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.
We will, of course, be glad to send you our full-size, self-mailing
form
for reporting your cases, upon request. You can request for a form
by calling our office at 1.877.FLA.JURY (1.877.352.5879) or by email
at info@floridalegalperiodicals.com
| County
and Court: |
|
Name
of Case
[Please use complete style]: |
|
| Case/Docket Number: |
|
| Judge: |
|
| Plaintiff(s) Attorney(s)/Trial Counsel [Please include
full names, firm and city]: |
|
| Defendant(s) Attorney(s)/Trial Counsel [Please include
full names, firm and city]: |
|
| Age, Sex
and Occupation of Plaintiff or Defendant [at time of accident or
occurrence]: |
|
| For Wrongful Death cases, please give age and relationship
of survivors: |
|
| Date, Time and Place of Accident or Occurrence: |
|
| Cause of Injury [factual description including allegations
and defenses on liability]: |
|
| Nature of Injury: [please be specific concerning injuries,
treatment and medical testimony]: |
|
| Plaintiff's Expert Witnesses [include full name, degree,
specialty, and city]: |
|
| Defendant's Expert Witnesses [include full name, degree,
specialty, and city]: |
|
| Check Appropriate Box: |
Verdict
Settlement |
| Date of Verdict or Settlement |
|
| Verdict or Settlement Amount [please provide components
of itemized verdict/settlement]: |
|
| Comparative Negligence [if applicable]: |
|
| Judgment Amount: |
|
| Date of Judgment: |
|
| Defendant's Offer: |
|
| Plaintiff's Demand: |
|
| Attorney's Comments: |
|
| Submitted By: |
|
| Date: |
|
| Firm: |
|
| Address: |
|
| Phone: |
|
| Fax: |
|
| Email: |
|
|
|
|