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Petitioner requests allocation of the net proceeds of the settlement (after deduction of costs and attorneys fees) as follows: a. Petition for Leave to Settle or Compromise Wrongful Death and Survival Action ; To: John K. Trustworthy, Esquire Counsel Fees, 998,833.The Plaintiff has a cause of action against the Defendant(s) for causing the death of. There is an offer of (full) (partial) settlement without suit being filed. Instant access to fillable Microsoft Word or PDF forms. Minimize the risk of using outdated forms and eliminate rejected fillings. Step 1: COMPLETE THE FOLLOWING FORMS. Application to Approve Settlement and Distribution of Wrongful Death and Survival Claims (Form 14.0). 3: Report of Distribution of Wrongful Death and Survival Claims. ORDER APPROVING PETITION.