B45.03.A2 Verdict Form A--Single Plaintiff and Claimed Multiple Tortfeasors--No Comparative Negligence--Verdict for Plaintiff Against Some But Not All Defendants VERDICT FORM A We, the jury, find for [name of plaintiff] and against the following defendant or defendants: [Name of defendant 1] [Name of defendant 2] [Name of defendant 3] We further find the following: First: We find that the total amount of damages suffered by [name of plaintiff] as a proximate result of the occurrence in question is $____________, itemized as follows: The reasonable expense of past medical and medically related expenses: $____________ [Other damages, insert from IPI 30 series] PLAINTIFF'S TOTAL DAMAGES: $____________ $____________ Yes ______ Yes ______ Yes ______ No ______ No ______ No ______ Second: Assuming that 100% represents the total combined legal responsibility of all [persons] [or] [entities] who [that] proximately caused [name of plaintiff]'s injury, we find the percentage of legal responsibility attributable to each as follows: (a) (b) (c) [Defendant #1 name] [Defendant #2 name] [Defendant #3 name] ___% ___% ___% 100% TOTAL (Instructions to Jury: If you find that any other party listed on the verdict form was not legally responsible in a way that proximately caused plaintiff's injury, you should enter a zero (0)% as to that party.) ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ Verdict Form revised January 2010.