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DocuSign Envelope ID: C7BC913E-03C8-4C50-BA49-8807B604EE 1D
MC-350
ATIORNEY OR PARTY WllliOlJT ATIORNEY STATE BAR NUMBER:
FOR COURT USE ONLY
NAME: Gary A. Dordick, Esq. S/B# 128008; Dustin Z. Moaven, Esq. S/B# 320939
FIRM NAME: DORDICK LAW CORPORATION
STREET ADDREss: 509 s.
Beverly Drive
CITY: Beverly Hills STATE: CA ZIP CODE: 90212
TELEPHONE NO.: (31 Q) 551-0949 FAX NO. : (855) 299-4444
EMAIL ADDREss: dustin@dordicklaw.com
ATIORNEY FOR (NsmeJ: Plaintiff Candace Thompson
SUPERIOR COURT OF CAUFORNIA, COUNTY OF KERN
STREET ADDRESS: 1215 TRUXTUN AVENUE
MAILING ADDRESS: 1215 TRUXTUN AVENUE
CITY AND ZIP CODE: BAKERSFIELD CA 93301
BRANCH NAME: BAKERSFIELD COURT
CASE NAME: CASE NUMBER:
Candace Thompson v. Axel Eduardo Chavez Garcia BCV-22-1 02263
HEARING DATE:
PETITION FOR APPROVAL OF COMPROMISE OF CLAIM May21, 2024
OR ACTION OR DISPOSITION OF PROCEEDS OF DEPT.: TIME:
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY J 8:30am
NOTICE TO PETITIONER
Except as noted below, you must use this form to request court approval of (1) the compromise of a minor's disputed claim,
'
(2) the compromise or settlement of a pending action or proceeding to which a minor or a person with a disability (including a
conservatee) is a party, or (3) the disposition of the proceeds of a judgment awarded to a minor or a person with a disability. (See
Code Civ. Proc., § 372; Prob. Code,§§ 3500, 3600--3613.)
Both you and the minor or person with a disability must attend the hearing on this petition unless the court dispenses with a personal
appearance. The court may require the presence and testimony of witnesses, including the attending or examining physician, and the
presentation of other evidence relating to the claim and the nature and extent of the injury, care, treatment, and hospitalization.
The court has authority to consider a request for expedited approval without a hearing of the compromise of certain claims or actions
or the disposition of the proceeds of certain judgments. To determine whether your claim, action, or judgment qualifies, see Cal. Rules
of Court, rule 7.950.5. If you want to request expedited consideration, you must use form MC-350EX.
1. Petitioner (name or pseudonym*): Angel Thompson
is the (check all boxes that apply): [KJ Parent [KJ Guardian ad litem* D Guardian D Conservator
D Other (specify relationship):
of the claimant identified in item 2. (*Petitioner may appear under a pseudonym only if appointed as guardian ad litem under that
pseudonym. (See Code Civ. Proc., § 372.5.))
2. Claimant (name): Candace Thompson
a. Address: 4038 Weiman Avenue, Ridgecrest CA 93555
b. Date of birth: 06/01/1991 c. Age: 32 d. D Minor or [KJ Person with a disability
(If the claimant is an adult with a disability who (1) has capacity to consent to the order requested and (2) does not have a
conservator of the estate, check e. and f. and ensure that the claimant personally reads and signs item 21. (Prob. Code, § 3613.))
e. D Has the capacity, within the meaning of Probate Code section 812, to consent to the requested order or judgment.
f. [KJ Does not have a conservator of the estate.
3. Claim The claim of the minor or adult person with a disability (check one):
a. D Is not the subject of a pending action or proceeding. (Complete items 4-23.)
b. [][] Is the subject of a pending action or proceeding that will be compromised or settled without a trial. (Complete items 4-23.)
Name of court: BAKERSFIELD COURT
Case no.: BCV-22-102263 Trial date: VACATED
c. D Is the subject of an action or proceeding in which a judgment has been or will be entered for the claimant against the
defendants named below in the amount (excluding interest and costs) of (specify totaQ: $_ _ _ _ _ __
Defendants (names:
D Additional defendants listed on Attachment 3.
D The judgment was filed on (data):
(Attach a copy of the (proposed) judgment as Attachment 3c and complete items 12-23.)
Pqe1 of10
Form Adopted for Altemative Mandatory Use Code of Civil Procedure, § 372;
Instead of Form MC-350EX PETITION FOR APPROVAL OF COMPROMISE OF CLAIM Probate Code, §§ 3600, 360~613;
Judicial Council of california Cal. Rules of Court, rules 3.1384,
MC-350 [Rev. January 1, 2021]
OR ACTION OR DISPOSITION OF PROCEEDS OF 7.101, 7.950-7.952
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY www.coui1S.c..gov
DocuSign Envelope 10: C7BC913E-{)3C8-4C50-BA49-8807B604EE1D
MC-350
CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER:
BCV-22-1 02263
4. Incident or accident The incident or accident occurred as follows:
a. Date: 09/30/2020 Time: 6:30 PM
b. Place: West Weiman Avenue, Ridgecrest, CA 93555
c. Persons involved (names):
Candace Thompson; Axel Eduardo Chavez Garcia
D Continued on Attachment 4.
5. Natura of incident or accident
The facts, events, and circumstances of the incident or accident are (describe what happened):
On September 30, 2020, Candace Thompson walked down her driveway to check her mailbox on West Weiman Avenue in
Ridgecrest, California, when Defendant Axel Eduardo Chavez Garcia's dog named "Rambo" escaped from Defendant's property
and attacked Ms. Thompson, causing her to sustain severe physical, mental and emotional injuries. Candace Thompson is a person
lacking decision making capacity due to her Intellectual Developmental Disorder, which renders her incompetent to represent her
own interests in this lawsuit.
D Continued on Attachment 5.
6. Injuries
The following injuries ware sustained by the claimant as a result of the incident or accident (describe):
Candace Thompson sustained physical, mental, and emotional injuries including a deep dog bite wound to her inner thigh, Post
Traumatic Stress Disorder, and Major Depressive Disorder. She is now also extremely afraid of all types of dogs.
D Continued on Attachment6.
7. Treatment
The claimant received the following care and treatment for the injuries described in item 6 (describe):
Ms. Thompson received stitches at he hospital after she sustained injuries to her right leg and thigh from the dog bite. She also had
psychological therapy and follow up medical consultations for her wounds.
D Continued on Attachment 7.
8. Extant of injuries and recovery (An original or a photocopy of any doctor's report containing a diagnosis of the claimant's injuries
or a prognosis for the claimant's recovery, and a report of the claimant's current condition, must be attached to this petition as
Attachment 8. A new report is not necessary if a previous report accurately describes the claimant's current condition.)
a. D The claimant has recovered completely from the effects of the injuries described in item 6, and there are no permanent
injuries.
b. [KJ The claimant has not recovered completely from the effects of the injuries described in item 6, and the following injuries
from which the claimant has not recovered are temporary (describe the remaining injuries and symptoms):
Plaintiff still suffers from Post-traumatic Stress Disorder and Major Depressive Disorder, and is still afraid of dogs.
D Continued on Attachment8b.
c. D The claimant has not recovered completely from the effects of the injuries described in item 6, and the following injuries
from which the claimant has not recovered are permanent (describe the permanent injuries and symptoms):
D Continued on Attachment Be.
MC-350 [Rev. January 1, 2021] Page2of1D
PETITION FOR APPROVAL OF COMPROMISE OF CLAIM
OR ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
DocuSign Envelope ID: C7BC913E-{)3C8-4C50-BA49-8807B604EE1D
MC-350
CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER:
BCV-22-1 02263
9. [KJ Petitioner has made a careful and diligent Inquiry and Investigation Into the facts and circumstances of the Incident
or accident In which the claimant was Injured; the responsibility for the Incident or accident; and the nature, extent,
and seriousness of the claimant's Injuries. Petitioner understands that If the compromise proposed In this petition Is
approved by the court and consummated, the claimant will never be able to recover any more compensation from the
settling defendants named below even If the clalmanfs Injuries turn out to be more serious than they now appear.
10. Amount and terms of settlement
To settle the claim in 3a or 3b, the defendants named below have offered to pay the following amounts to the claimant:
a. The total amount offered by all defendants named below is (specify): $ 100,000.00
b. The defendants and amounts offered by each are as follows (specify):
Defendants (names) Amounts
Axel Eduardo Chavez Garcia $ 100,000.00
$
$
$
D Defendants and amounts offered continued on Attachment 1Ob.
c. The tenms of settlement are as follows. (If the settlement is to be paid in installments, both the total amount and the present
value of the settlement must be included.)
Plaintiff Candace Thompson shall receive $100,000.00 as full and final settlement ofher claims against Defendant
Axel Eduardo Chavez Garcia and in exchange, Plaintiff Thompson will dismiss the pending action with prejudice
and release Defendant Garcia of all liability for all related claims.
D Continued on Attachment 1Oc.
11. Settlement payments to others
a. [KJ No defendant named in item 1Ob has offered to pay money to any person or persons other than the claimant to settle
claims arising out of the same incident or accident that resulted in the claimant's injury.
b. D To settle claims arising out of the same incident or accident that resulted in the claimanfs injury, one or more defendants
named in item 1Ob have also offered to pay money to a person or persons other than claimant.
(1) The total amount offered by all defendants to others is (specify): $
(2) Petitioner D does not have D has a claim against the recovery of the claimant (other than for
reimbursement of fees or expenses paid by petitioner and listed under item 14).
(If you answered "has," explain in Attachment 11b(2) the circumstances and the effect your claim has on the proposed
compromise of the claim described in this petition.)
(3) Petitioner D is not D is a plaintiff in the same action with the claimant.
(If you answered "is," explain in Attachment 11 b(3) the circumstances and the effect your claim and its disposition has on
the proposed compromise of the claim or action described in this petition.)
(4) D Petitioner would receive money under the proposed settlement.
(5) The settlement payments are to be apportioned and distributed as follows:
Other plaintiffs or claimants (names) Amounts
$
$
$
$
D Additional plaintiffs or claimants and amounts are listed on Attachment 11 b(5).
(6) Reasons for the apportionment of the settlement payments between the claimant and each other plaintiff or claimant named
above are specified in Attachment 11 b(6).
MC-350 [Rev. January 1, 2021] Page3of10
PETITION FOR APPROVAL OF COMPROMISE OF CLAIM
OR ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
DocuSign Envelope 10: C7BC913E-{)3C8-4C50-BA49-8807B604EE1D
MC-350
CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER:
BCV-22-1 02263
12. The claimant's medical expenses-Including medical expenses paid by petitioner, Medicare, Medi-Cal, and private
Insurers-to be paid or reimbursed from proceeds of settlement or judgment
a. Totals
(1) Total medical expenses before any reductions: $ 12,524.59
(2) Total medical expenses paid (include payments by private insurance, Medi-Cal, or Medicare): ($ 1 '190.23)
(3) Total of negotiated, contractual, or statutory reductions, if any: ($ 4,730.37)
(4) Total medical expenses to be paid or reimbursed from the proceeds: $ 8,262.51
(5) Total amount of statutory or contractual liens, if any: $ 8,262.51
b. Medical expenses were paid and are to be reimbursed from the proceeds as follows:
(1) [KJ Paid by petitioner in the amount of: s _ _ _----=.3o::..:o:.:c.o:..::.o
(2) D Paid by private health insurance or a self-funded plan under:
(a) D An Employee Retirement Income Security Act (ERISA) insured plan.
(b) D An ERISA se~-funded plan.
(c) D A Non-ERISA insured plan.
(d) D A Non-ERISA self-funded plan.
(e) Amount paid by plan: $
(f) Amount of reimbursement to the plan from the proceeds of the settlement or judgment:
(i) D No reimbursement is requested by the plan.
(ii) D Reimbursement is to be made to the plan, and:
(A) D There is a contractual reduction of: ($ ),
(B) D There is a negotiated reduction of: ($ ),
(C) D No reduction has been agreed to,
for a total reimbursement to the plan, in full satisfaction of its lien rights, in the amount of: $_ _ _ _ _ __
(3) D Paid by Medicare in the amount of: $
less the statutory reduction in the amount of: ($
for a total reimbursement to Medicare in the amount of: $._ _ _ __
(Attach a copy of the final Medicare demand letter or letter agreement as Attachment 12b(3).)
(4) [KJ Paid by Medi-Cal in the amount of: $ 890.23
(a) [KJ Notice of this claim or action has been given to the Director of Health Care Services. (We~. & Ins!. Code,
§ 14124.73.) A copy of the notice and proof of delivery:
[KJ is attached D was filed in this case on (date):
(b) D Notice of this claim or action has not been given to the Director of Health Care Services. (Explain why notice has
not been given in Attachment 12b(4)(b).)
(c) [KJ In full satisfaction of its lien rights, Medi-Cal has agreed to accept reimbursement in the amount of:
$ 662.51
(Attach a copy of the final Medi-Cal demand letter or letter agreement as Attachment 12b(4)(c).)
(d) D Petitioner is entitled to a reduction of the Medi-Cal lien under Welfare and Institutions Code section 14124.76 and
(check one):
(i) D Is filing a motion seeking a reduction of the lien concurrently with this petition.
(ii) D Requests that the court reserve jurisdiction over this issue.
The amount of the lien in dispute is: $
(5) (a) (i) D There are no statutory or contractual liens for payment of claimanfs medical expenses.
(ii) [KJ There are one or more statutory or contractual liens of medical service providers for payment of claimant's
medical expenses. The total amount claimed under these liens is: $10,150.00
In full satisfaction of their lien claims, the lienholders have agreed to accept the sum of: $ 7,600.00
(Provide requested information for each lienholder and other specified medical service providers on next page.)
MC-350 [Rev. January 1, 2021] Page4of1D
PETITION FOR APPROVAL OF COMPROMISE OF CLAIM
OR ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
DocuSign Envelope 10: C7BC913E-{)3C8-4C50-BA49-8807B604EE1D
MC-350
CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER:
BCV-22-1 02263
12. Claimant's medical expenses (continued)
b. (5) (b) The name of each medical service provider that furnished care and treatmentto claimant and (1) has a lien for all or
any part of the charges or (2) was paid (or will be paid from the proceeds) by petitioner, for which payment petitioner
requests reimbursement; the amounts charged and paid; the amount of negotiated reductions of charges, if any; and
the amount to be paid from the proceeds of the settlement or judgment to each provider are as follows:
(i) (A) Provider (nama): Haven Orthopedics & Spine Institute
(B) Address: 10390 Commerce Center Dr., Sutie 100, Rancho Cucamonga, CA 91730
(C) Amount charged: $ 1,150.00
(D) Amount paid (whether or not by insurance): ($ 0.00)
(E) Negotiated reduction, if any: ($ 550.00)
(F) Amount to be paid from proceeds of settlement or judgment: $_ _ _____::60"'0:.::.0:.::0
(ii) (A) Provider (name): Premier Forensic Psychology
(B) Address: P.O. Box 7284, Fullerton, CA 92834
(C) Amount charged: $ 9,000.00
(D) Amount paid (whether or not by insurance): ($ 0.00)
(E) Negotiated reduction, if any: ($ 2,000.00)
(F) Amount to be paid from proceeds of settlement or judgment: $_ _ _.:_7'"'00"'0:.::.0:.::0
(iii) (A) Provider (name): Perk Plastic Surgery
(B) Address: 416 N. Bedford Dr., Suite 400, Beve~y Hills, CA 90210
(C) Amount charged: $ 300.00
(D) Amount paid (whether or not by insurance): ($ 300.00)
(E) Negotiated reduction, if any: ($ 0.00)
(F) Amount to be paid from proceeds of settlement or judgment: $_ _ _ _--'0:.::.0=0
[KJ Continued on Attachmem 12b(5). (Provide information about additional providers in the above format, including
providers paid or to be paid by petitioner, for which payment reimbursement is requested in item 12b(1), above.
You may use form MC-350(A-12b(5)) for this purpose.)
13. Claimant's attorney's fees and all other expanses (except for medical expanses), including expanses advanced by
claimant's attorney or paid or incurred by petitioner, to be reimbursed from proceeds of settlement or judgment
a. Total amount of attorney's fees for which court approval is requested: $ 33,300.00
(If fees are requested, attach as Attachment 13a a declaration from the attorney explaining the basis for the request, including a
discussion of applicable factors listed in rule 7.955(b) of the Cal. Rules of Court. Respond to item 17a(2) on page 7 and attach a
copy of any written attorney fee agreement as Attachment 17a.)
b. The following additional items of expense (other than medical expenses) have been incurred or paid, are reasonable, resulted
from the incident or accident, and should be paid out of claimanrs share of the proceeds of the setUement or judgment:
Items Amounts
Costs incurred by Dordick Law Corporation DORDICK LAW $ 1,921. 77
Costs incurred by Toler & Associates Toler & Associates $ 775.00
$
$
$
$
$
$
D Continued on Attachment 13b. Total: $ 2,696. 77
MC-350 [Rev. January 1, 2021] Page5of1D
PETITION FOR APPROVAL OF COMPROMISE OF CLAIM
OR ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
DocuSign Envelope 10: C7BC913E-{)3C8-4C50-BA49-8807B604EE1D
MC-350
CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER:
BCV-22-1 02263
14. Reimbursement of fees and expenses paid by petitioner
a. D Petitioner has paid none of the fees or expenses listed in items 12 and 13 for which reimbursement is requested.
b. D Petitioner has paid (or become obligated to pay) the following total amounts of the claimant's fees and expenses for which
reimbursement is requested.
(1) D Medical expenses listed in item 12: $
(2) D Attorney's fees included in the total fee amount shown in item 13a: $
(3) D Other expenses included in the total shown in item 13b: $
Total:$._ _ _ _ __
(Attach proofs of the fees and expenses incurred and the payments made or obligations to pay incurred, e.g., bills or invoices,
canceled checks, credit card statements, explanations of benefits from insurers, etc.)
15. Net balance of proceeds for the claimant
The balance of the proceeds of the proposed settlement or judgment remaining for the claimant
after payment of all requested fees and expenses is: $_ ___:5c:.5,"-74.:..:0::c.7"'2
16. Summary
a. Gross amount of proceeds of settlement or judgment: $ 100,000.00
b. Medical expenses to be paid from proceeds of settlement or judgment: $ 8,262.51
c. Attorney's fees to be paid from proceeds of settlement or judgment: $ 33,300.00
d. Expenses (other than medical) to be paid from proceeds of settlement
or judgment: $ 2,696.77
e. Total fees and expenses to be paid from proceeds of settlement or
judgment (add (b), (c), and (d)): ($ 44,259.28)
f. Balance of proceeds of settlement or judgment available for claimant
after payment of all fees and expenses (subtract (e) from (a)): $ 55,740.72
MC-350 [Rev. January 1, 2021] Page8of1D
PETITION FOR APPROVAL OF COMPROMISE OF CLAIM
OR ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
DocuSign Envelope 10: C7BC913E-{)3C8-4C50-BA49-8807B604EE1D
MC-350
CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER:
BCV-22-1 02263
17. Information about attorney representing or assisting petitioner
a. (1) D Petitioner has not been represented or assisted by an attorney in preparing this petition or in any other way with
respect to the claim asserted. (Skip the rest of item 17 and go to item 18.)
(2) 00 Petitioner has been represented or assisted by an attorney in preparing this petition or with respect to the claim
asserted. Petitioner and the attorney D do not 00 do have an agreement for services provided in
connection with the claim giving rise to this petition.
(If you answered "do," attach a copy of the agreement as Attachment 17a, and complete items 171>--17f.)
b. The attorney who has represented or assisted petitioner is (name):
Dustin Z. Moaven, Esq.
(1) State Bar number: SIB# 320939
(2) Law firm: Dordick Law Corporation
(3) Address:
509 S. Beve~y Dr., Beve~y Hills, CA 90212
(4) Telephone number: (310) 551-0949 (5) Email: dustin@dordicklaw.com
c. The attorney 00 has not D has received attorney's fees or other compensation in addition to that requested in
this petition for services provided in connection with the claim giving rise to this petition. (If you answered "has, • identify the
person who paid the fees or other compensation, the amounts paid, and the dates of payment):
From whom (names) Amounts
$
$
$
$
$
D Continued on Attachment 17c.
d. The attorney 00 did not D did become concerned with this matter, directly or indirectly, at the instance of a party
against whom the claim is asserted or a party's insurance carrier. (If you answered "did," explain the circumstances in
Attachment 17d.)
e. The attorney 00 is not D is representing or employed by any other party or any insurance carrier involved in the
matter. (If you answered "is, • identify the party or carrier and explain the relationship in Attachment 17e.)
f. The attorney 00 does not D does expect to receive attorney's fees or other compensation in addition to that
requested in this petition for services provided in connection with the claim giving rise to this petition. (If you answered "does,"
identify the person who will pay the fees or other compensation, the amounts to be paid, and the expected dates of payment):
From whom (names) Amounts Expected dates
$
$
$
$
$
D Continued on Attachment 17f.
MC-350 [Rev. January 1, 2021] Page 7 of 10
PETITION FOR APPROVAL OF COMPROMISE OF CLAIM
OR ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
DocuSign Envelope 10: C7BC913E-{)3C8-4C50-BA49-8807B604EE1D
MC-350
CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER:
BCV-22-1 02263
18. Disposition of balance for claimant (check either a orb, then check each option requested and enter amount(s)):
a. D There Is a guardianship of the estate of the minor or a conservatorship of the estate of the adult person with a disability
filed in (name of court):
Case no.:
(1) D Petitioner requests that $ of the proceeds in money or other property be paid or delivered to the
guardian or the conservator of the estate. The money or other property is specified in Attachment 18a(1 ).
(2) D Petitioner is the guardian or conservator of the estate of the minor or the adult person with a disability. Petitioner
requests authority to deposit or invest $ of the money or other property to be paid or delivered
under 18a(1) in insured accounts in one or more financial institutions in this state or with a trust company, subject to
withdrawal only on authorization of the court. The money or other property and the name, branch, and address of
each financial institution or trust company are specified in Attachment 18a(2).
(3) D Petitioner proposes that all or a portion of the proceeds not become part of the guardianship or conservatorship
estate. Petitioner requests authority to deposit or transfer these proceeds as follows (check all that apply):
(a) D $ to be deposited in insured accounts in one or more financial institutions in this state,
subject to withdrawal only on authorization of the court. The name, branch, and address of each depository are
specified in Attachment 18a(3)(a).
(b) D $ to be invested in a single-premium deferred annuity, subject to withdrawal only on
authorization of the court. The tenns and conditions oflhe annuity are specified in Attachment18a(3)(b).
(c) D $ to be transferred to a custodian for the benefrt of the minor under the California Uniform
Transfers to Minors Act. The name and address of the proposed custodian and the property to be transferred are
specified in Attachment 18a(3)(c).
(d) D $ to be transferred to the trustee of a trust that is either created by or approved in the order
approving the settlement or judgment for the minor. This trust is revocable when the minor reaches 18 years of
age and contains all other tenns and conditions detennined to be necessary by the court to protect the mino~s
interests. The tenns of the proposed trust and the property to be transferred are specified in Attachment 18a(3)
(d).
D A copy of the (proposed) judgment is attached as Attachment 3c.
(e) D $ to be transferred to the trustee of a special needs trust under Probate Code section 3604
for the benefit of the minor or the adult person with a disability. The tenns of the proposed special needs trust
and the property to be transferred are specified in Attachment 18a(3)(e).
b. 00 There is no guardianship or conservatorship of the estate of the claimant. Petitioner requests that the court order the
disposition of the balance of the proceeds of the settlement or judgment as follows (check each option requested):
(1) D A guardian of the estate of the minor or a conservator of the estate of the adult person with a disability be appointed
and $ of money or other property be paid or delivered to the person so appointed. The money or
other property are specified in Attachment 18b(1).
(2) D $ be deposited in insured accounts in one or more financial institutions in this state, subject to
withdrawal only on authorization of the court. The name, branch, and address of each depository are specified in
Attachment 18b(2).
(3) D $ be invested in a single-premium deferred annuity, subject to withdrawal only on authorization of
the court. The tenns and conditions of the annuity are specified in Attachment 18b(3).
(4) 00 $55,740.72 be paid or transferred to the trustee of a special needs trust established under Probate Code
section 3604 for the benefit of the minor or the adult person with a disability. The terms of the proposed special needs
trust and the money or other property to be paid or transferred are specified in Attachment 18b(4).
(5) D $ be paid or delivered to a parent of the minor, without bond, on the tenns and under the
conditions specified in Probate Code sections 3401-3402. The name and address of the parent and the money or
other property to be delivered are specified in Attachment18b(5). (Value of minor's entire estate, including the money
or property to be delivered, must not exceed $5,000.)
(6) D $ be transferred to a custodian for the benefit of the minor under the California Unifonn Transfers
to Minors Act. The name and address of the proposed custodian and the money or other property to be transferred
are specified in Attachment 18b(6).
MC-350 [Rev. January 1, 2021] Page8of1D
PETITION FOR APPROVAL OF COMPROMISE OF CLAIM
OR ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
DocuSign Envelope 10: C7BC913E-{)3C8-4C50-BA49-8807B604EE1D
MC-350
CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER:
BCV-22-1 02263
18. Disposition of balance of proceeds of settlement or judgment (continued)
b. D There is no guardianship or conservatorship of the estate of the claimant. Petitioner requests that the court order the
disposition of the balance of the proceeds of the settlement or judgment as follows (check each option requested):
(7) D $ be transferred to the trustee of a trust that is either created by or approved in the order
approving the settlement or judgment for the minor. This trust is revocable when the minor reaches 18 years of age,
and contains all other terms and conditions determined to be necessary by the court to protect the mino~s interests.
The terms of the proposed trust and the money or other property to be transferred are specified in Attachment 18b(7).
D A copy of the (proposed) judgment is attached as Attachment 3c.
(8) D $ of money be held on any conditions the court determines are in the best interest of the minor
or the adult person with a disability. The proposed conditions are specified on Attachment 18b(8). (Amount must not
exceed $20,000.)
(9) D $ of property other than money be held on the conditions that the court determines to be in the
best interest of the minor or adult person with a disability. The proposed conditions and the property are specified in
Attachment18b(9).
(1 0) D $ be deposited with the county treasurer of the County of (name):
The deposit is authorized under and subject to the conditions specified in Probate Code section 3611 (h).
(11) D $ be paid or delivered to the adult person with a disability. The money or other property is
specified in Attachment18b(11 ).
19. D Statutory liens for spacial needs trust
Petitioner requests an order for payment of funds to a special needs trust (explain how statutory liens under Probate Code
section 3604, if any, will be satisfied):
D Continued on Attachment 19.
20. D Additional orders
Petitioner requests the following additional orders (specify and explain):
D Continued on Attachment20.
MC-350 [Rev. January 1, 2021] Page 1 of1D
PETITION FOR APPROVAL OF COMPROMISE OF CLAIM
OR ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
DocuSign Envelope ID: C7BC913E-03C8-4C50-BA49-8807B604EE1D
MC-350
CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER:
BCV-22-102263
21 . D I, the claimant named in item 2, consent to the order or judgment requested in this petition.
(Required if the claimant is an adult with a disability who has the capacity, under Probate Code section 812, to consent to the
order or judgment and does not have a conservator of the estate. (See Prob. Code,§ 3613.))
Date:
(TYPE OR PRINT NAME OF CLAIMANT) (SIGNATURE OF CLAIMANT)
22. Petitioner recommends approval of the proposed compromise, settlement, or disposition of judgment proceeds to the court as fair,
reasonable, and in the best interest of the claimant. Petitioner requests that the court approve this compromise, settlement, or
disposition and make any other orders that are just and reasonable.
23. Number of pages attached: 97
Date: May 2, 2024
Dustin Z. Moaven, Esq.
(TYPE OR PRINT NAME OF ATIORNEY)
I declare under penalty of perjury under the laws of the State of California that the foregoing information on this form and all
attachments is true and correct.
Date: 5/3/2024
Angel Thompson
(TYPE OR PRINT NAME OF PETITIONER)
MC-350 [Rev. January 1, 2021) Page 10 of 10
PETITION FOR APPROVAL OF COMPROMISE OF CLAIM
OR ACTION OR DISPOSITION OF PROCEEDS OF
JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY
DocuSign Envelope 10: C7BC913E-03C8-4C50-BA49-8807B604EE1D
ATTACHMENT 8
From : Haven Orthooedic Fax: 18183093355 To: 6866 fax Fax: (310) 492-9967 Page: 1 of 4 11/24/2020 2:20PM
DocuSign Envelope ID: C7BC913E-03C8-4C50-BA49-8807B604EE1 D
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Preview
DocuSign Envelope ID: C7BC913E-03C8-4C50-BA49-8807B604EE 1D MC-350 ATIORNEY OR PARTY WllliOlJT ATIORNEY STATE BAR NUMBER: FOR COURT USE ONLY NAME: Gary A. Dordick, Esq. S/B# 128008; Dustin Z. Moaven, Esq. S/B# 320939 FIRM NAME: DORDICK LAW CORPORATION STREET ADDREss: 509 s. Beverly Drive CITY: Beverly Hills STATE: CA ZIP CODE: 90212 TELEPHONE NO.: (31 Q) 551-0949 FAX NO. : (855) 299-4444 EMAIL ADDREss: dustin@dordicklaw.com ATIORNEY FOR (NsmeJ: Plaintiff Candace Thompson SUPERIOR COURT OF CAUFORNIA, COUNTY OF KERN STREET ADDRESS: 1215 TRUXTUN AVENUE MAILING ADDRESS: 1215 TRUXTUN AVENUE CITY AND ZIP CODE: BAKERSFIELD CA 93301 BRANCH NAME: BAKERSFIELD COURT CASE NAME: CASE NUMBER: Candace Thompson v. Axel Eduardo Chavez Garcia BCV-22-1 02263 HEARING DATE: PETITION FOR APPROVAL OF COMPROMISE OF CLAIM May21, 2024 OR ACTION OR DISPOSITION OF PROCEEDS OF DEPT.: TIME: JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY J 8:30am NOTICE TO PETITIONER Except as noted below, you must use this form to request court approval of (1) the compromise of a minor's disputed claim, ' (2) the compromise or settlement of a pending action or proceeding to which a minor or a person with a disability (including a conservatee) is a party, or (3) the disposition of the proceeds of a judgment awarded to a minor or a person with a disability. (See Code Civ. Proc., § 372; Prob. Code,§§ 3500, 3600--3613.) Both you and the minor or person with a disability must attend the hearing on this petition unless the court dispenses with a personal appearance. The court may require the presence and testimony of witnesses, including the attending or examining physician, and the presentation of other evidence relating to the claim and the nature and extent of the injury, care, treatment, and hospitalization. The court has authority to consider a request for expedited approval without a hearing of the compromise of certain claims or actions or the disposition of the proceeds of certain judgments. To determine whether your claim, action, or judgment qualifies, see Cal. Rules of Court, rule 7.950.5. If you want to request expedited consideration, you must use form MC-350EX. 1. Petitioner (name or pseudonym*): Angel Thompson is the (check all boxes that apply): [KJ Parent [KJ Guardian ad litem* D Guardian D Conservator D Other (specify relationship): of the claimant identified in item 2. (*Petitioner may appear under a pseudonym only if appointed as guardian ad litem under that pseudonym. (See Code Civ. Proc., § 372.5.)) 2. Claimant (name): Candace Thompson a. Address: 4038 Weiman Avenue, Ridgecrest CA 93555 b. Date of birth: 06/01/1991 c. Age: 32 d. D Minor or [KJ Person with a disability (If the claimant is an adult with a disability who (1) has capacity to consent to the order requested and (2) does not have a conservator of the estate, check e. and f. and ensure that the claimant personally reads and signs item 21. (Prob. Code, § 3613.)) e. D Has the capacity, within the meaning of Probate Code section 812, to consent to the requested order or judgment. f. [KJ Does not have a conservator of the estate. 3. Claim The claim of the minor or adult person with a disability (check one): a. D Is not the subject of a pending action or proceeding. (Complete items 4-23.) b. [][] Is the subject of a pending action or proceeding that will be compromised or settled without a trial. (Complete items 4-23.) Name of court: BAKERSFIELD COURT Case no.: BCV-22-102263 Trial date: VACATED c. D Is the subject of an action or proceeding in which a judgment has been or will be entered for the claimant against the defendants named below in the amount (excluding interest and costs) of (specify totaQ: $_ _ _ _ _ __ Defendants (names: D Additional defendants listed on Attachment 3. D The judgment was filed on (data): (Attach a copy of the (proposed) judgment as Attachment 3c and complete items 12-23.) Pqe1 of10 Form Adopted for Altemative Mandatory Use Code of Civil Procedure, § 372; Instead of Form MC-350EX PETITION FOR APPROVAL OF COMPROMISE OF CLAIM Probate Code, §§ 3600, 360~613; Judicial Council of california Cal. Rules of Court, rules 3.1384, MC-350 [Rev. January 1, 2021] OR ACTION OR DISPOSITION OF PROCEEDS OF 7.101, 7.950-7.952 JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY www.coui1S.c..gov DocuSign Envelope 10: C7BC913E-{)3C8-4C50-BA49-8807B604EE1D MC-350 CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER: BCV-22-1 02263 4. Incident or accident The incident or accident occurred as follows: a. Date: 09/30/2020 Time: 6:30 PM b. Place: West Weiman Avenue, Ridgecrest, CA 93555 c. Persons involved (names): Candace Thompson; Axel Eduardo Chavez Garcia D Continued on Attachment 4. 5. Natura of incident or accident The facts, events, and circumstances of the incident or accident are (describe what happened): On September 30, 2020, Candace Thompson walked down her driveway to check her mailbox on West Weiman Avenue in Ridgecrest, California, when Defendant Axel Eduardo Chavez Garcia's dog named "Rambo" escaped from Defendant's property and attacked Ms. Thompson, causing her to sustain severe physical, mental and emotional injuries. Candace Thompson is a person lacking decision making capacity due to her Intellectual Developmental Disorder, which renders her incompetent to represent her own interests in this lawsuit. D Continued on Attachment 5. 6. Injuries The following injuries ware sustained by the claimant as a result of the incident or accident (describe): Candace Thompson sustained physical, mental, and emotional injuries including a deep dog bite wound to her inner thigh, Post Traumatic Stress Disorder, and Major Depressive Disorder. She is now also extremely afraid of all types of dogs. D Continued on Attachment6. 7. Treatment The claimant received the following care and treatment for the injuries described in item 6 (describe): Ms. Thompson received stitches at he hospital after she sustained injuries to her right leg and thigh from the dog bite. She also had psychological therapy and follow up medical consultations for her wounds. D Continued on Attachment 7. 8. Extant of injuries and recovery (An original or a photocopy of any doctor's report containing a diagnosis of the claimant's injuries or a prognosis for the claimant's recovery, and a report of the claimant's current condition, must be attached to this petition as Attachment 8. A new report is not necessary if a previous report accurately describes the claimant's current condition.) a. D The claimant has recovered completely from the effects of the injuries described in item 6, and there are no permanent injuries. b. [KJ The claimant has not recovered completely from the effects of the injuries described in item 6, and the following injuries from which the claimant has not recovered are temporary (describe the remaining injuries and symptoms): Plaintiff still suffers from Post-traumatic Stress Disorder and Major Depressive Disorder, and is still afraid of dogs. D Continued on Attachment8b. c. D The claimant has not recovered completely from the effects of the injuries described in item 6, and the following injuries from which the claimant has not recovered are permanent (describe the permanent injuries and symptoms): D Continued on Attachment Be. MC-350 [Rev. January 1, 2021] Page2of1D PETITION FOR APPROVAL OF COMPROMISE OF CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY DocuSign Envelope ID: C7BC913E-{)3C8-4C50-BA49-8807B604EE1D MC-350 CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER: BCV-22-1 02263 9. [KJ Petitioner has made a careful and diligent Inquiry and Investigation Into the facts and circumstances of the Incident or accident In which the claimant was Injured; the responsibility for the Incident or accident; and the nature, extent, and seriousness of the claimant's Injuries. Petitioner understands that If the compromise proposed In this petition Is approved by the court and consummated, the claimant will never be able to recover any more compensation from the settling defendants named below even If the clalmanfs Injuries turn out to be more serious than they now appear. 10. Amount and terms of settlement To settle the claim in 3a or 3b, the defendants named below have offered to pay the following amounts to the claimant: a. The total amount offered by all defendants named below is (specify): $ 100,000.00 b. The defendants and amounts offered by each are as follows (specify): Defendants (names) Amounts Axel Eduardo Chavez Garcia $ 100,000.00 $ $ $ D Defendants and amounts offered continued on Attachment 1Ob. c. The tenms of settlement are as follows. (If the settlement is to be paid in installments, both the total amount and the present value of the settlement must be included.) Plaintiff Candace Thompson shall receive $100,000.00 as full and final settlement ofher claims against Defendant Axel Eduardo Chavez Garcia and in exchange, Plaintiff Thompson will dismiss the pending action with prejudice and release Defendant Garcia of all liability for all related claims. D Continued on Attachment 1Oc. 11. Settlement payments to others a. [KJ No defendant named in item 1Ob has offered to pay money to any person or persons other than the claimant to settle claims arising out of the same incident or accident that resulted in the claimant's injury. b. D To settle claims arising out of the same incident or accident that resulted in the claimanfs injury, one or more defendants named in item 1Ob have also offered to pay money to a person or persons other than claimant. (1) The total amount offered by all defendants to others is (specify): $ (2) Petitioner D does not have D has a claim against the recovery of the claimant (other than for reimbursement of fees or expenses paid by petitioner and listed under item 14). (If you answered "has," explain in Attachment 11b(2) the circumstances and the effect your claim has on the proposed compromise of the claim described in this petition.) (3) Petitioner D is not D is a plaintiff in the same action with the claimant. (If you answered "is," explain in Attachment 11 b(3) the circumstances and the effect your claim and its disposition has on the proposed compromise of the claim or action described in this petition.) (4) D Petitioner would receive money under the proposed settlement. (5) The settlement payments are to be apportioned and distributed as follows: Other plaintiffs or claimants (names) Amounts $ $ $ $ D Additional plaintiffs or claimants and amounts are listed on Attachment 11 b(5). (6) Reasons for the apportionment of the settlement payments between the claimant and each other plaintiff or claimant named above are specified in Attachment 11 b(6). MC-350 [Rev. January 1, 2021] Page3of10 PETITION FOR APPROVAL OF COMPROMISE OF CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY DocuSign Envelope 10: C7BC913E-{)3C8-4C50-BA49-8807B604EE1D MC-350 CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER: BCV-22-1 02263 12. The claimant's medical expenses-Including medical expenses paid by petitioner, Medicare, Medi-Cal, and private Insurers-to be paid or reimbursed from proceeds of settlement or judgment a. Totals (1) Total medical expenses before any reductions: $ 12,524.59 (2) Total medical expenses paid (include payments by private insurance, Medi-Cal, or Medicare): ($ 1 '190.23) (3) Total of negotiated, contractual, or statutory reductions, if any: ($ 4,730.37) (4) Total medical expenses to be paid or reimbursed from the proceeds: $ 8,262.51 (5) Total amount of statutory or contractual liens, if any: $ 8,262.51 b. Medical expenses were paid and are to be reimbursed from the proceeds as follows: (1) [KJ Paid by petitioner in the amount of: s _ _ _----=.3o::..:o:.:c.o:..::.o (2) D Paid by private health insurance or a self-funded plan under: (a) D An Employee Retirement Income Security Act (ERISA) insured plan. (b) D An ERISA se~-funded plan. (c) D A Non-ERISA insured plan. (d) D A Non-ERISA self-funded plan. (e) Amount paid by plan: $ (f) Amount of reimbursement to the plan from the proceeds of the settlement or judgment: (i) D No reimbursement is requested by the plan. (ii) D Reimbursement is to be made to the plan, and: (A) D There is a contractual reduction of: ($ ), (B) D There is a negotiated reduction of: ($ ), (C) D No reduction has been agreed to, for a total reimbursement to the plan, in full satisfaction of its lien rights, in the amount of: $_ _ _ _ _ __ (3) D Paid by Medicare in the amount of: $ less the statutory reduction in the amount of: ($ for a total reimbursement to Medicare in the amount of: $._ _ _ __ (Attach a copy of the final Medicare demand letter or letter agreement as Attachment 12b(3).) (4) [KJ Paid by Medi-Cal in the amount of: $ 890.23 (a) [KJ Notice of this claim or action has been given to the Director of Health Care Services. (We~. & Ins!. Code, § 14124.73.) A copy of the notice and proof of delivery: [KJ is attached D was filed in this case on (date): (b) D Notice of this claim or action has not been given to the Director of Health Care Services. (Explain why notice has not been given in Attachment 12b(4)(b).) (c) [KJ In full satisfaction of its lien rights, Medi-Cal has agreed to accept reimbursement in the amount of: $ 662.51 (Attach a copy of the final Medi-Cal demand letter or letter agreement as Attachment 12b(4)(c).) (d) D Petitioner is entitled to a reduction of the Medi-Cal lien under Welfare and Institutions Code section 14124.76 and (check one): (i) D Is filing a motion seeking a reduction of the lien concurrently with this petition. (ii) D Requests that the court reserve jurisdiction over this issue. The amount of the lien in dispute is: $ (5) (a) (i) D There are no statutory or contractual liens for payment of claimanfs medical expenses. (ii) [KJ There are one or more statutory or contractual liens of medical service providers for payment of claimant's medical expenses. The total amount claimed under these liens is: $10,150.00 In full satisfaction of their lien claims, the lienholders have agreed to accept the sum of: $ 7,600.00 (Provide requested information for each lienholder and other specified medical service providers on next page.) MC-350 [Rev. January 1, 2021] Page4of1D PETITION FOR APPROVAL OF COMPROMISE OF CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY DocuSign Envelope 10: C7BC913E-{)3C8-4C50-BA49-8807B604EE1D MC-350 CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER: BCV-22-1 02263 12. Claimant's medical expenses (continued) b. (5) (b) The name of each medical service provider that furnished care and treatmentto claimant and (1) has a lien for all or any part of the charges or (2) was paid (or will be paid from the proceeds) by petitioner, for which payment petitioner requests reimbursement; the amounts charged and paid; the amount of negotiated reductions of charges, if any; and the amount to be paid from the proceeds of the settlement or judgment to each provider are as follows: (i) (A) Provider (nama): Haven Orthopedics & Spine Institute (B) Address: 10390 Commerce Center Dr., Sutie 100, Rancho Cucamonga, CA 91730 (C) Amount charged: $ 1,150.00 (D) Amount paid (whether or not by insurance): ($ 0.00) (E) Negotiated reduction, if any: ($ 550.00) (F) Amount to be paid from proceeds of settlement or judgment: $_ _ _____::60"'0:.::.0:.::0 (ii) (A) Provider (name): Premier Forensic Psychology (B) Address: P.O. Box 7284, Fullerton, CA 92834 (C) Amount charged: $ 9,000.00 (D) Amount paid (whether or not by insurance): ($ 0.00) (E) Negotiated reduction, if any: ($ 2,000.00) (F) Amount to be paid from proceeds of settlement or judgment: $_ _ _.:_7'"'00"'0:.::.0:.::0 (iii) (A) Provider (name): Perk Plastic Surgery (B) Address: 416 N. Bedford Dr., Suite 400, Beve~y Hills, CA 90210 (C) Amount charged: $ 300.00 (D) Amount paid (whether or not by insurance): ($ 300.00) (E) Negotiated reduction, if any: ($ 0.00) (F) Amount to be paid from proceeds of settlement or judgment: $_ _ _ _--'0:.::.0=0 [KJ Continued on Attachmem 12b(5). (Provide information about additional providers in the above format, including providers paid or to be paid by petitioner, for which payment reimbursement is requested in item 12b(1), above. You may use form MC-350(A-12b(5)) for this purpose.) 13. Claimant's attorney's fees and all other expanses (except for medical expanses), including expanses advanced by claimant's attorney or paid or incurred by petitioner, to be reimbursed from proceeds of settlement or judgment a. Total amount of attorney's fees for which court approval is requested: $ 33,300.00 (If fees are requested, attach as Attachment 13a a declaration from the attorney explaining the basis for the request, including a discussion of applicable factors listed in rule 7.955(b) of the Cal. Rules of Court. Respond to item 17a(2) on page 7 and attach a copy of any written attorney fee agreement as Attachment 17a.) b. The following additional items of expense (other than medical expenses) have been incurred or paid, are reasonable, resulted from the incident or accident, and should be paid out of claimanrs share of the proceeds of the setUement or judgment: Items Amounts Costs incurred by Dordick Law Corporation DORDICK LAW $ 1,921. 77 Costs incurred by Toler & Associates Toler & Associates $ 775.00 $ $ $ $ $ $ D Continued on Attachment 13b. Total: $ 2,696. 77 MC-350 [Rev. January 1, 2021] Page5of1D PETITION FOR APPROVAL OF COMPROMISE OF CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY DocuSign Envelope 10: C7BC913E-{)3C8-4C50-BA49-8807B604EE1D MC-350 CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER: BCV-22-1 02263 14. Reimbursement of fees and expenses paid by petitioner a. D Petitioner has paid none of the fees or expenses listed in items 12 and 13 for which reimbursement is requested. b. D Petitioner has paid (or become obligated to pay) the following total amounts of the claimant's fees and expenses for which reimbursement is requested. (1) D Medical expenses listed in item 12: $ (2) D Attorney's fees included in the total fee amount shown in item 13a: $ (3) D Other expenses included in the total shown in item 13b: $ Total:$._ _ _ _ __ (Attach proofs of the fees and expenses incurred and the payments made or obligations to pay incurred, e.g., bills or invoices, canceled checks, credit card statements, explanations of benefits from insurers, etc.) 15. Net balance of proceeds for the claimant The balance of the proceeds of the proposed settlement or judgment remaining for the claimant after payment of all requested fees and expenses is: $_ ___:5c:.5,"-74.:..:0::c.7"'2 16. Summary a. Gross amount of proceeds of settlement or judgment: $ 100,000.00 b. Medical expenses to be paid from proceeds of settlement or judgment: $ 8,262.51 c. Attorney's fees to be paid from proceeds of settlement or judgment: $ 33,300.00 d. Expenses (other than medical) to be paid from proceeds of settlement or judgment: $ 2,696.77 e. Total fees and expenses to be paid from proceeds of settlement or judgment (add (b), (c), and (d)): ($ 44,259.28) f. Balance of proceeds of settlement or judgment available for claimant after payment of all fees and expenses (subtract (e) from (a)): $ 55,740.72 MC-350 [Rev. January 1, 2021] Page8of1D PETITION FOR APPROVAL OF COMPROMISE OF CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY DocuSign Envelope 10: C7BC913E-{)3C8-4C50-BA49-8807B604EE1D MC-350 CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER: BCV-22-1 02263 17. Information about attorney representing or assisting petitioner a. (1) D Petitioner has not been represented or assisted by an attorney in preparing this petition or in any other way with respect to the claim asserted. (Skip the rest of item 17 and go to item 18.) (2) 00 Petitioner has been represented or assisted by an attorney in preparing this petition or with respect to the claim asserted. Petitioner and the attorney D do not 00 do have an agreement for services provided in connection with the claim giving rise to this petition. (If you answered "do," attach a copy of the agreement as Attachment 17a, and complete items 171>--17f.) b. The attorney who has represented or assisted petitioner is (name): Dustin Z. Moaven, Esq. (1) State Bar number: SIB# 320939 (2) Law firm: Dordick Law Corporation (3) Address: 509 S. Beve~y Dr., Beve~y Hills, CA 90212 (4) Telephone number: (310) 551-0949 (5) Email: dustin@dordicklaw.com c. The attorney 00 has not D has received attorney's fees or other compensation in addition to that requested in this petition for services provided in connection with the claim giving rise to this petition. (If you answered "has, • identify the person who paid the fees or other compensation, the amounts paid, and the dates of payment): From whom (names) Amounts $ $ $ $ $ D Continued on Attachment 17c. d. The attorney 00 did not D did become concerned with this matter, directly or indirectly, at the instance of a party against whom the claim is asserted or a party's insurance carrier. (If you answered "did," explain the circumstances in Attachment 17d.) e. The attorney 00 is not D is representing or employed by any other party or any insurance carrier involved in the matter. (If you answered "is, • identify the party or carrier and explain the relationship in Attachment 17e.) f. The attorney 00 does not D does expect to receive attorney's fees or other compensation in addition to that requested in this petition for services provided in connection with the claim giving rise to this petition. (If you answered "does," identify the person who will pay the fees or other compensation, the amounts to be paid, and the expected dates of payment): From whom (names) Amounts Expected dates $ $ $ $ $ D Continued on Attachment 17f. MC-350 [Rev. January 1, 2021] Page 7 of 10 PETITION FOR APPROVAL OF COMPROMISE OF CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY DocuSign Envelope 10: C7BC913E-{)3C8-4C50-BA49-8807B604EE1D MC-350 CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER: BCV-22-1 02263 18. Disposition of balance for claimant (check either a orb, then check each option requested and enter amount(s)): a. D There Is a guardianship of the estate of the minor or a conservatorship of the estate of the adult person with a disability filed in (name of court): Case no.: (1) D Petitioner requests that $ of the proceeds in money or other property be paid or delivered to the guardian or the conservator of the estate. The money or other property is specified in Attachment 18a(1 ). (2) D Petitioner is the guardian or conservator of the estate of the minor or the adult person with a disability. Petitioner requests authority to deposit or invest $ of the money or other property to be paid or delivered under 18a(1) in insured accounts in one or more financial institutions in this state or with a trust company, subject to withdrawal only on authorization of the court. The money or other property and the name, branch, and address of each financial institution or trust company are specified in Attachment 18a(2). (3) D Petitioner proposes that all or a portion of the proceeds not become part of the guardianship or conservatorship estate. Petitioner requests authority to deposit or transfer these proceeds as follows (check all that apply): (a) D $ to be deposited in insured accounts in one or more financial institutions in this state, subject to withdrawal only on authorization of the court. The name, branch, and address of each depository are specified in Attachment 18a(3)(a). (b) D $ to be invested in a single-premium deferred annuity, subject to withdrawal only on authorization of the court. The tenns and conditions oflhe annuity are specified in Attachment18a(3)(b). (c) D $ to be transferred to a custodian for the benefrt of the minor under the California Uniform Transfers to Minors Act. The name and address of the proposed custodian and the property to be transferred are specified in Attachment 18a(3)(c). (d) D $ to be transferred to the trustee of a trust that is either created by or approved in the order approving the settlement or judgment for the minor. This trust is revocable when the minor reaches 18 years of age and contains all other tenns and conditions detennined to be necessary by the court to protect the mino~s interests. The tenns of the proposed trust and the property to be transferred are specified in Attachment 18a(3) (d). D A copy of the (proposed) judgment is attached as Attachment 3c. (e) D $ to be transferred to the trustee of a special needs trust under Probate Code section 3604 for the benefit of the minor or the adult person with a disability. The tenns of the proposed special needs trust and the property to be transferred are specified in Attachment 18a(3)(e). b. 00 There is no guardianship or conservatorship of the estate of the claimant. Petitioner requests that the court order the disposition of the balance of the proceeds of the settlement or judgment as follows (check each option requested): (1) D A guardian of the estate of the minor or a conservator of the estate of the adult person with a disability be appointed and $ of money or other property be paid or delivered to the person so appointed. The money or other property are specified in Attachment 18b(1). (2) D $ be deposited in insured accounts in one or more financial institutions in this state, subject to withdrawal only on authorization of the court. The name, branch, and address of each depository are specified in Attachment 18b(2). (3) D $ be invested in a single-premium deferred annuity, subject to withdrawal only on authorization of the court. The tenns and conditions of the annuity are specified in Attachment 18b(3). (4) 00 $55,740.72 be paid or transferred to the trustee of a special needs trust established under Probate Code section 3604 for the benefit of the minor or the adult person with a disability. The terms of the proposed special needs trust and the money or other property to be paid or transferred are specified in Attachment 18b(4). (5) D $ be paid or delivered to a parent of the minor, without bond, on the tenns and under the conditions specified in Probate Code sections 3401-3402. The name and address of the parent and the money or other property to be delivered are specified in Attachment18b(5). (Value of minor's entire estate, including the money or property to be delivered, must not exceed $5,000.) (6) D $ be transferred to a custodian for the benefit of the minor under the California Unifonn Transfers to Minors Act. The name and address of the proposed custodian and the money or other property to be transferred are specified in Attachment 18b(6). MC-350 [Rev. January 1, 2021] Page8of1D PETITION FOR APPROVAL OF COMPROMISE OF CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY DocuSign Envelope 10: C7BC913E-{)3C8-4C50-BA49-8807B604EE1D MC-350 CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER: BCV-22-1 02263 18. Disposition of balance of proceeds of settlement or judgment (continued) b. D There is no guardianship or conservatorship of the estate of the claimant. Petitioner requests that the court order the disposition of the balance of the proceeds of the settlement or judgment as follows (check each option requested): (7) D $ be transferred to the trustee of a trust that is either created by or approved in the order approving the settlement or judgment for the minor. This trust is revocable when the minor reaches 18 years of age, and contains all other terms and conditions determined to be necessary by the court to protect the mino~s interests. The terms of the proposed trust and the money or other property to be transferred are specified in Attachment 18b(7). D A copy of the (proposed) judgment is attached as Attachment 3c. (8) D $ of money be held on any conditions the court determines are in the best interest of the minor or the adult person with a disability. The proposed conditions are specified on Attachment 18b(8). (Amount must not exceed $20,000.) (9) D $ of property other than money be held on the conditions that the court determines to be in the best interest of the minor or adult person with a disability. The proposed conditions and the property are specified in Attachment18b(9). (1 0) D $ be deposited with the county treasurer of the County of (name): The deposit is authorized under and subject to the conditions specified in Probate Code section 3611 (h). (11) D $ be paid or delivered to the adult person with a disability. The money or other property is specified in Attachment18b(11 ). 19. D Statutory liens for spacial needs trust Petitioner requests an order for payment of funds to a special needs trust (explain how statutory liens under Probate Code section 3604, if any, will be satisfied): D Continued on Attachment 19. 20. D Additional orders Petitioner requests the following additional orders (specify and explain): D Continued on Attachment20. MC-350 [Rev. January 1, 2021] Page 1 of1D PETITION FOR APPROVAL OF COMPROMISE OF CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY DocuSign Envelope ID: C7BC913E-03C8-4C50-BA49-8807B604EE1D MC-350 CASE NAME: Candace Thompson v. Axel Eduardo Chavez Garcia CASE NUMBER: BCV-22-102263 21 . D I, the claimant named in item 2, consent to the order or judgment requested in this petition. (Required if the claimant is an adult with a disability who has the capacity, under Probate Code section 812, to consent to the order or judgment and does not have a conservator of the estate. (See Prob. Code,§ 3613.)) Date: (TYPE OR PRINT NAME OF CLAIMANT) (SIGNATURE OF CLAIMANT) 22. Petitioner recommends approval of the proposed compromise, settlement, or disposition of judgment proceeds to the court as fair, reasonable, and in the best interest of the claimant. Petitioner requests that the court approve this compromise, settlement, or disposition and make any other orders that are just and reasonable. 23. Number of pages attached: 97 Date: May 2, 2024 Dustin Z. Moaven, Esq. (TYPE OR PRINT NAME OF ATIORNEY) I declare under penalty of perjury under the laws of the State of California that the foregoing information on this form and all attachments is true and correct. Date: 5/3/2024 Angel Thompson (TYPE OR PRINT NAME OF PETITIONER) MC-350 [Rev. January 1, 2021) Page 10 of 10 PETITION FOR APPROVAL OF COMPROMISE OF CLAIM OR ACTION OR DISPOSITION OF PROCEEDS OF JUDGMENT FOR MINOR OR PERSON WITH A DISABILITY DocuSign Envelope 10: C7BC913E-03C8-4C50-BA49-8807B604EE1D ATTACHMENT 8 From : Haven Orthooedic Fax: 18183093355 To: 6866 fax Fax: (310) 492-9967 Page: 1 of 4 11/24/2020 2:20PM DocuSign Envelope ID: C7BC913E-03C8-4C50-BA49-8807B604EE1 D .. X\,1 (·)n ·. .'''LJ('