STATE OF ILLINOIS) )SS COUNTY OF WILL ) IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT WILL COUNTY, ILLINOIS _______________________________________ Plaintiff vs CASE NO: ______________________________ _______________________________________ Defendant SUPREME COURT RULE 222 ARBITRATION DISCLOSURE STATEMENT (Instructions: Complete this disclosure statement using all the information available to you at the time you file your initial pleading. Any effort to avoid disclosure of the information required to be disclosed in this statement is a serious violation of the Supreme Court Rule and could result in the trial court imposing sanctions provide for in Rule 219, including but not limited to dismissal of your action, entry of a default judgment against you, barring the testimony of any undisclosed witness or barring the introduction of other evidence, which should have been disclosed but was not. You have an obligation to supplement, update and revise this disclosure statement within 14 days after receipt of a written request from any other party.) 1. Identify and give the factual basis of the claim or defense. In the event of multiple claims or defenses, the factual basis for each claim or defense. _____________________________________________________________________________________ _____________________________________________________________________________________ 2. Identify the legal theory upon which each claim or defense is based including, where necessary for a reasonable understanding of the claim or defense, citations of pertinent legal or case authorities. _____________________________________________________________________________________ _____________________________________________________________________________________ 3. The names, addresses, and telephone numbers of any witnesses whom the disclosing party expects to call at trial with a designation of the subject matter about which each witness might be called to testify. _____________________________________________________________________________________ _____________________________________________________________________________________ 4. The names, addresses, and telephone numbers of all persons whom the party believes may have knowledge or information relevant to the events, transactions, or occurrences athat gave rise to the action, and the nature of the knowledge or information each such individual is believed to possess. _____________________________________________________________________________________ _____________________________________________________________________________________ 5. The names, addresses, and telephone numbers of all persons who have given statements, whether written or recorded, signed or unsigned, and the custodian of the copies of those statements. _____________________________________________________________________________________ ________________________________________________________________________________________ American LegalNet, Inc. www.USCourtForms.com a. Hospital, doctor and other medical bills; ___________________________________________________________________________________ ___________________________________________________________________________________ b. Property damage; ___________________________________________________________________________________ ___________________________________________________________________________________ c. Loss of income, salary and wages; and, ___________________________________________________________________________________ ___________________________________________________________________________________ d. Other; ___________________________________________________________________________________ ___________________________________________________________________________________ 6. The names, addresses, and telephone numbers of each person whom the disclosing party expects to call as an opinion witness at trial, the subject matter on which the opinion is expected to testify, the conclusions and opinions of the opinion witness and the bases therefore, the qualifications of the opinion witness, and copies of any reports prepared by the opinion witness. _____________________________________________________________________________________ _____________________________________________________________________________________ 7. A computation of the measure of damages alleged by the disclosing party and the document or testimony on which such computation and measure are based and the names, addresses, and telephone numbers of all damage witnesses. _____________________________________________________________________________________ _____________________________________________________________________________________ 8. The existence, location, custodian, and general description of any tangible evidence or documents that the disclosing party plans to use at trial and relevant insurance agreements. _____________________________________________________________________________________ _____________________________________________________________________________________ 9. A list of the documents or, in the case of voluminous documentary information, a list of the categories of documents, known by a party to exist whether or not in the party’s possession, custody or control and which that party believes may be relevant to the subject matter of the action, and those which appear reasonable calculated to lead to the discovery of admissible evidence, and the date(s) upon which those documents will made, or have been made, available for inspection and copying. Unless good cause is stated for not doing so, a copy of each document listed shall be served with the disclosure. If production is not made, the name and address of the custodian of the document shall be indicated. A party who produced documents for inspection shall produce them as they are kept in the usual course of business. PAMELA J. MCGUIRE, CLERK OF THE CIRCUIT COURT OF WILL COUNTY AR 2 (Revised 07/05) American LegalNet, Inc. www.USCourtForms.com