Northern District Of Illinois
Local Rules
LR16.1.2. Form of Pretrial Memorandum for Use in Personal Injury Cases
IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ILLINOIS
[indicate Eastern or Western] DIVISION
Plaintiff, v. Defendant. |
Civil Action No. Judge [Insert name of assigned judge] |
PRETRIAL MEMORANDUM
Plaintiff's Name: ________________________
Age: ________________________
Occupation: ________________________
Marital status: ________________________
Attorney for plaintiff [indicate name and phone number of trial attorney]:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Attorney for defendant [indicate name and phone number of trial attorney]:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Summary of injuries [note especially any permanent pathology]:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Date, hour, and place of occurrence:
______________________________________________________________________________
Attending physicians:
______________________________________________________________________________
Hospitals:
______________________________________________________________________________
Place of employment:
______________________________________________________________________________
______________________________________________________________________________
Part A. Compensatory Damages [Parts A & B are to be completed by plaintiffs counsel.]
(a) Medical fees $_____________
(b) Hospital bills $_____________
(c) Loss of income $_____________
(d) Miscellaneous expenses $_____________
TOTAL $_____________
damages claimed in this action? $_____________
Part B. Punitive Damages
a. Does the plaintiff claim punitive damages?
Yes ? No ? If yes, how much? $_____________
Brief Statement of Circumstances of Occurrence:
Plaintiffs view:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Defendants view:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
[At the direction of the court the parties are to attach to this memorandum any medical reports or other materials useful for discussion at the pretrial conference.]