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MC-351
ATTORNEY 0R PARTY wrrHouT AWORNEY(Name. szale Barnumber. and address).- FOR COURT use o~Lv
_MICHAEL G. KARBY #179786
H & K, INC .
, ATTORNEYS AT LAW
POST OFFICE BOX 6
DINUBA, CALI FORNIA 93 61 8
TELEPHONEN0.: (559) 591-3090 (559)
FAXNO.(0ptionao: 591-36
emu. ADDRESS (Optional):
ATTORNEYFORmame): Plainti ffs , and all Of them
SUPERIOR COURT 0F CALIFORNIA, COUNTY 0F FRESNO
" O"
STREET ADDRESS: ll30 STREET
"
MAILING ADDRESS:ll30 O" STREET
crrvAND ZIP cone:FRESNO , CAL I FORN IA 9372 l
RECEIVED
aRANCHNAME: B . F . SISK COURTHOUSE 4/6/2021 4:33 PM
CASE NAME: FRESNO COUNTY SUPERIOR COURT
By: A. Ramos, Deputy
Manuszak v Varela
ORDER APPROVING: CASE NUMBER:
m
m
COMPROMISE 0F DISPUTED CLAIM
COMPROMISE 0F PENDING ACTION
2 OCECGO 0 1 65
D DISPOSITION 0F PROCEEDS 0F JUDGMENT
E Minor D Person With A Disability
B§R7§%A;E'2“1""Y‘ 2E3;
1. Petitioner (name): AMANDA ELIN MOORE MANUSZAK has petitionedfor courtapproval of a
proposed compromise of a disputed claim of a minor or a pending action involving a minor or a person with a a
disability or
proposed disposition of the proceeds of a judgment for a minor or a person with a disability.
2. Hearing
a.
b.
D
m
No hearing
Date:
was
MARCH
held.
l7,
The
2021
an expedited
petition is petition
Time: 3:30
under rule
pm
7.950 of the California Rules of Court.
Dept: 403
c. Judicial officer:
3. Relationship to claimant
Petitionerhas the following relationship or relationships
toclaimant (check allapplicable boxes):
m
m
Parent
Guardian ad litem
a
D
hsngovsv
Guardian
Conservator
D
D
Claimant. an adult person with a
Other (specify).-
disability,
isthe petitioner.
4. Claimant (name): EVELYN SOFIA MANUSZAK
a.
b.
m
D
is
is
a minor.
a "person with a the meaning of Probate
disability" within Code section 3603 who is:
(1) D An
(a)
adult. Claimant's date of birth
D
is(specify):
Without a consenlator. Claimant has capacity to consent to meaning of
this order, within the
Probate Code section 812. and has consented to this order.
(b) D A conservatee; a person forwhom a conservator may be appointed: or without capacity
consent to this order. within the meaning of ProbateCode section 812.
to
(2) a A minor described in Probate Code section 3603(b)(3).
5. Defendant
The claim or action tobe compromised isasserted. or the judgment is entered, against (name of settling orjudgment defendant or
defendants (the "payer”)):
EDDIE GREGORY VARELA
Page1on
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mow law. Januan/mowl ACTION 0R DISPOSITION 0F PROCEEDS 0F JUDGMENT FOR '5
caL auxesovcoun.m:ésaqaaa.m
W~°°”’""’°“‘°°V
CEB' Emmi“ MINOR 0R PERSON WITH A DISABILITY
mm Elm (Miscellaneous)
MC-351
CASE NAME: CASE NUMBER:
Manuszak v Varela 20CECG00165
6. THE COURT FINDS that all notices required by law have been given.
7. THE COURT ORDERS
a. The granted and the proposed compromise of claim or action or the proposed disposition of the proceeds of the
petition is
judgment isapproved. The gross amount or value of the settlement orjudgment infavor of claimant is$ I
l7 l , 750 . 0 OI
b. D Welfare and
order of the court, jurisdiction
Until further
InstitutionsCode
isreserved to determine a claim for a reduction of a Medi-Cal
section 14124.76. The amount shown payable to the
lienunder
Department of Health Care Services
in item 70(1)(d) of this order
isthe amount
full department but
of the lien claimed by the issubject to reduction on further
order of the court upon determination of the claim for reduction.
c. The payer shall disburse theproceeds of the settlement orjudgment approved by thisorder inthe following manner:
(1) Payment of fees and expenses
Fees and expenses shallbe paid by one or more checks or drafts.drawn payable and the
to the order of the petitioner
petitioner's attorney,
if payment identified
any, or directly to third parties entitled to receive order for the following
in this
items of expense or damage. which are hereby authorized to be paid out of the proceeds of the settlement orjudgment:
(a) m Attorney's fees
Petitioner's
in the totalamount
Attorney
of:$ fiFEES
expressly
WAIVED
waived
I
payable
all
to (specify):
attorney's fees
in the Petition[MC—350] before the Court.
(b) m Reimbursement for medical and all other expenses paid by the
petitioner's attorney in the total amount of:
petitioner or the
$l O . O0 I
(c) m Medical, hospital, ambulance, nursing, and other
providers as follows,inthe totalamount of:
likeexpenses payable directly to
$I 66l . 0m
(i) Payee (name): GRANT MERCANTILE ANGENCY , INC .
(A) Address: P . O . BOX 65 8
OAKHURST , CALI FORNIA 93 64 4
(B) Amount: $ 66l . 0O
(ii) Payee (name):
(A) Address:
(B) Amount: $
D Continued on Attachment 70(1)(c). (Provide information about additional payees in the above format.)
(d) m Other authorized disbursements payable
(Describe and state the amount of each item and provide the
amount
directly to third parties in the total
name and address
of: $ llO
of each payee):
, 94 2 .96
THE EdCARE GROUP [an 871 Employee Benefit Plan]
and its administrator:
DELTA HEALTH SYSTEMS .
l 63 BAY STATE DRIVE
BRAINTREE, MA 02 l8 4
D Continued on Attachment 7c(1)(d).
(e) m Total allowance for fees and expenses from the settlement orjudgment: $ I
lll , 6O 3 .9 6|
MC—351 [Rev‘JanuaryL 20101 ORDER APPROVING COMPROMISE 0F DISPUTED CLAIM 0R PENDING Pagan”
ACTION OR DISPOSITION 0F PROCEEDS OF JUDGMENT FOR
CEB'
Wm Em'
Essential
MINOR OR PERSON WITH A DISABILITY
(Miscellaneous)
MC-351
CASE NAME: CASE NUMBER:
_Manuszak v Varela 20CECG00165
7. THE COURT ORDERS (cont)
c. The payer shall disburse the proceeds of the settlement orjudgment approved by this order inthe following manner:
(2) Balance
The balance of the settlementorjudgment available for claimant afterpayment of all allowed
fees and expenses is: $ I
6O , 14 6 . O 41
‘
The balance shallbe disbursed as follows:
(a) m By one or more checks or drafts in the total amount of (specify): $ 60 , l4 6 . 04
drawn payable to the order of the petitioner as trustee for the claimant. Each such check or draft must bear an
endorsement on the face or reverse that it is for deposit in one or more interest—bearing, federally insured
accounts inthe name and no withdrawals may be made from the
of the petitioner as trustee for the claimant.
accounts except as provided inthe Order to Deposit Money Into Blocked Account (form MC-355). which is
signed contemporaneously with this order ("blocked account").
(b) a By the following method(s) (descn'be each method, including the amount to be disbursed):
D Continued on Attachment 7c(2)(b).
(c) D Ifmoney istobe paid to a special needs trustunder Probate Code section 3604, allstatutory liens in favor
of the state Department of Health Care Services. the state Department of Mental Health. the state
Department of Developmental Services. and any cityand county inCalifornia must firstbe satisfied by the
following method (special):
D Continued on Attachment 7c(2)(c).
8. D Further orders of the court concerning blocked accounts
The courtmakes the following additional orders concerning any part of the balance ordered to be deposited ina blocked
account under item 7c(2)(a):
a. Within 48 hours of receipt of a check ordraftdescribed in item 7c(2)(a), the petitioner and the petitioner’s attorney.
if
any. must deposit the check name as trustee for the
or draft in the petitioner's claimant inone or more blocked accounts
at (specifyname, branch, and address of each depository, and the amount of each account):
D Continued on Attachment 8a.
mm 1.2mm
[Rev.January ORDER APPROVING COMPROMISE 0F DISPUTED CLAIM 0R PENDING Pagesom
CEB- Essential ACTION 0R DISPOSITION 0F PROCEEDS 0F JUDGMENT FOR
mom Elm MINOR 0R PERSON WITH A DISABILITY
(Miscellaneous)
MC-351
CASE NAME:
CASE NUMBER:
_Manuszak v Varela 20CECG00165
8. Further orders of the court concerning blocked accounts
The court makes the following additional orders concerning any part of the balance
ordered to be deposited in a blocked
account under item 7c(2)(a):
b. The petitionerand the petitioner's attorney,any, must deliver to each depository at the time of deposit three copies of
if
the Order to Deposit Money Into Blocked Account (form MC-355), which is signed contemporaneously with this
order.
and three copies of the Receipt and Acknowledgment of Order for the
Deposit of Money Into Blocked Account (form
MC-356). The petitioner or the petitioner's attorney must file a copy of the
receipt with this court within 15 days of the
deposit. The sole responsibilities of the petitioner and the petitioner's
attorney, if
any, are to place the balance ina
blocked account or accounts and to timely file a copy of the receipt.
c. The balance of the proceeds of the settlement orjudgment deposited ina blocked account or accounts under item
7c(2)(a)may be withdrawn only as follows (check (1) or (2)):
(1) D No withdrawals of principal or interest may be made from the blocked account or
written order under this case name and number, signed
accounts without a further
by a judge, and bearing the seal of this court. The
money on deposit is not subject to escheat.
(2) m The blocked account or accounts belong to a minor. The minor was born on
No withdrawals of principal or interest may be made from the blocked account
(date): 0 6/2 l /2 O l 6
or accounts without a further
written orderunder this case name and number, signed
by a judicial officer. and bearing the seal of this
minor attains the age of 18 years. When the minor attains the age of 18
court, until the
years. the depository,
without further order of this court,
isauthorized and directed to pay by check or draft directly to the former
minor, upon proper demand, allmoneys including interest deposited under this order. The money on
deposit
not subject to escheat.
m
is
9. Authorization to execute settlement documents
The petitionerisauthorized to execute settlement documents as follows (check
a. D Upon receipt of thefull amount of the settlement sum approved
petitioner is authorized and directed to execute and deliver to
only one):
by this order and the deposit of funds, the
the payer a full, complete, and final release and
discharge of any and all claims and demands of the claimant
by reason of the accident or incident described in
the petition and the resultant injuries to the claimant and a ‘
properly executed dismissal with prejudice.
b. m The petitioneris authorized and directed to execute any and
the terms of the settlement.
alldocuments reasonably necessary to carry out
c. D The petitionerisauthorized and directed (specify):
D Continued on Attachment 9c.
10. Bond is D ordered and fixed in the amount of:$ m not required.
11. A copy of thisorder shall be served on the payer forthwith.
12. D Additional orders
The court makes the following additional orders (specify):
D Continued on Attachment 12.
Date:
D JUDICIAL OFFICER
SIGNATURE FOLLOWS LAST ATTACHMENT
MC-351
[Rev- January 1.20101
ORDER APPROVING COMPROMISE 0F DISPUTED CLAIM OR PENDING Pagan”
CEB'
tebwm Em
Essential ACTION 0R DISPOSITION OF PROCEEDS 0F JUDGMENT FOR
MINOR 0R PERSON WITH A DISABILITY
(Miscellaneous)
Preview
MC-351 ATTORNEY 0R PARTY wrrHouT AWORNEY(Name. szale Barnumber. and address).- FOR COURT use o~Lv _MICHAEL G. KARBY #179786 H & K, INC . , ATTORNEYS AT LAW POST OFFICE BOX 6 DINUBA, CALI FORNIA 93 61 8 TELEPHONEN0.: (559) 591-3090 (559) FAXNO.(0ptionao: 591-36 emu. ADDRESS (Optional): ATTORNEYFORmame): Plainti ffs , and all Of them SUPERIOR COURT 0F CALIFORNIA, COUNTY 0F FRESNO " O" STREET ADDRESS: ll30 STREET " MAILING ADDRESS:ll30 O" STREET crrvAND ZIP cone:FRESNO , CAL I FORN IA 9372 l RECEIVED aRANCHNAME: B . F . SISK COURTHOUSE 4/6/2021 4:33 PM CASE NAME: FRESNO COUNTY SUPERIOR COURT By: A. Ramos, Deputy Manuszak v Varela ORDER APPROVING: CASE NUMBER: m m COMPROMISE 0F DISPUTED CLAIM COMPROMISE 0F PENDING ACTION 2 OCECGO 0 1 65 D DISPOSITION 0F PROCEEDS 0F JUDGMENT E Minor D Person With A Disability B§R7§%A;E'2“1""Y‘ 2E3; 1. Petitioner (name): AMANDA ELIN MOORE MANUSZAK has petitionedfor courtapproval of a proposed compromise of a disputed claim of a minor or a pending action involving a minor or a person with a a disability or proposed disposition of the proceeds of a judgment for a minor or a person with a disability. 2. Hearing a. b. D m No hearing Date: was MARCH held. l7, The 2021 an expedited petition is petition Time: 3:30 under rule pm 7.950 of the California Rules of Court. Dept: 403 c. Judicial officer: 3. Relationship to claimant Petitionerhas the following relationship or relationships toclaimant (check allapplicable boxes): m m Parent Guardian ad litem a D hsngovsv Guardian Conservator D D Claimant. an adult person with a Other (specify).- disability, isthe petitioner. 4. Claimant (name): EVELYN SOFIA MANUSZAK a. b. m D is is a minor. a "person with a the meaning of Probate disability" within Code section 3603 who is: (1) D An (a) adult. Claimant's date of birth D is(specify): Without a consenlator. Claimant has capacity to consent to meaning of this order, within the Probate Code section 812. and has consented to this order. (b) D A conservatee; a person forwhom a conservator may be appointed: or without capacity consent to this order. within the meaning of ProbateCode section 812. to (2) a A minor described in Probate Code section 3603(b)(3). 5. Defendant The claim or action tobe compromised isasserted. or the judgment is entered, against (name of settling orjudgment defendant or defendants (the "payer”)): EDDIE GREGORY VARELA Page1on Fomggfxceguvgémngmngse ORDER APPROVING COMPROMISE 0F DISPUTED CLAIM 0R PENDING cgggbggecggdgwfiggghgz; mow law. Januan/mowl ACTION 0R DISPOSITION 0F PROCEEDS 0F JUDGMENT FOR '5 caL auxesovcoun.m:ésaqaaa.m W~°°”’""’°“‘°°V CEB' Emmi“ MINOR 0R PERSON WITH A DISABILITY mm Elm (Miscellaneous) MC-351 CASE NAME: CASE NUMBER: Manuszak v Varela 20CECG00165 6. THE COURT FINDS that all notices required by law have been given. 7. THE COURT ORDERS a. The granted and the proposed compromise of claim or action or the proposed disposition of the proceeds of the petition is judgment isapproved. The gross amount or value of the settlement orjudgment infavor of claimant is$ I l7 l , 750 . 0 OI b. D Welfare and order of the court, jurisdiction Until further InstitutionsCode isreserved to determine a claim for a reduction of a Medi-Cal section 14124.76. The amount shown payable to the lienunder Department of Health Care Services in item 70(1)(d) of this order isthe amount full department but of the lien claimed by the issubject to reduction on further order of the court upon determination of the claim for reduction. c. The payer shall disburse theproceeds of the settlement orjudgment approved by thisorder inthe following manner: (1) Payment of fees and expenses Fees and expenses shallbe paid by one or more checks or drafts.drawn payable and the to the order of the petitioner petitioner's attorney, if payment identified any, or directly to third parties entitled to receive order for the following in this items of expense or damage. which are hereby authorized to be paid out of the proceeds of the settlement orjudgment: (a) m Attorney's fees Petitioner's in the totalamount Attorney of:$ fiFEES expressly WAIVED waived I payable all to (specify): attorney's fees in the Petition[MC—350] before the Court. (b) m Reimbursement for medical and all other expenses paid by the petitioner's attorney in the total amount of: petitioner or the $l O . O0 I (c) m Medical, hospital, ambulance, nursing, and other providers as follows,inthe totalamount of: likeexpenses payable directly to $I 66l . 0m (i) Payee (name): GRANT MERCANTILE ANGENCY , INC . (A) Address: P . O . BOX 65 8 OAKHURST , CALI FORNIA 93 64 4 (B) Amount: $ 66l . 0O (ii) Payee (name): (A) Address: (B) Amount: $ D Continued on Attachment 70(1)(c). (Provide information about additional payees in the above format.) (d) m Other authorized disbursements payable (Describe and state the amount of each item and provide the amount directly to third parties in the total name and address of: $ llO of each payee): , 94 2 .96 THE EdCARE GROUP [an 871 Employee Benefit Plan] and its administrator: DELTA HEALTH SYSTEMS . l 63 BAY STATE DRIVE BRAINTREE, MA 02 l8 4 D Continued on Attachment 7c(1)(d). (e) m Total allowance for fees and expenses from the settlement orjudgment: $ I lll , 6O 3 .9 6| MC—351 [Rev‘JanuaryL 20101 ORDER APPROVING COMPROMISE 0F DISPUTED CLAIM 0R PENDING Pagan” ACTION OR DISPOSITION 0F PROCEEDS OF JUDGMENT FOR CEB' Wm Em' Essential MINOR OR PERSON WITH A DISABILITY (Miscellaneous) MC-351 CASE NAME: CASE NUMBER: _Manuszak v Varela 20CECG00165 7. THE COURT ORDERS (cont) c. The payer shall disburse the proceeds of the settlement orjudgment approved by this order inthe following manner: (2) Balance The balance of the settlementorjudgment available for claimant afterpayment of all allowed fees and expenses is: $ I 6O , 14 6 . O 41 ‘ The balance shallbe disbursed as follows: (a) m By one or more checks or drafts in the total amount of (specify): $ 60 , l4 6 . 04 drawn payable to the order of the petitioner as trustee for the claimant. Each such check or draft must bear an endorsement on the face or reverse that it is for deposit in one or more interest—bearing, federally insured accounts inthe name and no withdrawals may be made from the of the petitioner as trustee for the claimant. accounts except as provided inthe Order to Deposit Money Into Blocked Account (form MC-355). which is signed contemporaneously with this order ("blocked account"). (b) a By the following method(s) (descn'be each method, including the amount to be disbursed): D Continued on Attachment 7c(2)(b). (c) D Ifmoney istobe paid to a special needs trustunder Probate Code section 3604, allstatutory liens in favor of the state Department of Health Care Services. the state Department of Mental Health. the state Department of Developmental Services. and any cityand county inCalifornia must firstbe satisfied by the following method (special): D Continued on Attachment 7c(2)(c). 8. D Further orders of the court concerning blocked accounts The courtmakes the following additional orders concerning any part of the balance ordered to be deposited ina blocked account under item 7c(2)(a): a. Within 48 hours of receipt of a check ordraftdescribed in item 7c(2)(a), the petitioner and the petitioner’s attorney. if any. must deposit the check name as trustee for the or draft in the petitioner's claimant inone or more blocked accounts at (specifyname, branch, and address of each depository, and the amount of each account): D Continued on Attachment 8a. mm 1.2mm [Rev.January ORDER APPROVING COMPROMISE 0F DISPUTED CLAIM 0R PENDING Pagesom CEB- Essential ACTION 0R DISPOSITION 0F PROCEEDS 0F JUDGMENT FOR mom Elm MINOR 0R PERSON WITH A DISABILITY (Miscellaneous) MC-351 CASE NAME: CASE NUMBER: _Manuszak v Varela 20CECG00165 8. Further orders of the court concerning blocked accounts The court makes the following additional orders concerning any part of the balance ordered to be deposited in a blocked account under item 7c(2)(a): b. The petitionerand the petitioner's attorney,any, must deliver to each depository at the time of deposit three copies of if the Order to Deposit Money Into Blocked Account (form MC-355), which is signed contemporaneously with this order. and three copies of the Receipt and Acknowledgment of Order for the Deposit of Money Into Blocked Account (form MC-356). The petitioner or the petitioner's attorney must file a copy of the receipt with this court within 15 days of the deposit. The sole responsibilities of the petitioner and the petitioner's attorney, if any, are to place the balance ina blocked account or accounts and to timely file a copy of the receipt. c. The balance of the proceeds of the settlement orjudgment deposited ina blocked account or accounts under item 7c(2)(a)may be withdrawn only as follows (check (1) or (2)): (1) D No withdrawals of principal or interest may be made from the blocked account or written order under this case name and number, signed accounts without a further by a judge, and bearing the seal of this court. The money on deposit is not subject to escheat. (2) m The blocked account or accounts belong to a minor. The minor was born on No withdrawals of principal or interest may be made from the blocked account (date): 0 6/2 l /2 O l 6 or accounts without a further written orderunder this case name and number, signed by a judicial officer. and bearing the seal of this minor attains the age of 18 years. When the minor attains the age of 18 court, until the years. the depository, without further order of this court, isauthorized and directed to pay by check or draft directly to the former minor, upon proper demand, allmoneys including interest deposited under this order. The money on deposit not subject to escheat. m is 9. Authorization to execute settlement documents The petitionerisauthorized to execute settlement documents as follows (check a. D Upon receipt of thefull amount of the settlement sum approved petitioner is authorized and directed to execute and deliver to only one): by this order and the deposit of funds, the the payer a full, complete, and final release and discharge of any and all claims and demands of the claimant by reason of the accident or incident described in the petition and the resultant injuries to the claimant and a ‘ properly executed dismissal with prejudice. b. m The petitioneris authorized and directed to execute any and the terms of the settlement. alldocuments reasonably necessary to carry out c. D The petitionerisauthorized and directed (specify): D Continued on Attachment 9c. 10. Bond is D ordered and fixed in the amount of:$ m not required. 11. A copy of thisorder shall be served on the payer forthwith. 12. D Additional orders The court makes the following additional orders (specify): D Continued on Attachment 12. Date: D JUDICIAL OFFICER SIGNATURE FOLLOWS LAST ATTACHMENT MC-351 [Rev- January 1.20101 ORDER APPROVING COMPROMISE 0F DISPUTED CLAIM OR PENDING Pagan” CEB' tebwm Em Essential ACTION 0R DISPOSITION OF PROCEEDS 0F JUDGMENT FOR MINOR 0R PERSON WITH A DISABILITY (Miscellaneous)