Free CCL-0056 - Illinois

3400 PRE-TRIAL MEMORANDUM

(Rev. 12/4/01) CCL 0056 A

IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS

PRE-TRIAL MEMORANDUM
(Completed Memorandum must be served on all defendants and filed with Court 30 days before Pre-Trial date)

________________________________________ (1) ________________________________________ (2)
v.

________________________________________ (1) ________________________________________ (2)
Pltf. Atty. (Trial) _____________________________ (Firm) _____________________________ (Address) ___________________________ (Phone) ____________________________ (Atty. No.) _______________ Def. Atty. (Trial) _____________________________ (No. 1) (Firm) _____________________________ (Address) _________________________________ (Phone) __________________________________ (Atty. No.) _______________ Repr. ______________________________ Occurrence Allegations (Ins. Co)

) ) ) ) ) ) ) ) )

No. ___________________________________

Initial Pretrial Date: __________________

Date of Occ.: ___________________________ Loc. of Occ.: ___________________________

____________________________
Time of Occ.: ____________________________

Def. Atty. (Trial) _________________________ (No. 2) (Firm) ___________________________ (Address) _______________________________ (Phone) ________________________________ (Atty. No.) _______________ Repr. __________________________ (Ins. Co.)

Pltf. No. 1 Conduct: ________________________________________________________________ Pltf. No. 2 Conduct: ________________________________________________________________ Def. No. 1 Conduct: ________________________________________________________________ Def. No. 2 Conduct: ________________________________________________________________ Pltf.'s Theory of Liability ____________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ (OVER) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS

PRE-TRIAL MEMORANDUM

(Rev. 12/4/01) CCL 0056 B

A SEPARATE MEMORANDUM MUST BE PREPARED FOR EACH PLAINTIFF Damages of Plaintiff _________________________________________ Case Number _________________ (Name) Description of Injuries: __________________________________________________________________

_______________________________________________________________________________________________
MEDICAL EXPENSES: Dates Names Charges

Hospital Emergency Room ( __________________ ) Hospital Confinement ( ________ to _________ ) Treating Doctor Treating Doctor Consulting Doctor Examining Doctor X-Ray Laboratory Physical Therapy ( ________ to _________ ) ( ________ to _________ ) ( ____________________) ( ____________________) ( ____________________) ( ____________________)

_____________________________ $ ___________ _____________________________ _____________________________ _____________________________ _____________________________ ______________________________ _____________________________ _____________________________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________

Medical Aids (Describe): ______________________________________________________________ LOSS OF EARNINGS:

TOTAL $ ___________

From _____________ to ____________ employed at _____________________________ $ ___________ From _____________ to ____________ employed at _____________________________

___________

TOTAL $ ___________ PROPERTY DAMAGE: (Year: ________ Make ________________ Model _____________ ) (Repaired) (Estimated) by ____________________________________________ at cost of $ ___________ (Auto Rental) (Towing) (Deductible Collision Payment) ______________________________

___________

TOTAL $ ___________ OTHER CLAIMED DAMAGES: Describe: _______________________________________________________________ $ ___________ Pltf. Demand $ __________________ Def. No. 1 Offer ______________ Def. No. 2 Offer ___________

DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS