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Filing # 192972588 E-Filed 02/28/2024 07:42:57 PM
IN THE CIRCUIT COURT OF THE 13TH JUDICIAL CIRCUIT
IN AND FOR HILLSBOROUGH COUNTY, FLORIDA
In Re: CASE NO:
Approval of Transfer of
Payment Rights by
CBC Settlement Funding, LLC,
Petitioner.
/
PETITION/APPLICATION FOR COURT APPROVAL OF A TRANSFER OF
STRUCTURED SETTLEMENT PAYMENT RIGHTS
CBC Settlement Funding, LLC (“CBC”), a Delaware limited liability company
, by and
through its undersigned attorney, hereby brings this Petition/Application,
pursuant to the Florida
Structured Settlement Transfer Act, Florida Statute 626.99296 (the “Statute”)
and alleges as
follows:
1 CBC is a limited liability company under the laws of the State
of Delaware, and is a transferee as defined by the Statute.
2 Payee is an individual who is over the age of eighteen and domiciled in the
Hillsborough County, Florida and is the Payee, as defined by the Statute.
3 Payee became entitled to receive the certain guaranteed
periodic payments from Athene Assignment Corporation (“Athene” or “Struct
ured Settlement
Obligor”) under the terms of the settlement agreement (the “Settlement”)
(the “Periodic
Payments”). To fund its obligation to remit the Periodic Payments, Athene
purchased an annuity
policy from Athene Annuity and Life Company (“Athene Life” or “Annui
ty Issuer”).
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Filed: | udicial Circuit Page 1
\
4 CBC submits this application to approve a structured settlement payment sale
or
transfer in accordance with F.S. s. 626.99296, governing the “Transfers of Structur
ed Settlement
Payment Rights” (the “Statute”).
5 Payee entered into a Purchase and Sale Agreement (the “Purchase Agreement”,
a
true copy of which is attached hereto as Exhibit “A”) with CBC under which Payee
is seeking to
sell and transfer to CBC the following Periodic Payments:
iGo
6 It is submitted that transfer outlined within the Purchase Agreement should be
approved, since the requirements of the Statute have been satisfied. Specifically,
CBC furnished
to Payee, as required by the Statute, a separate Disclosure Statement (Exhibit
“C”), in bold type
no smaller than 14 points, setting forth the following:
the amounts and due dates of the Assigned Payments;
the aggregate amount of the Assigned Payments;
the discounted present value of the Assigned Payments, which
shall be identified as the "calculation of current value of the
transferred structured settlement payments under federal standards
for valuing annuities" and the amount of the applicable federal rate
used in calculating the discounted present value;
the gross advance amount to the Payee in exchange for the
payments;
an itemized listing of all applicable transfer expenses, including all
brokers’ commissions, service charges, application fees,
processing fees, closing costs, filing fees, referral fees,
administrative fees, legal fees, and notary fees and other
commissions, fees, costs, expenses, and charges payable by the
2/28/2024 7:42 PM Electronically Filed: Hillsborough County/13th J udicial Circuit Page 2
Payee or deductible from the gross amount otherwise payable to
the Payee;
The net amount payable to the Payee in exchange for the
Assigned Payments;
The quotient, expressed as a percentage, obtained by dividing the
net payment amount by the discounted present value of the
Assigned Payments.
The effective annual interest rate
The amount of any penalty and the aggregate amount of
any liquidated damages, including penalties, payable by the Payee
in the event of a breach of the transfer agreement by the Payee.
7. Payee has received or waived his right to receive independent professional
advice
regarding the legal, tax and financial implications of the transfer.
8 Payee has established that the transfer is in her/his best interests, taking into
account the welfare and support of her/his dependents. Specifically, the attached affidavit of
Payee includes a sworn statement regarding the Purchase Agreement and
sets forth the facts as
required by the Act (Exhibit “B”).
9 CBC has given written notice of the Transferee’s name, address, and
taxpayer
identification number to the annuity issuer and the structured settlem
ent obligor and has filed a
copy of the notice with the court.
10. Payee is domiciled in this state, any disputes between the parties will be govern
ed
in accordance with the laws of this state and that the domicile state of Payee
is the proper venue
to bring any cause of action arising out of a breach of the agreement.
11, The net amount payable to Payee is fair, just and reasonable under the
circumstances then existing.
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12. The notice provisions of the Statute have also been satisfied. Specifically, not
less than 20 days prior to the scheduled hearing on this application for authorizing a transfer of
structured settlement payment rights, CBC filed with the court and all interested parties a notice
of hearing and the proposed transfer and the application for its authorization, including with the
notice, the following:
A copy of the CBC’s application to the court;
A copy of the Purchase Agreement;
A copy of the disclosure statement required under subsection 3 of the Statute;
Notification that an interested party may support, oppose or otherwise respond to
the CBC's application, in person or by counsel, by submitting written comments
to the court or by participating in the hearing; and
Notification of the time and place of the hearing and notification of the manner in
which, and the time by which, written responses to the application shall be filed,
which shall be not less than 15 days after service of the transferee's notice, in
order to be considered by the court or responsible administrative authority.
13, The proposed transfer complies with all the requirements of the Statute and
federal law as codified in 26 U.S.C. § 5891, et seq. and will not contravene any
applicable federal or state statute, or order of any court or other government agency or
responsible administrative authority.
WHEREFORE, Petitioner, CBC, hereby requests entry of an Order pursuant to F.S.
s. 626
permitting Payee to transfer the Assigned Payments to CBC and detailing the findings
as contained
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in the form of an Order.
Dated: March 1, 2024.
/s/ Kenneth B. Dion
Kenneth B. Dion, Esquire
Florida Bar No: 949043
Attorney for Petitioner
823 North Olive Ave.
West Palm Beach, FL 33401
(561) 835-9833
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DocuSign Envelope ID: EOF70501-D82E-4F88-B05E-
826DE2DF3D29
CBC File #47455
Page 4
PURCHASE AND SALE AGREEMENT
|
This contract is for the sale of structured settlement
payments payable under annuity policy number
(policy) Issued by Athens e Annuit and Life Compa
al
Settlement Funding, ny (issuer) by and among CBC
LLC (we, us, our) and Hj
KM (you, your, seller).
You will sell the future annuity payments identified
on Exhibit A to us for the purchase price
oj accord
ing to this contract and the dos cuments listed on the List
De MmEnis. of Closing
Defined Terms
Business day means any weekday that banks are
open for normal business in New York City.
CBC Settlement Funding, LLC means CBC Settlement
Funding, LLC a Delaware Limited Liabtlity Compan
y.
Closing date means the date on which the purchase
price is released to the seller,
Contract or contract documents means, this Purcha
se A greement and the documents listed on the
List of Closing Documents, and any other documents
inco: rporated by reference.
Contract date means the date on which the
parties execute the Signature page of this contra
ct,
Encumbrance means any claim, right, lien, policy loan,
or restriction.
Issuer means the life insurance company that issued
the policy.
Obligor means the entity which is listed as the
owner of the policy.
Party means one of you or us. Parties means both you and us.
Person means any natural person or legal entity.
Policy means the annuity policy described on this
contract’: 8 first page and on Exhibit C ~ Policy
Description.
We, us, or our means CBC Settlement Funding, LLC, with its successors,
assigns, and designees.
You or your means the Person named on this
contract’s fir: st page. Some of the documents listed
on the List of Closing Documents refer to you as the seller
.
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DocuSign Envelope ID: E0F70501-D82E-4F68-B05E-826DE2
DF3029
CBC Fite # 47455
Page 5
Sale of the policy
A On the closing date, you will; (i) Sell, transfer or assi ign
to us the policy free from any
encumbranes; and (ii) name us the policy’s sole payee
and beneficiary for the duration
of the payments fisted on Exhibit A.
In exchange for; (i) selling the payments liste d on Exhibit
A; {ii} changing the beneficiary to
us; and (iii) fulfilling your promises under thi is contract,
we will pay you the purchase price.
Cc. We are not buying any additional
benefits tha’ it may be payable under the Policy. Any
additional unencumbered payments go to the address desig
nated by you,
Uh Purchase price
A. The net purchase price is SE vayavic by check or ACH.
B. The purchase price is fair and reasonable to you and us,
C. You understand that the purchase price is less than the aggreg
ate payments being sold.
You understand that we may have to hold back a portion
of the purcha se price until such
time as the issuer provides confirmation that all payment
transferred pursuant to this
agreement will be sent to us, The hol Id back payments may
be used to satisfy any payments
received by you belonging to us. Fr Ol m the closing date,
you will provide updated contact and
banking information for ninety (90) da ys. Failure to do so
will subject escrowed payments toa
monthly service fee after ninety (90) days of one-half
(1/2) of one (1) percent,
E. We may adjust the purchase price by the follow! ing amount
s, if any: (i) Fees charged by the
annuity Issuer or Obligor (if applicable); (ii) Any
costs associated with obtaining court approval;
(ili) Any other amounts as directed by y' ‘ou; and (Iv) Paymen
ts you owe to brokers that helped
you sell the policy (if any). Any adjust ments shail be disclosed to you in a disclosure
statement (Schedule 1),
The adjusted amount is the net purchase price.
I. Closing procedures
Before the sale can be completed, the following condit
ions must be satisfied
A. You provided us signed originals of the contract
documents.
B You provided us all documentation about the policy.
C. You are living on the closing date.
Db, To the best of your knowledge (i) Ever y Statement made
by you in this contract and the
closing documents is true and comple lete on the closing
date; and (ji) There is no
threatened or pending liti gation, governmental action
or change in law or rule that affects
the legallty and enforceal bility of this contract.
NV. Your representations
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DocuSign Envelope ID: E0F70501-D82E-4F88-BO5E-826DE2
DF3D29
CBC File #47455
Page 6
Except as disclose by you In the contract documents, you repres
ent and warrant to us that on the
contract date ail of the following:
A. You are the policy's sole and undisputed payee,
B The payments listed on Exhibit A are free of any encumbrance,
Cc. There are no restrictions on your ability to sell the policy
to us.
No law, divorce decree or other legal proceeding ( |) require
s you to keep the Policy for the
benefit of a current or former spouse, dependent children,
or other person; or ( ji) forbids you
from contracting with us, selling the policy, and changing the
policy’s beneficiary.
You are competent and have the authority to contract with us
to sell the payments.
Either You have never filed for bankruptey; or If you filed for bankru
ptcy, the policy was not
subject to the claims of your creditors. Yor u gave us @ copy
of the bankruptcy discharge
Papers and any bankruptcy papers related to the policy.
You have fulfilled all child support.
There are no tax liens against you or your property,
including the policy.
You legally live in, and your primary residence is in, the State
of FL
Any future owner of the payments will have all of our rights
and duties you owe to us under
this contract, This includes the right to ma ke a claim against
you for violating any of the
representations or promises you made in this contra ct.
You had sufficient time to consider the sale of the policy
and this contract,
You got independent professional advi ice about the sale
of the policy and this contract or
knowingly waived such advice.
We did not provide tax, financial, or legal advice about
this contract.
The issuer may require that the entire mont! hly paymen
t be sent to us even if you have not
sold the entire payment. In such an event, we will
timely remit any portions due you to such
address as you may designate.
You freely and voluntarily agree to this contract.
If you are married, your spouse understands this contra
ct,
We may sell, transfer, or assign the policy in a sale, securitization, or other
financing
transaction (resale),
You recognize that after the cancellation Period we
will expend significant legal fees to
obtain court order approval of this transa ction. You will not ent
‘er into any other agreement
with any other third party to sell any of the payments outlined
in Exhibit A.
Your promises fo us
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DocuSign Envelope ID: E0F70501-D82E-4F88-805E-8
26DE2DF3D29
CBC File #47455
Page 7
Before and after the closing date, you will cooper
ate in completing and signing documents to
transfer the policy’s ownershi ip and change its
beneficiary and correct any documentation
errors in this contract; and
From the contract date to the closin: ig date, you will not; (i) sign any
policy to any person other than us, (il) change agreement to sell the
the policy's owner or beneficiary to any
person other than us, or (ili) grant ai iny other
encumbrance against the policy.
From the contract date to the closing date,
you will give us any information necessary to
update your representations and promises in
this co! ntract. You wil ll provide updated
documents and information when they becom
e available.
Restrictions on Assignment: Your Settlement Agree
ment and related settlement documents
may contain language prohibiting your power T to accele
rate, defer, increase, decrease or
assign your payments. You hereby waive a ind
release any such restriction if your settlement
agreement and/or related settlement docum
ents contain this or sit milar fanguage. As such,
you understand and a gree that you will never
claim or assert that the payments you are now
selling were not transi ferrable, or t that this language
renders this Agreement void and/or
voldable.
Vi. Cancellation by us
We may cancel this contract before the closing
date if:
A You breach any representation or warranty contai
ned In this contract.
B We are sued or threatened with an y litigation or regula
tory action regarding about this
contract or the policy.
Cc. Any voluntary or involuntary bankruptcy is filed
involving You.
D You are no longer living.
cE A major rating agency downgrades the issuer
or obligor’s credit rating.
F. The Issuer or obligor is insolvent or under
regulatory supervision,
G. We are unable to provide the purchase price
when due.
VIL Cancellation by you
A You may end this contract prior to the tenth (10th)
day following your execution of this
contract and the disclosure statement. This is the cancellation period.
B. To end this contract, you must notify us
in writing before the cancellation period
ends.
Vill. Indemnification
You will pay us for losses or actual damages we
suffer:
A If you do not comply with your responsibili
ties under this contract;
B Because any representation or warranty you
made in this contract was false or incomplete
;
c You failed to keep any promise you
made in this contract.
IX. Notices
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DocuSign Envelope ID; E0F70501-D826-4F88-805E-
826DE2DF3D29
CBC File #47455
Page 8
All notices about this contract must be in wri iting. Notice
is deemed delivered when received at the
addresses listed below:
If to you:
H
If to us:
CBC Settlement Funding, LLC
181 Washington St., Suite 375
Conshohocken, PA 19428
Miscellaneous
A. This contract is the entire agreement between you
and us.
B. Both parties must agree in writing to any change
to this contract or waiver of its terms,
You cannot voluntarily or involu intarily sell, assign,
or transfer this cor ntract, or any of your
rights or duties under this conti ract.
This Agreement and any disputes between the parties shall
be governed, interpreted,
construed and enforce: d in accordance with the internal
law: ‘sof the state issuing the court
order approving the transfer of the structured settlement payme
The Approval State is the proper venue to brin ig
nts ("Approval State").
any Cauisé of action. The parties agree to
Jurisdiction in any court of competent jurisdicti
ion within the Approval State,
Fallure to snforce any provision of this contract
is not a waiver of that provision,
If a court undoes any part of this contract, the rest
of the contract remains valid,
The parties may sign this contract in on @ OF more Counte
rparis. Each counterpart will be
considered an original,
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DoecuSign Envelope ID: E0F70501-D82E-4F88-805E-826DE2
DF3D29
CBC File #47455
Page 9
Making iiisieading or false statements or rej presentations is crime and penaites ney include
imprisonment, fines, denial of benefits, and civil damage
s.
The parties signed this contract on the dates written below:
You: 1a Ga
Doousigned by:
tl
itimia Hog
setneuzen zeae
2/23/2024 | 8:36 AM PST
(Seller's Signature)
(Date}
(Sellers Spouse’s Signature, if applicable)
(Date)
CBC SETTLEMENT FUNDING, LLC
Deven Khuen,
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DocuSign Envelope 1D; EOF70501 -D82E-4F88-B0SE
-826DE2DF3D29
CBC File #47455
Page 10
Exhibit A
The following payments are to be transferred pursu
ant to this Agreement:
All other annuity payments shall remain payable to
the Seller unless subject to
_another assignment, sale or encumbran ce.
4
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erm
AFFIDAVIT OF HASHAWNIA KERR SUPP ORT OF
TRANSFER OF STRUC DS. MENT MEN 3
vi KJfbcing duly sworn upon my oath depose and say:
i Tam over the age of eighteen, of sound mind, sane and not under the influence of
alcohol or dnigs, and | am not suffering from any physical or mental impairment affecting my
judgment. 1am fully and personally cognizant of all facts and matters stated in this Affidavit. 1
have never bees adjudged mcompetent by any court,
22 tam domiciled in the State of Florida,
3. Tam single and have no dependents.
4 | am signing and submitting this Affidavit in connection with that certain
Purchase, Transfer and Assignment Agreement (‘Transfer Agreement”) executed by and
between myself as the Seller and CBC Settlement Funding, LLC (“CBC”) as the Purchaser.
Capitalized terms not otherwise defined in this Affidavit shail have the meanings given to them
in the Transfer Agreement. The “Transaction” shall hereafter refer to the transaction set forth
and described in the Transfer Agreement and related documents, involving the sale and
assignment of my right to receive certain future payments to CBC.
55. 1 have read and understand the Transfer Agreement and related documents and
understand the transaction. Iam fully aware of the economic consequences of this transaction
and am fully capable of managing my financial, personal and business affairs.
6 1 am entitled to the settlement payments set forth in the Transfer Agreement. The
structured settlement payments arose from the medical malpractice lawsuit, The cause of action
associated with the lawsuit has been resolved. Pursuant to a settlement agreement and release, I
was entitled to receive monthly payments in the amount ha aaa)
— esses
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t have never d future ary Y payinents.
1 do not rely upon the Periodic Payments to pay i food
my monthly | living expens:
sloth shelter, and medical care). 1 do desire to sell a portion of Periodic Payments, to wit
160 monthly payments in the amount of
$1,2 0 beginning on February May 9, 2024, thr vugh
and inc’ ing Augu 9, 2037. (Collectively, hereinafter “Assigned Payments”)
9 1 desire to transfer the A: igned Payment in exchange for a lump sum today to
reeeive the current market value of my payment
ules]
16. | have determined that the sale of the
igned Payments to CBC is fair and
Teasonable, will improve the quality my life and is in my best interest. I plan on using the
funds from this transaction to invest in a high-yield bonds that
guara antee a 13% rate of return
‘This investment will ensure more substantial growth over the next
10 years,
i, Before entering this transaction, 1 analyzed the financial and legal
consequences
of this transaction. [ have not received any accounting, tax, legal or other advice from
CBC in
connection with this transaction. 1 was advised in writing by CBC to seek independent
professional advice regarding the legal tax and financial implicati
ons of this transaction, and
after strong consideration, | have decided to knowingly and voluntarily
waive my tight to receive
such advice,
12, 1 understand that the Settlement Agreement and/or settlement documents
may
contain provisions that restrict or prohibit the assignment or transfer of the Assigned
P; ‘ayments, I
waive all such restrictions and prohibitions and desire to complete the transaction
notwithstanding such restrictions and prohibitions,
2 nen nreteesenemnsnnteneseeneere!|
2/28/2024 7:42 PM Electronically Filed: Hillsborough County/13th J udicial Circuit Page 14
13. | understand and acknowledge that
each of the tepreientations, warranties,
avenants, agreements, obligations, and duties | make
under the Transfer Agreement and related
locuments are being relied upon by CBC. | understand
that if | breach or violate any terms of
the Transfer Agreement or related documents, CBC will suffer
substantial damages as a result.
14. 1 will not permit anyone claiming by or through me (other than CBC), to
do
anything that would divert the Assigned Payments
from CBC.
15. 1 recognize and accept the continuing and irrevocable duty and obligation under
the Transfer Agreement to cooperate with CBC to make sure that CBC receives the entire
Assigned Payments, including the duty to immediately deliver to CBC any checks, funds or other
form of payments received by me which constitute any portion of the Assigned Payments. I
understand that this duty exists regardless of whether the Assigned Payments are received by
mistake or as a result of any action or omission on the part of CBC.
16. 1 have not previously pledged, promised, assigned, sold or encumbered any of my
rights in or to the Assigned Payments due under the Annuity (except as may be set forth and
fully disclosed in the Disclosure Statement and/or other closing documents in this transaction),
nor have any such payment rights or benefits ever been attached, levied, foreclosed upon, seized,
restricted, or subjected to garnishment or other legal process or proceeding.
Yh ‘Twenty days or more prior to the date of the hearing on approval of this matter, I
received, and I hereby accept service of the Petition for Court Approval of a Transfer of
Structured Settlement Payment Rights, along with all required documents and information
pursuant to Florida Statute 626.99296 et. seq.
18. ‘Ten days or more prior to the date | first incurred an obligation with respect to this
Preview
Filing # 192972588 E-Filed 02/28/2024 07:42:57 PM IN THE CIRCUIT COURT OF THE 13TH JUDICIAL CIRCUIT IN AND FOR HILLSBOROUGH COUNTY, FLORIDA In Re: CASE NO: Approval of Transfer of Payment Rights by CBC Settlement Funding, LLC, Petitioner. / PETITION/APPLICATION FOR COURT APPROVAL OF A TRANSFER OF STRUCTURED SETTLEMENT PAYMENT RIGHTS CBC Settlement Funding, LLC (“CBC”), a Delaware limited liability company , by and through its undersigned attorney, hereby brings this Petition/Application, pursuant to the Florida Structured Settlement Transfer Act, Florida Statute 626.99296 (the “Statute”) and alleges as follows: 1 CBC is a limited liability company under the laws of the State of Delaware, and is a transferee as defined by the Statute. 2 Payee is an individual who is over the age of eighteen and domiciled in the Hillsborough County, Florida and is the Payee, as defined by the Statute. 3 Payee became entitled to receive the certain guaranteed periodic payments from Athene Assignment Corporation (“Athene” or “Struct ured Settlement Obligor”) under the terms of the settlement agreement (the “Settlement”) (the “Periodic Payments”). To fund its obligation to remit the Periodic Payments, Athene purchased an annuity policy from Athene Annuity and Life Company (“Athene Life” or “Annui ty Issuer”). 2/28/2024 -7:42-P-M Electronically Hillsborough-County/13th Filed: | udicial Circuit Page 1 \ 4 CBC submits this application to approve a structured settlement payment sale or transfer in accordance with F.S. s. 626.99296, governing the “Transfers of Structur ed Settlement Payment Rights” (the “Statute”). 5 Payee entered into a Purchase and Sale Agreement (the “Purchase Agreement”, a true copy of which is attached hereto as Exhibit “A”) with CBC under which Payee is seeking to sell and transfer to CBC the following Periodic Payments: iGo 6 It is submitted that transfer outlined within the Purchase Agreement should be approved, since the requirements of the Statute have been satisfied. Specifically, CBC furnished to Payee, as required by the Statute, a separate Disclosure Statement (Exhibit “C”), in bold type no smaller than 14 points, setting forth the following: the amounts and due dates of the Assigned Payments; the aggregate amount of the Assigned Payments; the discounted present value of the Assigned Payments, which shall be identified as the "calculation of current value of the transferred structured settlement payments under federal standards for valuing annuities" and the amount of the applicable federal rate used in calculating the discounted present value; the gross advance amount to the Payee in exchange for the payments; an itemized listing of all applicable transfer expenses, including all brokers’ commissions, service charges, application fees, processing fees, closing costs, filing fees, referral fees, administrative fees, legal fees, and notary fees and other commissions, fees, costs, expenses, and charges payable by the 2/28/2024 7:42 PM Electronically Filed: Hillsborough County/13th J udicial Circuit Page 2 Payee or deductible from the gross amount otherwise payable to the Payee; The net amount payable to the Payee in exchange for the Assigned Payments; The quotient, expressed as a percentage, obtained by dividing the net payment amount by the discounted present value of the Assigned Payments. The effective annual interest rate The amount of any penalty and the aggregate amount of any liquidated damages, including penalties, payable by the Payee in the event of a breach of the transfer agreement by the Payee. 7. Payee has received or waived his right to receive independent professional advice regarding the legal, tax and financial implications of the transfer. 8 Payee has established that the transfer is in her/his best interests, taking into account the welfare and support of her/his dependents. Specifically, the attached affidavit of Payee includes a sworn statement regarding the Purchase Agreement and sets forth the facts as required by the Act (Exhibit “B”). 9 CBC has given written notice of the Transferee’s name, address, and taxpayer identification number to the annuity issuer and the structured settlem ent obligor and has filed a copy of the notice with the court. 10. Payee is domiciled in this state, any disputes between the parties will be govern ed in accordance with the laws of this state and that the domicile state of Payee is the proper venue to bring any cause of action arising out of a breach of the agreement. 11, The net amount payable to Payee is fair, just and reasonable under the circumstances then existing. 2/28/202-4-7:42-P M-Electronically Filed-Hillsborough County/13th J udicial Circuit Page 3 12. The notice provisions of the Statute have also been satisfied. Specifically, not less than 20 days prior to the scheduled hearing on this application for authorizing a transfer of structured settlement payment rights, CBC filed with the court and all interested parties a notice of hearing and the proposed transfer and the application for its authorization, including with the notice, the following: A copy of the CBC’s application to the court; A copy of the Purchase Agreement; A copy of the disclosure statement required under subsection 3 of the Statute; Notification that an interested party may support, oppose or otherwise respond to the CBC's application, in person or by counsel, by submitting written comments to the court or by participating in the hearing; and Notification of the time and place of the hearing and notification of the manner in which, and the time by which, written responses to the application shall be filed, which shall be not less than 15 days after service of the transferee's notice, in order to be considered by the court or responsible administrative authority. 13, The proposed transfer complies with all the requirements of the Statute and federal law as codified in 26 U.S.C. § 5891, et seq. and will not contravene any applicable federal or state statute, or order of any court or other government agency or responsible administrative authority. WHEREFORE, Petitioner, CBC, hereby requests entry of an Order pursuant to F.S. s. 626 permitting Payee to transfer the Assigned Payments to CBC and detailing the findings as contained 2/28/2024 7:42 PM Electronically Filed: Hillsborough County/13th J udicial Circuit Page 4 in the form of an Order. Dated: March 1, 2024. /s/ Kenneth B. Dion Kenneth B. Dion, Esquire Florida Bar No: 949043 Attorney for Petitioner 823 North Olive Ave. West Palm Beach, FL 33401 (561) 835-9833 2/28/2024 7:42 PM Electronically Filed: Hillsborough County/13th J udicial Circuit Page 5 DocuSign Envelope ID: EOF70501-D82E-4F88-B05E- 826DE2DF3D29 CBC File #47455 Page 4 PURCHASE AND SALE AGREEMENT | This contract is for the sale of structured settlement payments payable under annuity policy number (policy) Issued by Athens e Annuit and Life Compa al Settlement Funding, ny (issuer) by and among CBC LLC (we, us, our) and Hj KM (you, your, seller). You will sell the future annuity payments identified on Exhibit A to us for the purchase price oj accord ing to this contract and the dos cuments listed on the List De MmEnis. of Closing Defined Terms Business day means any weekday that banks are open for normal business in New York City. CBC Settlement Funding, LLC means CBC Settlement Funding, LLC a Delaware Limited Liabtlity Compan y. Closing date means the date on which the purchase price is released to the seller, Contract or contract documents means, this Purcha se A greement and the documents listed on the List of Closing Documents, and any other documents inco: rporated by reference. Contract date means the date on which the parties execute the Signature page of this contra ct, Encumbrance means any claim, right, lien, policy loan, or restriction. Issuer means the life insurance company that issued the policy. Obligor means the entity which is listed as the owner of the policy. Party means one of you or us. Parties means both you and us. Person means any natural person or legal entity. Policy means the annuity policy described on this contract’: 8 first page and on Exhibit C ~ Policy Description. We, us, or our means CBC Settlement Funding, LLC, with its successors, assigns, and designees. You or your means the Person named on this contract’s fir: st page. Some of the documents listed on the List of Closing Documents refer to you as the seller . 2/28/2024 7:42 PM Electronically Filed: Hillsborough County/13th J udicial Circuit Page 6 DocuSign Envelope ID: E0F70501-D82E-4F68-B05E-826DE2 DF3029 CBC Fite # 47455 Page 5 Sale of the policy A On the closing date, you will; (i) Sell, transfer or assi ign to us the policy free from any encumbranes; and (ii) name us the policy’s sole payee and beneficiary for the duration of the payments fisted on Exhibit A. In exchange for; (i) selling the payments liste d on Exhibit A; {ii} changing the beneficiary to us; and (iii) fulfilling your promises under thi is contract, we will pay you the purchase price. Cc. We are not buying any additional benefits tha’ it may be payable under the Policy. Any additional unencumbered payments go to the address desig nated by you, Uh Purchase price A. The net purchase price is SE vayavic by check or ACH. B. The purchase price is fair and reasonable to you and us, C. You understand that the purchase price is less than the aggreg ate payments being sold. You understand that we may have to hold back a portion of the purcha se price until such time as the issuer provides confirmation that all payment transferred pursuant to this agreement will be sent to us, The hol Id back payments may be used to satisfy any payments received by you belonging to us. Fr Ol m the closing date, you will provide updated contact and banking information for ninety (90) da ys. Failure to do so will subject escrowed payments toa monthly service fee after ninety (90) days of one-half (1/2) of one (1) percent, E. We may adjust the purchase price by the follow! ing amount s, if any: (i) Fees charged by the annuity Issuer or Obligor (if applicable); (ii) Any costs associated with obtaining court approval; (ili) Any other amounts as directed by y' ‘ou; and (Iv) Paymen ts you owe to brokers that helped you sell the policy (if any). Any adjust ments shail be disclosed to you in a disclosure statement (Schedule 1), The adjusted amount is the net purchase price. I. Closing procedures Before the sale can be completed, the following condit ions must be satisfied A. You provided us signed originals of the contract documents. B You provided us all documentation about the policy. C. You are living on the closing date. Db, To the best of your knowledge (i) Ever y Statement made by you in this contract and the closing documents is true and comple lete on the closing date; and (ji) There is no threatened or pending liti gation, governmental action or change in law or rule that affects the legallty and enforceal bility of this contract. NV. Your representations 2/28/2024 7:42 PM Electronically Filed: Hillsborough County/13th J udicial Circuit Page 7 DocuSign Envelope ID: E0F70501-D82E-4F88-BO5E-826DE2 DF3D29 CBC File #47455 Page 6 Except as disclose by you In the contract documents, you repres ent and warrant to us that on the contract date ail of the following: A. You are the policy's sole and undisputed payee, B The payments listed on Exhibit A are free of any encumbrance, Cc. There are no restrictions on your ability to sell the policy to us. No law, divorce decree or other legal proceeding ( |) require s you to keep the Policy for the benefit of a current or former spouse, dependent children, or other person; or ( ji) forbids you from contracting with us, selling the policy, and changing the policy’s beneficiary. You are competent and have the authority to contract with us to sell the payments. Either You have never filed for bankruptey; or If you filed for bankru ptcy, the policy was not subject to the claims of your creditors. Yor u gave us @ copy of the bankruptcy discharge Papers and any bankruptcy papers related to the policy. You have fulfilled all child support. There are no tax liens against you or your property, including the policy. You legally live in, and your primary residence is in, the State of FL Any future owner of the payments will have all of our rights and duties you owe to us under this contract, This includes the right to ma ke a claim against you for violating any of the representations or promises you made in this contra ct. You had sufficient time to consider the sale of the policy and this contract, You got independent professional advi ice about the sale of the policy and this contract or knowingly waived such advice. We did not provide tax, financial, or legal advice about this contract. The issuer may require that the entire mont! hly paymen t be sent to us even if you have not sold the entire payment. In such an event, we will timely remit any portions due you to such address as you may designate. You freely and voluntarily agree to this contract. If you are married, your spouse understands this contra ct, We may sell, transfer, or assign the policy in a sale, securitization, or other financing transaction (resale), You recognize that after the cancellation Period we will expend significant legal fees to obtain court order approval of this transa ction. You will not ent ‘er into any other agreement with any other third party to sell any of the payments outlined in Exhibit A. Your promises fo us 2/28/2024 7:42 PM Electronically Filed: Hillsborough County/13th J udicial Circuit Page 8 DocuSign Envelope ID: E0F70501-D82E-4F88-805E-8 26DE2DF3D29 CBC File #47455 Page 7 Before and after the closing date, you will cooper ate in completing and signing documents to transfer the policy’s ownershi ip and change its beneficiary and correct any documentation errors in this contract; and From the contract date to the closin: ig date, you will not; (i) sign any policy to any person other than us, (il) change agreement to sell the the policy's owner or beneficiary to any person other than us, or (ili) grant ai iny other encumbrance against the policy. From the contract date to the closing date, you will give us any information necessary to update your representations and promises in this co! ntract. You wil ll provide updated documents and information when they becom e available. Restrictions on Assignment: Your Settlement Agree ment and related settlement documents may contain language prohibiting your power T to accele rate, defer, increase, decrease or assign your payments. You hereby waive a ind release any such restriction if your settlement agreement and/or related settlement docum ents contain this or sit milar fanguage. As such, you understand and a gree that you will never claim or assert that the payments you are now selling were not transi ferrable, or t that this language renders this Agreement void and/or voldable. Vi. Cancellation by us We may cancel this contract before the closing date if: A You breach any representation or warranty contai ned In this contract. B We are sued or threatened with an y litigation or regula tory action regarding about this contract or the policy. Cc. Any voluntary or involuntary bankruptcy is filed involving You. D You are no longer living. cE A major rating agency downgrades the issuer or obligor’s credit rating. F. The Issuer or obligor is insolvent or under regulatory supervision, G. We are unable to provide the purchase price when due. VIL Cancellation by you A You may end this contract prior to the tenth (10th) day following your execution of this contract and the disclosure statement. This is the cancellation period. B. To end this contract, you must notify us in writing before the cancellation period ends. Vill. Indemnification You will pay us for losses or actual damages we suffer: A If you do not comply with your responsibili ties under this contract; B Because any representation or warranty you made in this contract was false or incomplete ; c You failed to keep any promise you made in this contract. IX. Notices 2/28/2024 7:42 PM Electronically Filed: Hillsborough County/13th J udicial Circuit Page 9 DocuSign Envelope ID; E0F70501-D826-4F88-805E- 826DE2DF3D29 CBC File #47455 Page 8 All notices about this contract must be in wri iting. Notice is deemed delivered when received at the addresses listed below: If to you: H If to us: CBC Settlement Funding, LLC 181 Washington St., Suite 375 Conshohocken, PA 19428 Miscellaneous A. This contract is the entire agreement between you and us. B. Both parties must agree in writing to any change to this contract or waiver of its terms, You cannot voluntarily or involu intarily sell, assign, or transfer this cor ntract, or any of your rights or duties under this conti ract. This Agreement and any disputes between the parties shall be governed, interpreted, construed and enforce: d in accordance with the internal law: ‘sof the state issuing the court order approving the transfer of the structured settlement payme The Approval State is the proper venue to brin ig nts ("Approval State"). any Cauisé of action. The parties agree to Jurisdiction in any court of competent jurisdicti ion within the Approval State, Fallure to snforce any provision of this contract is not a waiver of that provision, If a court undoes any part of this contract, the rest of the contract remains valid, The parties may sign this contract in on @ OF more Counte rparis. Each counterpart will be considered an original, 2/28/2024 7:42 PM Electronically Filed: Hillsborough County/13th J udicial Circuit Page 10 DoecuSign Envelope ID: E0F70501-D82E-4F88-805E-826DE2 DF3D29 CBC File #47455 Page 9 Making iiisieading or false statements or rej presentations is crime and penaites ney include imprisonment, fines, denial of benefits, and civil damage s. The parties signed this contract on the dates written below: You: 1a Ga Doousigned by: tl itimia Hog setneuzen zeae 2/23/2024 | 8:36 AM PST (Seller's Signature) (Date} (Sellers Spouse’s Signature, if applicable) (Date) CBC SETTLEMENT FUNDING, LLC Deven Khuen, 2/28/2024 7:42 PM Electronically Filed: Hillsborough County/13th J udicial Circuit Page 11 DocuSign Envelope 1D; EOF70501 -D82E-4F88-B0SE -826DE2DF3D29 CBC File #47455 Page 10 Exhibit A The following payments are to be transferred pursu ant to this Agreement: All other annuity payments shall remain payable to the Seller unless subject to _another assignment, sale or encumbran ce. 4 2/28/2024 7:42 PM Electronically Filed: Hillsborough County/13th J udicial Circuit Page 12 erm AFFIDAVIT OF HASHAWNIA KERR SUPP ORT OF TRANSFER OF STRUC DS. MENT MEN 3 vi KJfbcing duly sworn upon my oath depose and say: i Tam over the age of eighteen, of sound mind, sane and not under the influence of alcohol or dnigs, and | am not suffering from any physical or mental impairment affecting my judgment. 1am fully and personally cognizant of all facts and matters stated in this Affidavit. 1 have never bees adjudged mcompetent by any court, 22 tam domiciled in the State of Florida, 3. Tam single and have no dependents. 4 | am signing and submitting this Affidavit in connection with that certain Purchase, Transfer and Assignment Agreement (‘Transfer Agreement”) executed by and between myself as the Seller and CBC Settlement Funding, LLC (“CBC”) as the Purchaser. Capitalized terms not otherwise defined in this Affidavit shail have the meanings given to them in the Transfer Agreement. The “Transaction” shall hereafter refer to the transaction set forth and described in the Transfer Agreement and related documents, involving the sale and assignment of my right to receive certain future payments to CBC. 55. 1 have read and understand the Transfer Agreement and related documents and understand the transaction. Iam fully aware of the economic consequences of this transaction and am fully capable of managing my financial, personal and business affairs. 6 1 am entitled to the settlement payments set forth in the Transfer Agreement. The structured settlement payments arose from the medical malpractice lawsuit, The cause of action associated with the lawsuit has been resolved. Pursuant to a settlement agreement and release, I was entitled to receive monthly payments in the amount ha aaa) — esses 2/28/2024 7:42 PM Electronically Filed: Hillsborough County/13th J udicial Circuit Page 13 t have never d future ary Y payinents. 1 do not rely upon the Periodic Payments to pay i food my monthly | living expens: sloth shelter, and medical care). 1 do desire to sell a portion of Periodic Payments, to wit 160 monthly payments in the amount of $1,2 0 beginning on February May 9, 2024, thr vugh and inc’ ing Augu 9, 2037. (Collectively, hereinafter “Assigned Payments”) 9 1 desire to transfer the A: igned Payment in exchange for a lump sum today to reeeive the current market value of my payment ules] 16. | have determined that the sale of the igned Payments to CBC is fair and Teasonable, will improve the quality my life and is in my best interest. I plan on using the funds from this transaction to invest in a high-yield bonds that guara antee a 13% rate of return ‘This investment will ensure more substantial growth over the next 10 years, i, Before entering this transaction, 1 analyzed the financial and legal consequences of this transaction. [ have not received any accounting, tax, legal or other advice from CBC in connection with this transaction. 1 was advised in writing by CBC to seek independent professional advice regarding the legal tax and financial implicati ons of this transaction, and after strong consideration, | have decided to knowingly and voluntarily waive my tight to receive such advice, 12, 1 understand that the Settlement Agreement and/or settlement documents may contain provisions that restrict or prohibit the assignment or transfer of the Assigned P; ‘ayments, I waive all such restrictions and prohibitions and desire to complete the transaction notwithstanding such restrictions and prohibitions, 2 nen nreteesenemnsnnteneseeneere!| 2/28/2024 7:42 PM Electronically Filed: Hillsborough County/13th J udicial Circuit Page 14 13. | understand and acknowledge that each of the tepreientations, warranties, avenants, agreements, obligations, and duties | make under the Transfer Agreement and related locuments are being relied upon by CBC. | understand that if | breach or violate any terms of the Transfer Agreement or related documents, CBC will suffer substantial damages as a result. 14. 1 will not permit anyone claiming by or through me (other than CBC), to do anything that would divert the Assigned Payments from CBC. 15. 1 recognize and accept the continuing and irrevocable duty and obligation under the Transfer Agreement to cooperate with CBC to make sure that CBC receives the entire Assigned Payments, including the duty to immediately deliver to CBC any checks, funds or other form of payments received by me which constitute any portion of the Assigned Payments. I understand that this duty exists regardless of whether the Assigned Payments are received by mistake or as a result of any action or omission on the part of CBC. 16. 1 have not previously pledged, promised, assigned, sold or encumbered any of my rights in or to the Assigned Payments due under the Annuity (except as may be set forth and fully disclosed in the Disclosure Statement and/or other closing documents in this transaction), nor have any such payment rights or benefits ever been attached, levied, foreclosed upon, seized, restricted, or subjected to garnishment or other legal process or proceeding. Yh ‘Twenty days or more prior to the date of the hearing on approval of this matter, I received, and I hereby accept service of the Petition for Court Approval of a Transfer of Structured Settlement Payment Rights, along with all required documents and information pursuant to Florida Statute 626.99296 et. seq. 18. ‘Ten days or more prior to the date | first incurred an obligation with respect to this