(a)(2), or
(ii) agreement for the periodic payment of compensation under any workers' compensation law excludable from
the gross income of the recipient under section 104( a)( 1), and
(B) under which the periodic payments are--
(i) of the character described in subparagraphs (A) and (B) of section 130( c )(2), and
(ii) payable by a person who is a party to the suit or agreement or to the workers' compensation claim or by a
person who has assumed the liability for such periodic payments under a qualified assignment in accordance with
section 130.
(2) Structured settlement payment rights.-- The term "structured settlement payment rights" means rights to
receive payments under a structured settlement.
(3) Structured settlement factoring transaction.--
(A) In general.--The term "structured settlement factoring transaction" means a transfer of structured
settlement payment rights (including portions of structured settlement payments) made for consideration by means
of sale, assignment, pledge, or other form of encumbrance or alienation for consideration.
(B) Exception.--Such term shall not include--
(i) the creation or perfection of a security interest in structured settlement payment rights under a blanket security
agreement entered into with an insured depository institution in the absence of any action to redirect the structured
settlement payments to such institution (or agent or successor thereot) or otherwise to enforce such blanket security
interest as against the structured settlement payment rights, or
(ii) a subsequent transfer of structured settlement payment rights acquired in a structured settlement factoring
transaction.
(4) Factoring discount.--The term "factoring discount" means an amount equal to the excess of--
(A) the aggregate undiscounted amount of structured settlement payments being acquired in the structured
settlement factoring transaction, over
(B) the total amount actually paid by the acquirer to the person from whom such structured settlement payments
are acquired.
(5) Responsible administrative authority.-- The term "responsible administrative authority" means the
Copr. @ West 2002 No Claim to Orig. U.S. Govt. Works
26 USCA ~ 5891
26 U.S.C.A. ~ 5891
Page 3
administrative authority which had jurisdiction over the underlying action or proceeding which was resolved by
means of the structured settlement.
(6) State.--The term "State" includes the Commonwealth of Puerto Rico and any possession of the United States.
(d) Coordination with other provisions.--
(1) In general.--If theapplicable requirements of sections 72, I 04(a)(1), 104 ( a)(2), 130, and 461 (h) were satisfied
at the time the structured settlement involving structured settlement payment rights was entered into, the subsequent
occurrence of a structured settlement factoring transaction shall not affect the application of the provisions of
such sections to the parties to the structured settlement (including an assignee under a qualified assignment under
section 130) in any taxable year.
(2) No withholding of tax.-- The provisions of section 3405 regarding withholding of tax shall not apply to the
person making the payments in the event of a structured settlement factoring transaction.
CREDIT(S)
2002 Pocket Part
(Added Pub.L. 107-134, Title I, ~ 115(a), Jan. 23, 2002, 115 Stat. 2436.)
<General Materials (GM) - References, Annotations, or Tables>
HISTORICAL AND STATUTORY NOTES
Revision Notes and Legislative Reports
2002 Acts. Statement of President, see 2001 U.S. Code Congo and Adm. News, p. 1812.
Effective and Applicability Provisions
2002 Acts. Pub.L. 107-134, Title I, & 115(c), Jan. 23, 2002,115 Stat. 2438, provided that:
"(1) In general.-- The amendments made by this section [enacting this chapter] (other than the provisions of
section 5891(d) of the Internal Revenue Code of 1986, as added by this section [26 U.S.C.A. ~ 5891(d)]) shall apply
to structured settlement factoring transactions (as defined in section 5891(c) of such Code (as so added) [26
U.S.C.A. ~ 589 I (c)]) entered into on or after the 30th day following the date of the enactment of this Act [Jan. 23,
2002].
"(2) Clarification of existing law.--Section 5891(d) of such Code (as so added) [26 U.S.c.A. ~ 5891(d)] shall
apply to structured settlement factoring transactions (as defined in section 5891(c) of such Code (as so added)
[26 U.S.C.A. ~ 5891(c)]) entered into before, on, or after such 30th day.
"(3) Transition rule.--In the case of a structured settlement factoring transaction entered into during the period
beginning on the 30th day following the date of the enactment of this Act [Jan. 23, 2002] and ending on July I,
Copr. @ West 2002 No Claim to Orig. U.S. Govt. Works
26 USCA S 5891
26 U.S.C.A. S 5891
Page 4
2002, no tax shall be imposed under section 5891(a) of such Code [26 U.S.C.A. S 5891(a)] if--
"(A) The structured settlement payee is domiciled in a State (or possession of the United States) which has not
enacted a statute providing that the structured settlement factoring transaction is ineffective unless the
transaction has been approved by an order, judgment, or decree of a court (or where applicable, a responsible
administrative authority) which finds that such transaction--
"(i) does not contravene any Federal or State statute or the order of any court (or responsible administrative
authority); and
"(ii) is in the best interest of the structured settlement payee or is appropriate in light of a hardship faced by the
payee; and
"(B) the person acquiring the structured settlement payment rights discloses to the structured settlement payee in
advance of the structured settlement factoring transaction the amounts and due dates of the payments to be
transferred, the aggregate amount to be transferred, the consideration to be received by the structured settlement
payee for the transferred payments, the discounted present value of the transferred payments (including the present
value as determined in the manner described in section 7520 of such Code [26 U.S.C.A. * 75201), and the expenses
required under the terms of the structured settlement factoring transaction to be paid by the structured settlement
payee or deducted from the proceeds of such transaction."
26 U.S.C.A. S 5891
26 USCA S 5891
END OF DOCUMENT
Copr. @ West 2002 No Claim to Orig. U.S. Govt. Works
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