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We want to hear
about YOUR cases!
Reproduced below is
our Case Information Sheet. Please use this form for reporting verdicts or settlements.
If you prefer to dictate a letter, please use the form as a guide.
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* Required fields
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County and Court:*
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Name of Case
[Please use complete style]:*
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Case/Docket Number:*
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Judge:*
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Plaintiff(s) Attorney(s)/Trial Counsel [Please include full names, firm and city]:*
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Defendant(s) Attorney(s)/Trial Counsel [Please include full names, firm and city]:*
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Age, Sex and Occupation of Plaintiff or Defendant [at time of accident or occurrence]:*
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For Wrongful Death cases, please give age and relationship of survivors:*
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Date, Time and Place of Accident or Occurrence: *
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Cause of Injury [factual description including allegations and defenses on liability]:
*
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Nature of Injury: [please be specific concerning injuries, treatment and medical
testimony]: *
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Plaintiff's Expert Witnesses [include full name, degree, specialty, and city]: *
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Defendant's Expert Witnesses [include full name, degree, specialty, and city]: *
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Check Appropriate Box:*
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Verdict
Settlement
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Date of Verdict or Settlement *
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Verdict or Settlement Amount [please provide components of itemized verdict/settlement]:*
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Comparative Negligence [if applicable]:*
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Judgment Amount:*
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Date of Judgment:*
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Defendant's Offer:*
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Plaintiff's Demand:*
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Attorney's Comments:*
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Submitted By:*
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Date:*
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Firm:*
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Address:*
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Phone:*
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Fax:*
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Email:*
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| Type the text from the image above:*
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