Settlement Disbursal Sheet

for Your State

This Settlement Disbursal Sheet is for use when determining a client's net payment after settlement of a lawsuit. This sheet contains the total amount of settlement, fees for attorney's and liens, costs and the total net payment to the client.

For Immediate Download

$3.99 Add to Cart
Free eSignature included
with every order
Please select a state

File types included

  • Microsoft Word
  • Adobe PDF
  • WordPerfect
  • Rich Text Format

Compatible with

  • Windows
  • Mac OS X
  • Linux

For Immediate Download

$3.99 Add to Cart
Free eSignature included
with every order
Please select a state

Attorney prepared

Our forms are kept up-to-date and accurate by our lawyers

Unlike other sites, every document on FindLegalForms.com is prepared by an attorney, so you can be sure that you are getting a form that is accurate and valid in your state.

Valid in your state

Our forms are guaranteed
to be valid in your state

Our team works tirelessly to keep our products current. As the laws change in your state, so do our forms.

Over 3,500,000
satisfied customers

In over 10 years of creating and selling legal forms, our focus has never changed: providing our customers high quality legal products, low prices and an experience that takes some confusion out of the law.

Free eSignature

Sign your form online, free with any form purchase

We now provide a free Electronic Signature Service to all of our visitors. There are no hidden charges or subscription fees, it's just plain free.

60-Days Money Back

Try our forms with no risk

If you are unhappy with your form purchase for any reason at all, contact us within 60 days and we will refund 100% of your money back.
This Settlement Disbursal Sheet sets forth a client's net payment after settlement of a lawsuit. This disbursement sheet sets out the total amount of the settlement, percentage paid as attorney's fees, costs (such as fees for copies, phone calls and reports), medical liens and net settlement amount due to the client. This Settlement Disbursement Sheet is simple to use and can easily be tailored to fit the unique needs of your cases.

This Settlement Disbursal Sheet includes the following:
  • Total: Sets out the total amount which was paid to settle the case;
  • Attorney Fees: Percentage amount of the settlement which was agreed to as an attorney fee;
  • Costs: Detailed description of all costs paid on the client's behalf which may include medical records, police reports and in-house copies;
  • Liens: Medical liens and other payments which were promised to providers or experts who rendered services on client's behalf;
  • Net Payment: Net settlement payment to client after all other fees have been deducted;
  • Signature: The client must sign and date this disbursal sheet which will act as acknowledgment of payment.

Protect yourself and your client by using our attorney-prepared forms.

This attorney-prepared packet contains:
  1. Information
  2. Settlement Disbursal Sheet
State Law Compliance: This form complies with the laws of all states
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.
Settlement Disbursal Sheet

 

   
   DISBURSAL SHEET
 
TOTAL AMOUNT OF SETTLEMENT             $__________________
 
ATTORNEYS FEES ________%            $__________________
 
ATTORNEYS COSTS:
 
Medical records:         $_____________
Police Report   :   $_____________
Legal Fees   :   $_____________
Copies      :   $_____________
Telephone   :   $_____________
Faxes      :   $_____________
Misc.      :   $_____________
 
Total Costs   $__________________
 
Total Attorney fees & costs   $__________________
 
 
MEDICAL LIENS & OTHER PAYMENTS:
 
_______________________________         $__________________
_______________________________         $__________________
_______________________________         $__________________
_______________________________         $__________________
_______________________________         $__________________
 
Total Payments      $__________________
 
NET PAYMENT TO CLIENT      $__________________
 
 
 
__________________________________      ________________________
Signature of Client                     Date   
Number of Pages2
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#28063
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.
Settlement Disbursal Sheet

 

   
   DISBURSAL SHEET
 
TOTAL AMOUNT OF SETTLEMENT             $__________________
 
ATTORNEYS FEES ________%            $__________________
 
ATTORNEYS COSTS:
 
Medical records:         $_____________
Police Report   :   $_____________
Legal Fees   :   $_____________
Copies      :   $_____________
Telephone   :   $_____________
Faxes      :   $_____________
Misc.      :   $_____________
 
Total Costs   $__________________
 
Total Attorney fees & costs   $__________________
 
 
MEDICAL LIENS & OTHER PAYMENTS:
 
_______________________________         $__________________
_______________________________         $__________________
_______________________________         $__________________
_______________________________         $__________________
_______________________________         $__________________
 
Total Payments      $__________________
 
NET PAYMENT TO CLIENT      $__________________
 
 
 
__________________________________      ________________________
Signature of Client                     Date   
You've found your form, but will you need others? If there are other related forms you may need in the future, it may be beneficial to look at our combo packages. On average, customers who purchase a combo package save 40% on the related forms they need. Take a look at the combo packages below to see if one is right for you.
Civil Attorney Practice Premier Combo Package Get 16 forms for just $99.95 Save 11%! Popular Save Money with this premier combo package containing all of our civil attorney practice forms

Looking for something else?