
I, Patrick Thomas, authorize my attorneys, Miller & Zois, LLC to endorse a settlement check on my behalf and disburse the sum of $1,200,000.00 arising out of a settlement for injuries sustained as a result of the negligence of Franklin M. Pakacki on March 12, 2004 as follows:
TOTAL SETTLEMENT: $1,200,000.00
Deductions:
Attorneys Fees: $480,000.00 (2/3 to Miller & Zois; 1/3 to Law Offices of Daniel Patrick
Attorney Expenses: $ 5,834.40 (See attached exhibit A)
Total: $485,834.40
GROSS RECOVERY TO CLIENT: $714,165.60
Liens:
Meridian: $ 588.00 (See attached exhibit B)
U.S. Dept. of Labor: $ 62,202.47 (See attached exhibit C)
Total Deductions: $162,790.47
Credit Against Future Benefits: $100,995.11 (See attached exhibit D)
I hereby authorize my attorneys to disburse the above referenced funds as allocated above. As of the date of this disbursement, I am not aware of any other lien than the entities mentioned above.
____________________ _______________________
DATE PATRICK IERARDI
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