2(b). Model Form of Verdict for Wrongful Death Damages [These or similar damage questions should appear in the verdict form after findings on liability issues.] [In determining the amount of damages, do not make any reduction because of the negligence, if any, of (name). If you find that (name) was to any extent negligent, the court in entering judgment will make an appropriate reduction in the damages awarded.] Please answer question[s] [*]. Damages of the Estate [*]. What is the total amount of any damages lost by the estate for [any earnings of the decedent lost from the date of injury to the death not including any amount of support lost by a survivor in that period] [,] [the amount of any medical or funeral expenses resulting from (decedent)'s injury and death charged to the estate or paid by someone other than a survivor] [,] [and] [loss of net accumulations] [,] [(list other damages sustained by estate)]? Damages of (surviving spouse) [a*]. What is amount of any damages sustained by (surviving spouse) for the [loss of the (decedent)'s support] [and] [services] [, and] [medical or funeral expenses resulting from (decedent)'s injury and death paid by (surviving spouse)]? [b*]. What is the total amount of damage sustained by (surviving spouse) for the loss of [his wife's] [her husband's] companionship and protection and for [his] [her] pain and suffering as a result of (decedent)'s injury and death? Total Damages of (surviving spouse) (add lines [a*] and [b*]) Damages of (surviving child) [a*]. What is amount of any damages sustained by (surviving child) for the [loss of (decedent)'s support] [and] [services] [, and] [medical or funeral expenses resulting from (decedent)'s death paid by (surviving child)]? [b*]. What is the total amount of damage sustained by (surviving child) for the loss of parental companionship, instruction and guidance and (surviving child)'s pain and suffering as a result of (decedent)'s injury and death? Total Damages of (surviving child) (add lines [a*] and [b*]) $ $ $ $ $ $ $ Damages of (surviving mother) [*]. What is amount of damages sustained by (surviving mother) for her [pain and suffering as a result of the injury and death of (minor child)] [and] [medical or funeral expenses resulting from (decedent)'s injury and death paid by (surviving mother)]? Total Damages of (surviving mother) Damages of (surviving father) [*]. What is amount of damages sustained by (surviving father) for his [pain and suffering as a result of the injury and death of (minor child)] [and] [medical or funeral expenses resulting from (decedent)'s injury and death paid by (surviving father)]? Total Damages of (surviving father) $ $ *Insert appropriate numbers.