3400 PRE-TRIAL MEMORANDUM (Rev. 12/4/01) CCL 0056 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS PRE-TRIAL MEMORANDUM (Completed Memorandum must be served on all defendants and filed with Court 30 days before Pre-Trial date) ________________________________________ (1) ________________________________________ (2) v. ________________________________________ (1) ________________________________________ (2) Pltf. Atty. (Trial) _____________________________ (Firm) _____________________________ (Address) ___________________________ (Phone) ____________________________ (Atty. No.) _______________ Def. Atty. (Trial) _____________________________ (No. 1) (Firm) _____________________________ (Address) _________________________________ (Phone) __________________________________ (Atty. No.) _______________ Repr. ______________________________ Occurrence Allegations (Ins. Co) ) ) ) ) ) ) ) ) ) No. ___________________________________ Initial Pretrial Date: __________________ Date of Occ.: ___________________________ Loc. of Occ.: ___________________________ ____________________________ Time of Occ.: ____________________________ Def. Atty. (Trial) _________________________ (No. 2) (Firm) ___________________________ (Address) _______________________________ (Phone) ________________________________ (Atty. No.) _______________ Repr. __________________________ (Ins. Co.) Pltf. No. 1 Conduct: ________________________________________________________________ Pltf. No. 2 Conduct: ________________________________________________________________ Def. No. 1 Conduct: ________________________________________________________________ Def. No. 2 Conduct: ________________________________________________________________ Pltf.'s Theory of Liability ____________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ (OVER) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS PRE-TRIAL MEMORANDUM (Rev. 12/4/01) CCL 0056 B A SEPARATE MEMORANDUM MUST BE PREPARED FOR EACH PLAINTIFF Damages of Plaintiff _________________________________________ Case Number _________________ (Name) Description of Injuries: __________________________________________________________________ _______________________________________________________________________________________________ MEDICAL EXPENSES: Dates Names Charges Hospital Emergency Room ( __________________ ) Hospital Confinement ( ________ to _________ ) Treating Doctor Treating Doctor Consulting Doctor Examining Doctor X-Ray Laboratory Physical Therapy ( ________ to _________ ) ( ________ to _________ ) ( ____________________) ( ____________________) ( ____________________) ( ____________________) _____________________________ $ ___________ _____________________________ _____________________________ _____________________________ _____________________________ ______________________________ _____________________________ _____________________________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ Medical Aids (Describe): ______________________________________________________________ LOSS OF EARNINGS: TOTAL $ ___________ From _____________ to ____________ employed at _____________________________ $ ___________ From _____________ to ____________ employed at _____________________________ ___________ TOTAL $ ___________ PROPERTY DAMAGE: (Year: ________ Make ________________ Model _____________ ) (Repaired) (Estimated) by ____________________________________________ at cost of $ ___________ (Auto Rental) (Towing) (Deductible Collision Payment) ______________________________ ___________ TOTAL $ ___________ OTHER CLAIMED DAMAGES: Describe: _______________________________________________________________ $ ___________ Pltf. Demand $ __________________ Def. No. 1 Offer ______________ Def. No. 2 Offer ___________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Print This Form For your protection and privacy, please press the Clear This Form button after you have printed the form. Clear This Form