IN THE CIRCUIT COURT FOR PRINCE GEORGE’S, MARYLAND

Ari Gold - Plaintiff

v

Dr. Vincent Chase- Defendant

* * * * *
         CASE NO.: 24-C-05-026677 OT
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

                                               LIMITED POWER OF ATTORNEY

     The undersigned, Ari Gold, hereby appoint RONALD V. MILLER, JR., of Miller & Zois, LLC, as my true lawful attorney to endorse a settlement check from USAA in the amount of $496,000.00 arising out of an automobile accident on July 15, 2013.  We further direct our attorney to disburse the settlement as follows:


TOTAL SETTLEMENT:     $496,000          powerofattorney
Deductions:

Attorneys' Fees    $165,167    
Attorneys' Expenses (see attached): $1,488.33                                                     

Outstanding Medical Bills: $0

Blue Cross Lien: $85,301

Total Deductions: $251,956.33

DISBURSEMENT TO MR. GOLD: $244,043

                                                                                                                         

 

___________________                                                                                                   
Date                                                                       Ari Gold

 

STATE OF MARYLAND                                    :

COUNTY OF HOWARD                                 :

 

I HEREBY CERTIFY that on this             day of __________, 2007, personally appeared Ari Gold, and made oath in due form of law that the matters and facts set forth in the aforegoing Limited Power of Attorney are true and correct to the best of her knowledge, information and belief.

                                                            
Notary Public
My Commission Expires:                           

 

  • More Sample Attorney Forms
  • Get a Sample Demand Letter