PRETRIAL MEMO JD-ES-47 Rev. 10-08 P.B. §§ 14-13, 14-14 www.jud.ct.gov INSTRUCTIONS Each party claiming damages or that party's attorney shall complete Part I below and at the commencement of the pretrial session give a copy to the judge or judge trial referee and to each other party. Attach additional sheets if necessary. NOTICE: This memo is intended for pretrial purposes only and shall not be construed as an admission against any party. COURT USE ONLY PRETMEM DOCKET NUMBER DATE PART I (To be completed by attorney/pro se party) PLAINTIFF PLAINTIFF'S TRIAL COUNSEL INTERVENING TRIAL COUNSEL RETURN DATE PHONE NO. PHONE NO. DEFENDANT #1 DEFENDANT #2 DEFENDANT #3 TYPE OF CLAIM DOES YOUR CLIENT HAVE ANY OBJECTION TO A REFERRAL TO NON-BINDING A.D.R.? DEFENDANT'S TRIAL COUNSEL DEFENDANT'S TRIAL COUNSEL DEFENDANT'S TRIAL COUNSEL PHONE NO. PHONE NO. PHONE NO. TRIAL DATE DATE CERT. OF CLOSED PLEADINGS FILED HAVE YOU DISCUSSED APPROPRIATE A.D.R. WITH YOUR CLIENT? YES NO YES NO DATE AND TIME OF ACCIDENT (if applicable) CLAIM (e.g. Accident) INTERVENOR'S CLAIM NATURE OF DAMAGES OR DEMAND DAMAGES OR DEMAND (e.g. Injuries) IF APPLICABLE LAST MEDICAL EXAM PERMANENCY OF INJURIES/LIFE EXPECTANCY AGE OF PARTY REASON 1. Doctor(s) COST EXPLANATION 2. Hospital(s) 3. Subtotal (Add 1 & 2) 4. Future Medical LOST WAGES SPECIALS 5. Wages FUTURE CAPACITY 6. OTHER (Prop. Dam., etc.) 7. TOTAL Copies of all medical bills and reports have been furnished to the Defendant(s) (Page 1 of 2) YES NO American LegalNet, Inc. www.FormsWorkFlow.com CLAIMS OF LAW (Include all anticipated evidentiary and procedural problems) IS DISCOVERY COMPLETE? NAME OF PREPARER YES NO, IF NO, EXPLAIN: TELEPHONE NO. ATTORNEY FOR (Name of party represented) PART II (To be completed by judge or judge trial referee) COMP. NEGLIG. LIABILITY % DEMAND OFFER COURT VALUE EST. LENGTH OF TRIAL GOOD FAIR POOR CHANCE OF SETTLEMENT GOOD FAIR POOR JURY SELECTION STATUS OF PLEADINGS EVIDENCE PLAINTIFF TO REPORT TO JUDGE OR JUDGE TRIAL REFEREE BY: DEFENDANT TO REPORT TO JUDGE OR JUDGE TRIAL REFEREE BY: TRIAL DATE (if applicable): PLEADINGS AND EXHIBITS EXHIBITS STIPULATED UPON OTHER COMMENTS - DEFENDANT'S CLAIMS OF LAW, ETC. RESULTS OF PRETRIAL SETTLED STIPULATED JUDGMENT W/DRAWN NONSUIT/DEFAULT PURSUANT TO P.B. 14-3 CONTINUED TO SPECIFY DATE OR NO. OF WEEKS OTHER: SIGNED (Judge/Judge Trial Referee) _____________________________________ JD-ES-47 (back/page 2) Rev. 10-07 DATE _______________________ American LegalNet, Inc. www.FormsWorkFlow.com (Page 2 of 2)