45.04.B Wrongful Death Act--Survival Act--Verdict Form B--Contributory Fault of Decedent Only We, the jury, find for the estate of [name of decedent], deceased, and against the following defendants: [name of defendant 1] Defendant 1 [name of defendant 2] Defendant 2 We further find the following: First: We find that the total amount of damages suffered by the Estate of [name of decedent], deceased, is $_____________, itemized as follows: [Loss of money, goods and services]: [Grief, sorrow and mental suffering]: [Loss of society] and [loss of sexual relations]: [Other damages: insert from 30.04, 30.04.01, 30.05, 30.05.01, 30.06, 30.07, 30.09 or as applicable] PLAINTIFF'S TOTAL DAMAGES $_____________ $_____________ $_____________ $_____________ $_____________ Yes ___ Yes ___ No ___ No ___ Second: Assuming that 100% represents the total combined [negligence] [fault] [responsibility] of all [persons] [or entities] whose [negligence] [fault] [responsibility] proximately caused the death of [name of decedent], we find the percentage of [negligence] [fault] [responsibility] attributable to each as follows: (a) (b) (c) [Name of decedent] decedent [Name of defendant 1] Defendant 1 [Name of defendant 2] Defendant 2 _____% _____% _____% Third: After reducing the plaintiff's total damages from paragraph "First" by the percentage of [negligence] [[other damage reducing defense]] if any, of [name of decedent] from line (a) in paragraph "Second," we award [name of plaintiff] recoverable damages in the amount of $_____________. _________________________________ Foreperson _________________________________ __________________________________ __________________________________ _________________________________ _________________________________ _________________________________ _________________________________ __________________________________ __________________________________ __________________________________ __________________________________