B. A minor's parent or guardian may enter into a settlement agreement outside of a court proceeding with a person against whom the minor has a claim if a guardian ad litem, guardian, or conservator has not been appointed for the minor, and the total amount of the settlement proceeds is greater than One Thousand Five Hundred Dollars ($1,500.00) and less than or equal to Twenty-five Thousand Dollars ($25,000.00), after reduction from the total settlement amount of all medical expenses, medical liens, all other liens, and reasonable attorney fees and costs. Monies recovered from such a settlement shall be deposited by the parent or guardian in a savings account that accrues interest at one or more federally insured banking, credit union, or savings and loan institutions; in a trust established for the minor by a bank or trust company having trust powers under state or federal law; or into a structured settlement by the terms of which the proceeds of the settlement may be invested in an annuity to be paid to or for the benefit of the minor by an insurance company licensed in this state. All or a portion of the recovered monies may also be deposited in an account pursuant to the Oklahoma College Savings Plan Act with the minor designated as the sole beneficiary of the account.The parent or guardian acting on behalf of the person who is less than eighteen (18) years of age shall complete an affidavit or verified statement in conformity with this section. The parent or guardian entering into the settlement agreement on behalf of the minor shall retain a copy of the affidavit or verified statement for the minor until the minor reaches the age of majority. If the minor is represented by counsel, the attorney shall also retain in the attorney file a copy of the affidavit or verified statement until one (1) year after the minor attains eighteen (18) years of age.
Any federally insured banking, credit union, or savings and loan institution receiving the monies for deposit shall complete a receipt of deposit signed by an officer of the bank, credit union, or savings and loan institution in conformity with subsection J of this section. A federally insured banking, credit union, or savings and loan institution may accept the affidavit without further investigation and the bank, credit union, or savings and loan institution shall not be liable to the minor or parent or guardian provided the account is administered as set forth in the affidavit and receipt of deposit provided for in this section.
I. The minor's parent or guardian shall complete an affidavit or verified statement in substantial conformity with the applicable provisions as follows:"I, [Name of Affiant], being of lawful age and after being duly sworn upon oath, state as follows:
1. I am the parent or guardian of [Name of minor child] ("XX"), a minor child.2. XX's date of birth is MM-DD-YYYY.3. [Briefly state when, where, and how the incident in question occurred.]4. [Briefly state how minor was injured in the incident, describe his or her injuries, medical care received, if any, and how they are doing today.]5. As a result of the injuries sustained by XX in the incident in question, I, individually and on behalf of XX, a minor, agreed to settle the claims of XX against [Name of tortfeasor(s)], with their insurer, [if any, provide the name of Third-Party Liability Insurance Carrier(s)], in the amount of $XXXX; and with my UM/UIM insurer, [if any, provide the name of First-Party-Liability Insurance Carrier(s)], in the amount of $XXXX, [add additional tortfeasor or first-party coverages where applicable] for a total settlement in the amount of $XXXX.6. I understand that all medical expenses, liens and subrogation claims must be paid from the settlement: [List all outstanding medical expenses, liens and subrogation providers and the amounts.]7. I understand that I (or another parent or guardian of the minor) may be reimbursed from the settlement for medical expenses that I or we have paid for the care or treatment of XX as a result of injuries incurred by XX due to the subject incident as follows: [List all relevant medical expenses of XX, paid for by a parent or guardian, for which reimbursement is sought from the settlement.]8. I understand that $XXXX will be paid from the settlement to [Name of Firm/Attorney, if any] for attorney fees and costs in securing the settlement pursuant to my contract with [Name of Firm/Attorney].9. I understand that pursuant to subsection B of Section 83 of Title 12 of the Oklahoma Statutes, the net of XX's settlement in the amount of $XXXX must be deposited in a savings account that accrues interest at one or more federally insured banking, credit union or savings and loan institutions; in a trust established for XX, by a bank or trust company having trust powers under state or federal law; or into a structured settlement, by the terms of which the proceeds of a settlement may be invested in an annuity to be paid to or for the benefit of XX by an insurance company licensed in this state. All or a portion of the recovered monies may be deposited in an account pursuant to the Oklahoma College Savings Plan Act with XX designated as a beneficiary of the account.10. I understand that such funds may not be withdrawn, removed, paid out, or transferred to anyone until XX is eighteen (18) years of age, except pursuant to court order or upon the minor's death. When the minor XX reaches the age of eighteen (18) years, the funds may be withdrawn, removed, paid out or transferred by the minor without a court order.11. I understand that I must deposit the funds, secure a Receipt of Deposit from the bank, and if I am represented, to return the Receipt of Deposit to my attorney. I must also advise the minor of the settlement and the location of the settlement funds as soon as the minor has the ability to understand its existence and at the time the minor reaches eighteen (18) years of age.12. I understand that should I not settle this matter on behalf of the minor, I have the right to ask for a jury trial in this matter, and that a jury may have awarded more, less, or the same amount, but by settling XX's claims, I am giving up this right to a jury trial.13. I understand that should I not settle this matter, or pursue a jury trial on behalf of XX, XX would alternatively have a right to bring a cause of action against [Name of Tortfeasor(s)] within the one (1) year between XX's 18th and 19th birthdays; however, by settling this matter at this time on XX's behalf, I am waiving his or her right to bring a cause of action at that time, and relatedly his or her opportunity to obtain a verdict through jury trial.14. I understand that by settling XX's claims, whether for already known or later-discovered additional injuries from the subject incident and/or if XX requires future medical care, I will not be able to open this claim or bring any future cause of action against [Name of Tortfeasor(s) or their insurer(s)], [Name of Insurance Carrier, if any], to request additional sums of money.15. I believe this is a fair and reasonable settlement of XX's claim: that to the best of my knowledge the minor will be fully compensated by the settlement, or there is no practical way to obtain additional amounts from the other party/parties entering into the settlement agreement.16. I believe this settlement is in the best interests of XX.17. I understand that this settlement is full and final; I have not been coerced, pressured, or threatened into entering this settlement in any way.FURTHER AFFIANT SAYETH NOT.
__________________________________________________
__________________________________________________
[Name of Affiant]
[Address of Affiant]
[Phone Number of Affiant]
I state under penalty of perjury under the laws of Oklahoma that the foregoing is true and correct.
Date Signature of Parent or Legal Guardian of XX
Approved as to form and content by:
__________________________________________________
[Attorney Name, if any]"
J. Any federally insured banking, credit union, or savings and loan institution receiving the monies for deposit shall complete a receipt of deposit referenced herein in conformity with the following:"RECEIPT OF DEPOSIT
The undersigned, an Officer of [Name of Bank], does hereby acknowledge receipt of the Affidavit of [Name of Affiant], and that $XXXXX was deposited for the benefit of the minor, XX.
It is understood that the funds so deposited, pursuant to provisions under Section 83 of Title 12 of the Oklahoma Statutes, may not be withdrawn, removed, paid out, or transferred by anyone until XX is eighteen (18) years of age, except pursuant to court order or upon the minor's death.
When XX reaches the age of eighteen (18) years of age, the funds may be withdrawn, removed, paid out, or transferred by XX without court order.
BY:
Signature
__________________________________________________
Printed Name
__________________________________________________
Title
Subscribed and sworn to before me this ________day of ___________, 20.
__________________________________________________
Notary Public
My Commission Expires:
___________________________"