2220 Adoption of local rules of civil procedure 216, 1012, 2039 and 2206 and revision of 1018.1, 1915.3 and 1915.7; no. 12-2319; no. 21 DR 2012

Title 255—LOCAL
COURT RULES

CARBON COUNTY

Adoption of Local Rules of Civil Procedure 216, 1012, 2039 and 2206 and Revision of 1018.1, 1915.3 and 1915.7; No. 12-2319; No. 21 DR 2012

[42 Pa.B. 7097]
[Saturday, November 17, 2012]

Administrative Order No. 22-2012

 And Now, this 31st day of October, 2012, it is hereby Ordered and Decreed that, effective December 1, 2012, the Carbon County Court of Common Pleas Adopts Carbon County Rule of Civil Procedure CARB.R.C.P. 216 governing the Grounds for Continuance, CARB.R.C.P. 1012 governing Entry of Appearance, Withdrawal of Appearance and Notice, CARB.R.C.P. 2039 governing Compromise, Settlement, Discontinuance and Distribution and CARB.R.C.P. 2206 governing Settlement Compromise, Discontinuance and Judgment.

 It Is Further Ordered and Decreed that the Carbon County Court of Common Pleas Revises CARB.R.C.P. 1018.1 governing Notice to Defend, Form, CARB.R.C.P. 1915.3 governing Commencement of Action, Complaint, Order and CARB.R.C.P. 1915.7 governing Consent Order.

 The Carbon County District Court Administrator is Ordered and Directed to

 1. File one (1) certified copy of this Administrative Order with the Administrative Office of Pennsylvania Courts.

 2. File two (2) certified copies and one (1) computer diskette with the Legislative Reference Bureau for publication in the Pennsylvania Bulletin.

 3. File one (1) certified copy with the Civil Procedural Rules Committee.

 4. Forward one (1) copy for publication in the Carbon County Law Journal.

 5. Forward one (1) copy to the Carbon County Law Library.

 6. Keep continuously available for public inspection copies of the Administrative Order in the Prothonotary's Office and the Domestic Relations Office.

By the Court

ROGER N. NANOVIC, 
President Judge

Rule 216. Grounds for Continuance.

 All Motions for Continuance shall be filed at least three (3) working days before the scheduled event.

 When a Motion for Continuance is requested because of an attachment of another Court, the Attorney shall provide a copy of said attachment with the Motion for Continuance.

 Any motion filed that is not in compliance with this rule shall be entertained only if the opportunity to timely file it did not exist previously or the interest of justice requires it.

Rule 1012. Entry of Appearance. Withdrawal of Appearance. Notice.

 1. Any attorney representing a party in a proceeding before this Court shall enter his appearance of record in the Prothonotary's Office by filing the appropriate praecipe. The Prothonotary shall promptly docket and make note in the record.

 2. Any attorney who provides representation to a Custody or Support litigant at a Custody Conference, Support Conference and/or a Support Hearing shall be permitted to enter a Limited Appearance. The Praecipe for Entry of Limited Appearance is attached hereto as Exhibit ''A''.

 3. Upon completion of the representation, the attorney shall file a Praecipe for Withdrawal of Limited Appearance. This Praecipe shall be filed without leave of court and shall direct the Prothonotary to send all future notices directly to the litigant and shall set forth the litigant's last-known address. The Praecipe for Withdrawal of Limited Appearance is attached hereto as Exhibit ''B''.

IN THE COURT OF COMMON PLEAS OF
CARBON COUNTY, PENNSYLVANIA

(CIVIL ACTION/DOMESTIC RELATIONS)

	:
Plaintiff	:
	:
vs.	:	NO.
	:
	:
Defendant	:

PRAECIPE FOR ENTRY OF LIMITED APPEARANCE

 To the Prothonotary:

 Kindly enter my Limited Appearance for ______ (Plaintiff's/Defendant's Name), the Plaintiff/Defendant in the above-captioned matter.

 This Appearance is limited to providing representation on behalf of this party at the Custody Conference/Support Conference/Support Hearing.

_________________
Name of Attorney for (Plaintiff/Defendant)

_________________
Firm

_________________
Address

_________________
City, State, Zip

_________________
Telephone Number

_________________
Supreme Court ID Number

IN THE COURT OF COMMON PLEAS OF
CARBON COUNTY, PENNSYLVANIA

(CIVIL ACTION/DOMESTIC RELATIONS)

	:
Plaintiff	:
	:
vs.	:	NO.
	:
	:
Defendant	:

PRAECIPE FOR WITHDRAWAL OF LIMITED APPEARANCE

 To the Prothonotary:

 Kindly withdraw my Limited Appearance for ______ (Plaintiff's/Defendant's Name), the Plaintiff/Defendant in the above-captioned matter.

 Withdrawal of this Limited Appearance is permitted pursuant to Carbon County Local Rule of Civil Procedure CARB.R.C.P. 1012. All future notices should be sent directly to (Plaintiff's/Defendant's Name), the Plaintiff/Defendant, at ______ (set forth last-known address for this party).

_________________
Name of Attorney for (Plaintiff/Defendant)

_________________
Firm

_________________
Address

_________________
City, State, Zip

_________________
Telephone Number

_________________
Supreme Court ID Number

Rule 1018.1. Notice to Defend. Form.

 As required by Pa.R.C.P.1018.1(c), the following shall be designated in the notice to defend as the person from whom legal referral can be obtained:

North Penn Legal Services
2 East Broad Street, Suite 205
Hazleton, PA 18201
Phone [phone]
Fax [phone]
 
or
 
Carbon County Lawyer Referral
777 Blakeslee Blvd. Dr., Suite 2
Lehighton, PA 18235
Phone [phone]
Fax [phone]

Rule 1915.3. Commencement of Action. Complaint. Order.

 The person to be named in the notice shall be pursuant to CARB.R.C.P.1018.1.

 A proposed order substantially in the same form as Form ''A'' following this rule shall be attached to the complaint or petition.

 An Affidavit substantially in the same form as Form ''B'' following this rule shall be attached to the complaint or petition.

''FORM A''
IN THE COURT OF COMMON PLEAS OF
CARBON COUNTY, PENNSYLVANIA

CIVIL ACTION—LAW

______ ,	:
Plaintiff/Petitioner	:
	:
vs.	:	NO.
	:
______ ,	:
Defendant/Respondent	:
______	-	Counsel for Plaintiff
______	-	Counsel for Defendant

ORDER OF COURT

 AND NOW this __ day of _____ , 20__ , it is hereby ORDERED and DECREED as follows:

 1. This Order of Court shall govern the custodial situation of the following children:

__________

__________

 2. In accordance with the statutory laws of this Commonwealth, each party shall be provided all access to the medical, dental, religious and school records of the child(ren) involved. Absent an emergency situation, each party shall be informed in regard to the medical and dental needs of the child(ren) involved.

 3. Jurisdiction of the child(ren) and this matter shall remain with the Court of Common Pleas of Carbon County, Pennsylvania, unless or until jurisdiction would change under the Uniform Child Custody Jurisdiction Act.

 4. The welfare of the child(ren) shall be the primary consideration of the parties in any application of the terms of this Agreement. The parties shall exert every reasonable effort to foster a feeling of affection between the child(ren) of the other party. Neither party shall do anything to estrange the child(ren) from the other party, to injure the opinion of the child(ren) as to the other party, or to hamper the free and natural development of the child(ren)'s love and respect of the other party.

 5. Primary Physical custody of the child(ren) shall be as follows:

__________

 6. The Plaintiff/Defendant, Father/Mother, shall have partial physical custody and visitation rights in accordance with the following schedule:

 (a) During the week: __________

 (b) Weekends:_________________;

 (c) Major Holidays:_________________;

 (d) Minor Holidays:_________________;

 (e) Mother's Day and Mother's Birthday shall be with the Mother;

 (f) Father's Day and Father's Birthday shall be with the Father.

 (g) Child(ren)'s Birthday(s):______;

 (h) Vacation/Summers:_________________;

 (i) Other times:_________________.

 7. All other periods of partial custody by either party shall be by mutual agreement of both parties after reasonable request, and such agreement shall not be unreasonable withheld.

 8. Each party agrees to keep the other advised of their current residential address and telephone number. Each party shall be entitled to speak to the child(ren) by telephone at reasonable times and intervals when the child(ren) is/are in the custody of the other party.

 9. Each party agrees to give to the other a general itinerary of all vacations they plan to take with the child(ren).

 10. Each party shall endeavor to give at least twenty-four (24) hours prior notice to the other in the event that it will not be possible to exercise any of the rights herein identified.

 11. The custodial parent(s) shall not change the residence of the child(ren) if such change significantly impairs the custodial schedule or the ability of the other parent to spend time with the child(ren) and participate in the child(ren)'s life. In the event the custodial parent desires to relocate as described above, he/she shall provide Notice as required by 23 P. S. 5337. No relocation shall occur without written consent of the other parent, or without Order of Court.

 12. The attached ''Appendix to Order'' is incorporated herein and shall be part of this Order.

BY THE COURT:

______
J.

APPENDIX TO ORDER

 Certain rules of conduct generally applicable to custody matters are set forth below and are binding on both parties, the breach of which could become the subject of contempt proceedings before this Court, or could constitute grounds for amendment of our order. If these general rules conflict with the specific requirements of our order, the order shall prevail.

 1.

 Neither party will undertake nor permit in his or her presence the poisoning of the minor child's mind against the other party by conversation which explicitly or inferentially derides, ridicules, condemns, or in any manner derogates the other party.

 2.

 The parties shall not conduct arguments or heated conversations when they are together in the presence of their child(ren).

 3.

 Neither party will question the child(ren) as to the personal lives of the other parent except insofar as necessary to insure the personal safety of the child(ren). By this we mean that the child(ren) will not be used as a spy on the other party. It is harmful to a child to be put in the role of ''spy''.

 4.

 Neither party will make extravagant promises to the minor child(ren) for the purposes of ingratiating himself or herself to the minor child(ren) at the expense of the other party; further, any reasonable promise to the child(ren) should be made with the full expectation of carrying it out.

 5.

 The parties should at all times consider the child(ren)'s best interests, and act accordingly. It is in a child(ren)'s best interests to understand that he or she is trying desperately to cope with the fact of his parents' separation, and needs help in loving both parents, rather than interference of censure.

 6.

 The parties should remember that they cannot teach their child(ren) moral conduct by indulging in improper conduct themselves. Children are quick to recognize hypocrisy, and the parent who maintains a double standard will lose the respect of his or her child(ren).

 7.

 Weekend and evening visitation shall be subject to the following rules:

 A. Arrangements will be worked out beforehand between the parties without forcing the child(ren) to make choices and run the risk of parental displeasure. However, the child shall be consulted as to his or her schedule.

 B. Visitation rights should be exercised at reasonable hours and under circumstances reasonably acceptable to the other party and to the needs and desires of the minor child(ren).

 C. If a party finds him or herself unable to keep an appointment, he or she should give immediate notice to the other party, so as to avoid subjecting the child(ren) to unnecessary apprehension and failure of expectations.

 D. The party having custody of the child(ren) should prepare him or her both physically and mentally for the visitation with the other party and have him or her available at the time and place mutually agreed upon.

 E. If either party or the child(ren) has plans which conflict with a scheduled visit and wish to adjust such visitation, the parties should make arrangements for an adjustment acceptable to the schedules of everyone involved. Predetermined schedules are not written in stone, and both parties should be flexible for the sake of the child(ren).

 F. If a party shows up for a visit under the influence of alcohol or drugs, the visit may be considered forfeited on those grounds alone.

 8.

 During the time that the child(ren) is/are living with a party, that party has the responsibility of imposing and enforcing the rules for day-to-day living. However, unless otherwise ordered, both parents should consult with one another on the major decisions affecting the child(ren)'s life, such as education, religious training, medical treatment, and so forth.

FORM ''B''
IN THE COURT OF COMMON PLEAS OF
CARBON COUNTY, PENNSYLVANIA

CIVIL ACTION—LAW

______ ,	:
Plaintiff/Petitioner	:
	:
vs.	:	NO.
	:
______ ,	:
Defendant/Respondent	:
______	-	Counsel for Plaintiff
______	-	Counsel for Defendant

AFFIDAVIT

 I, ______ , hereby swear or affirm that I, or a member of my household (Circle One) HAVE HAVE NOT been charged, convicted of, or pleaded guilty or no contest to any of the following offenses, either in the Commonwealth of Pennsylvania or in another jurisdiction with substantially equivalent offenses as listed below:

18 Pa.C.S. Ch. 25	(relating to criminal homicide)
18 Pa.C.S. § 2702	(relating to aggravated assault)
18 Pa.C.S. § 2706	(relating to terroristic threats)
18 Pa.C.S. § 2709.1	(relating to stalking)
18 Pa.C.S. § 2901	(relating to kidnapping)
18 Pa.C.S. § 2902	(relating to unlawful restraint)
18 Pa.C.S. § 2903	(relating to false imprisonment)
18 Pa.C.S. § 2910	(relating to luring a child into a motor vehicle or structure)
18 Pa.C.S. § 3121	(relating to rape)
18 Pa.C.S. § 3122.1	(relating to statutory sexual assault)
18 Pa.C.S. § 3123	(relating to involuntary deviate sexual intercourse)
18 Pa.C.S. § 3124.1	(relating to sexual assault)
18 Pa.C.S. § 3125	(relating to aggravated indecent assault)
18 Pa.C.S. § 3126	(relating to indecent assault)
18 Pa.C.S. § 3127	(relating to indecent exposure)
18 Pa.C.S. § 3129	(relating to sexual intercourse with animal)
18 Pa.C.S. § 3130	(relating to conduct relating to sex offenders)
18 Pa.C.S. § 3301	(relating to arson and related offenses)
18 Pa.C.S. § 4302	(relating to incest)
18 Pa.C.S. § 4303	(relating to concealing death of child)
18 Pa.C.S. § 4304	(relating to endangering welfare of children)
18 Pa.C.S. § 4305	(relating to dealing in infant children)
18 Pa.C.S. § 5902(b)	(relating to prostitution and related offenses)
18 Pa.C.S. § 5903(c) or (d)	(relating to obscene and other sexual materials and performances)
18 Pa.C.S. § 6301	(relating to corruption of minors)
18 Pa.C.S. § 6312	(relating to sexual abuse of children)
18 Pa.C.S. § 6318	(relating to unlawful contact with minor)
18 Pa.C.S. § 6320	(relating to sexual exploitation of children)
Section 6114 The former	(relating to contempt for violation of order or agreement)
75 Pa.C.S. § 3731	(relating to driving under influence of alcohol or controlled substance)
75 Pa.C.S. Ch. 38	(relating to driving after imbibing alcohol or utilizing drugs)
Section 13 (a) (1) of the act of April 14, 1972 (P. L. 233, No. 64), known as The Controlled Substance, Drug, Device and Cosmetic Act, to the extent that it prohibits the manufacture, sale or delivery, holding, offering for sale or possession of any controlled substance or other drug or device.

IF PARTY, LIST OFFENSE OR OFFENSES BELOW:

NONE: ______
IF YES:
NAME OF PARTY	OFFENSE	DATE
______	______	_____
	______	_____
	______	_____
LIST NAMES OF ADULTS RESIDING IN HOUSEHOLD:
___________________________
___________________________
___________________________
IF AN OFFENSE ADDRESSES A MEMBER OF HOUSEHOLD AND NOT A PARTY, LIST THE NAME OF HOUSEHOLD MEMBER AND OFFENSE BELOW:
NONE: ______
IF YES:
NAME OF HOUSEHOLD MEMBER	OFFENSE	DATE
______	______	_____
______	______	_____
______	______	_____

VERIFICATION

 I, the undersigned, do hereby verify that the statements made herein are true and correct to the best of my own personal knowledge, information and belief. I understand that false statements made herein are subject to the penalties of 18 Pa.C.S. § 4904 (relating to unsworn falsifications to authorities).

DATE: ______ _____ ______

Rule 1915.7. Consent Order.

 A proposed consent order substantially in the same form as Form ''A'' following this Rule shall be attached to the stipulation or agreement.

''FORM A''
IN THE COURT OF COMMON PLEAS OF
CARBON COUNTY, PENNSYLVANIA
CIVIL ACTION—LAW

______ ,	:
Plaintiff	:
	:
vs.	:	NO.
	:
______ ,	:
Defendant	:
______	-	Counsel for Plaintiff
______	-	Counsel for Defendant

ORDER OF COURT

 AND NOW this __ day of _____ , 20__, upon review of the attached Agreement between the parties regarding custody of the child(ren), it is hereby

 ORDERED and DECREED that said Agreement is approved and shall be incorporated into this Order of Court as if more fully set forth herein.

 The custodial parent(s) shall not change the residence of the child(ren) if such change significantly impairs the custodial schedule or the ability of the other parent to spend time with the child(ren) and participate in the child(ren)'s life. In the event the custodial parent desires to relocate as described above, he/she shall provide Notice as required by 23 P. S. 5337. No relocation shall occur without written consent of the other parent, or without Order of Court.

 The attached ''Appendix to Order'' is incorporated herein and shall be part of this Order.

BY THE COURT:

______
J.

IN THE COURT OF COMMON PLEAS OF
CARBON COUNTY, PENNSYLVANIA
CIVIL ACTION—LAW

______ ,	:
Plaintiff	:
	:
vs.	:	NO.
	:
______ ,	:
Defendant	:
______	-	Counsel for Plaintiff
______	-	Counsel for Defendant

AGREEMENT FOR ENTRY OF SHARED CUSTODY ORDER OF COURT

 AND NOW, this __ day of _____ , 20__, the following agreement is entered into upon stipulation of the parties:

 1. This Agreement and ensuing Order of Court shall govern the custodial situation of the following children:

__________

__________

 2. In accordance with the statutory laws of this Commonwealth, each party shall be provided all access to the medical, dental, religious and school records of the child(ren) involved. Absent an emergency situation, each party shall be informed in regard to the medical and dental needs of the child(ren) involved.

 3. Jurisdiction of the child(ren) and this matter shall remain with the Court of Common Pleas of Carbon County, Pennsylvania, unless or until jurisdiction would change under the Uniform Child Custody Jurisdiction Act.

 4. The welfare of the child(ren) shall be the primary consideration of the parties in any application of the terms of this Agreement. The parties shall exert every reasonable effort to foster a feeling of affection between the child(ren) of the other party. Neither party shall do anything to estrange the child(ren) from the other party, to injure the opinion of the child(ren) as to the other party, or to hamper the free and natural development of the child(ren)'s love and respect of the other party.

 5. Primary Physical custody of the child(ren) shall be as follows:

__________

 6. The Plaintiff/Defendant, Father/Mother, shall have partial physical custody and visitation rights in accordance with the following schedule:

 (a) During the week:_________________;

 (b) Weekends:_________________;

 (c) Major Holidays:_________________;

 (d) Minor Holidays:_________________;

 (e) Mother's Day and Mother's Birthday shall be with the Mother;

 (f) Father's Day and Father's Birthday shall be with the Father.

 (g) Child(ren)'s Birthday(s):______:

 (h) Vacation/Summers:_________________;

 (i) Other times:_________________.

 7. All other periods of partial custody by either party shall be by mutual agreement of both party after reasonable request, and such agreement shall not be unreasonably withheld.

 8. Each party agrees to keep the other advised of their current residential address and telephone number. Each party shall be entitled to speak to the child(ren) by telephone at reasonable times and intervals when the child(ren) is/are in the custody of the other party.

 9. Each party agrees to give to the other a general itinerary of all vacations they plan to take with the child(ren).

 10. Each party shall endeavor to give at least twenty-four (24) hours prior notice to the other in the event that it will not be possible to exercise any of the rights herein identified.

 11. It is the intention of the parties that this agreement will be adopted into an Order of Court.

 12. The filing fee for the stipulated order shall be paid by the ________________(Indicate Plaintiff or Defendant) to the Prothonotary of Carbon County simultaneous with the filing of the stipulated order.

 13. The custodial parent(s) shall not change the residence of the child(ren) if such change significantly impairs the custodial schedule or the ability of the other parent to spend time with the child(ren) and participate in the child(ren)'s life. In the event the custodial parent desires to relocate as described above, he/she shall provide Notice as required by 23 P. S. 5337. No relocation shall occur without written consent of the other parent, or without Order of Court.

_________________	______
WITNESS AS TO PLAINTIFF	PLAINTIFF
_________________	______
WITNESS AS TO DEFENDANT	DEFENDANT

APPENDIX TO ORDER

 Certain rules of conduct generally applicable to custody matters are set forth below and are binding on both parties, the breach of which could become the subject of contempt proceedings before this Court, or could constitute grounds for amendment of our order. If these general rules conflict with the specific requirements of our order, the order shall prevail.

 1.

 Neither party will undertake nor permit in his or her presence the poisoning of the minor child's mind against the other party by conversation which explicitly or inferentially derides, ridicules, condemns, or in any manner derogates the other party.

 2.

 The parties shall not conduct arguments or heated conversations when they are together in the presence of their child(ren).

 3.

 Neither party will question the child(ren) as to the personal lives of the other parent except insofar as necessary to insure the personal safety of the child(ren). By this we mean that the child(ren) will not be used as a spy on the other party. It is harmful to a child to be put in the role of ''spy''.

 4.

 Neither party will make extravagant promises to the minor child(ren) for the purposes of ingratiating himself or herself to the minor child(ren) at the expense of the other party; further, any reasonable promise to the child(ren) should be made with the full expectation of carrying it out.

 5.

 The parties should at all times consider the child(ren)'s best interests, and act accordingly. It is in a child(ren)'s best interests to understand that he or she is trying desperately to cope with the fact of his parents' separation, and needs help in loving both parents, rather than interference of censure.

 6.

 The parties should remember that they cannot teach their child(ren) moral conduct by indulging in improper conduct themselves. Children are quick to recognize hypocrisy, and the parent who maintains a double standard will lose the respect of his or her child(ren).

 7.

 Weekend and evening visitation shall be subject to the following rules:

 A. Arrangements will be worked out beforehand between the parties without forcing the child(ren) to make choices and run the risk of parental displeasure. However, the child shall be consulted as to his or her schedule.

 B. Visitation rights should be exercised at reasonable hours and under circumstances reasonably acceptable to the other party and to the needs and desires of the minor child(ren).

 C. If a party finds him or herself unable to keep an appointment, he or she should give immediate notice to the other party, so as to avoid subjecting the child(ren) to unnecessary apprehension and failure of expectations.

 D. The party having custody of the child(ren) should prepare him or her both physically and mentally for the visitation with the other party and have him or her available at the time and place mutually agreed upon.

 E. If either party or the child(ren) has plans which conflict with a scheduled visit and wish to adjust such visitation, the parties should make arrangements for an adjustment acceptable to the schedules of everyone involved. Predetermined schedules are not written in stone, and both parties should be flexible for the sake of the child(ren).

 F. If a party shows up for a visit under the influence of alcohol or drugs, the visit may be considered forfeited on those grounds alone.

 8.

 During the time that the child(ren) is/are living with a party, that party has the responsibility of imposing and enforcing the rules for day-to-day living. However, unless otherwise ordered, both parents should consult with one another on the major decisions affecting the child(ren)'s life, such as education, religious training, medical treatment, and so forth.

Rule L2039. Compromise, Settlement, Discontinuance and Distribution.

A. Settlements:

 (1) Motions for Settlement of a case in which a minor or incapacitated person has an interest shall be filed and served pursuant to Carbon County Local Rule of Civil Procedure CARB R.C.P. 208.3(a).

 (2) The petition shall:

 (A) Set forth the factual circumstances of the case;

 (B) State the reasons why the settlement is a reasonable one; and

 (C) Be accompanied by the following:

 (1) A proposed order of distribution;

 (2) A written report of a physician setting forth the present condition of the minor or incapacitated person;

 (3) A statement under oath by a parent or guardian certifying (a) the present physical or mental condition of the minor or incapacitated person, and (b) approval of the proposed settlement and distribution thereof;

 (4) A statement of the professional opinion of counsel as to the reasonableness of the proposed settlement and the basis for such opinion;

 (5) In the event that the minor is fourteen years of age or over, his or her written approval of the proposed settlement and distribution thereof; and

 (6) If there is to be an allocation between parents and children or among children, the amounts allocated to each party

 (3) The Order of Distribution shall include an award of counsel fees. The standard for the award of counsel fees in the representation of minors is that such fees must be reasonable in accordance with the guidelines set forth in Rule 1.5 of the Rules of Professional Conduct. Under normal circumstances a counsel fee in the amount of twenty-five percent (25%) of the fund recovered shall be considered reasonable, subject to the approval of the Court. The attorney fee determined shall be reduced by the amount of collateral payments received as counsel fees for representation involving the same matter from third parties such as Blue Cross/Blue Shield.

 (4) The approving Judge, to whom the Petition is submitted, may, at his or her discretion, require the personal appearance of the minor, guardians, physicians, or any other relevant party, as well as, the production of any other evidence deemed necessary for adjudication of the Petition.

B. Distribution:

 (1) Motions for Allowance of Distribution of funds in which a minor or incapacitated person has an interest shall be filed and served pursuant to Carbon County Local Rule of Civil Procedure CARB R.C.P. 208.3(a).

 (2) The petition shall include:

 (A) The facts and circumstances surrounding the origination of the minor's fund;

 (B) A chronological statement of all prior requests for allowance, including the reasons there for, the amounts thereof, and the disposition;

 (C) The age of the minor at the time the fund was created and the minor's present age;

 (D) The original amount of the minor's fund and the present balance of same; and

 (E) The circumstances and reasons supporting the request for allowance.

 (3) All petitions shall be accompanied by:

 (A) A proposed Order;

 (B) A copy of the Original Petition for Compromise and the Order of Distribution;

 (C) Copies of all prior requests for allowances and the Orders with respect to same;

 (D) Substantiating documentation to support the proposed request; and

 (E) A consent filed by the petitioner.

Rule L2206. Settlement Compromise, Discontinuance and Judgment.

 (1) Court approval of settlements in wrongful death cases shall be required only where a minor or incapacitated person has an interest.

 (2) Motions for Settlement of a case in which a minor or incapacitated person has an interest shall be filed and served pursuant to Carbon County Local Rule of Civil Procedure CARB R.C.P. 208.3(a).

 (3) The petition shall:

 (A) Set forth the factual circumstances of the case;

 (B) State the reasons why the settlement is a reasonable one;

 (C) Be accompanied by the following:

 (1) A proposed order approving the settlement and allocation between wrongful death and survival; the proposed order shall comply substantially with the prescribed format in Form A.

 (2) A statement of the professional opinion of counsel as to the reasonableness of the proposed settlement and the basis for such opinion;

 (3) A statement setting forth the proposed allocation between wrongful death and survival actions and the amount proposed to be allocated to each beneficiary;

 (4) A statement clearly identifying those parties believed to be beneficiaries under each of the actions, attaching a copy of the will of the decedent, if any;

 (5) A statement setting forth the following:

 (a) The time between the injury and death;

 (b) Whether or not the decedent was conscious, and the circumstances prior to his or her death;

 (c) The amount of the medical and funeral bills;

 (d) The amount of the decedent's wage loss; and

 (e) The age, employment and any other circumstances of any potential beneficiaries under the Wrongful Death Act.

 (6) A certification of service of notice and a copy of the petition to all parties with a possible interest, together with a list of those persons notified.

 (7) A letter from the Department of Revenue stating either their approval or objection to the proposed settlement.

IN THE COURT OF COMMON PLEAS OF
CARBON COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW

	:
Plaintiff	:
	:
vs.	:	NO.
	:
	:
Defendant	:

ORDER OF COURT

 AND NOW, this  day of   , 20  , upon consideration of the Motion to Compromise Wrongful Death and Survival Action filed on   , 20  , it is hereby ORDERED that Petitioner is authorized to enter into a settlement with Defendant(s)    in the gross sum of ($   ).

 It is further ORDERED and DECREED that the settlement proceeds be distributed as follows:

1. To:______,Esq.	$______
For Costs
2. To:______,Esq.	$______
Counsel Fees
3. The balance of the settlement, the sum of	$______
is apportioned as follows:
Wrongful Death Claim	$______
Survival Claim	$______
a. The Wrongful Death Claim shall be paid as follows:
I. To: Spouse; and/or	$______
ii. Adult Child(ren)	$______
iii. To: Minor Child(ren)1
$______
as provided hereunder

OPTION 1

 Counsel is hereby authorized to execute all documentation necessary to purchase saving certificate(s), from federally insured banks or savings institutions having an office in Carbon County, in the sum of $ ______, each not to exceed the insured amount, with the funds payable to the minor upon majority. The certificate shall be titled in the name of the minor and shall be restricted as follows:

 ______ , a minor, not to be redeemed except for renewal in its entirety, not to be withdrawn, assigned, negotiated, or, otherwise alienated before the minor attains majority, except upon prior Order of Court.

 Counsel shall open a savings account in the sum of $______ in the name of the minor. The savings account shall be restricted as follows:

 ______ , a minor, not to be withdrawn, before the minor attains majority, except for the payment of city, state, and federal income taxes on the interest earned by the savings certificate and savings account, or upon prior Order of Court.

OPTION 2

To: ______ , Guardian $______

of the Estate of ______ , a minor; provided, however, that no payment shall be made to the guardian until the guardian has posted additional security as may be required by the Orphans' Court Division of Carbon County pursuant to 20 Pa.C.S. § 5121, et seq. An appropriate Petition shall be filed with the Orphans' Court within thirty (30) days.

 OR

[To: Guardian of the Estate of $______

 ______ , a minor, upon appointment by the Orphans' Court Division of Carbon County and upon the posting of any security as required by the said Orphans' Court pursuant to 20 Pa.C.S. § 5121, et seq. An appropriate Petition shall be filed with the Orphans' Court within thirty (30) days. Counsel shall not make any Distribution to said Guardian upon appointment until this provision is fully complied with.]; and/or

iv. To: Parent(s) $______

 b. The Survival Claim, in the sum of $______

shall be paid to ______ , Administrator/Executor of the Estate of  ______ , Deceased; provided, however, that counsel shall not distribute any funds to the said Administrator/Executor until additional security as may be required by the Register of Wills of Carbon County pursuant to 20 Pa.C.S. § 3323(b)(3) is posted.

 Within thirty (30) days from the date of this Order, counsel shall file with the Motion's Court an Affidavit from counsel certifying compliance with this Order.

BY THE COURT:

_________________
J.

[Pa.B. Doc. No. 12-2220. Filed for public inspection November 16, 2012, 9:00 a.m.]

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