VF-3010. Excessive Use of Force--Unreasonable Arrest or Other Seizure (42 U.S.C. § 1983) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 We answer the questions submitted to us as follows: 1. Did [name of defendant] use excessive force in [arresting/detaining] [name of plaintiff]? ____ Yes ____ No If your answer to question 1 is yes, then answer question 2. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 2. Was [name of defendant] acting or purporting to act in the performance of [his/her] official duties? ____ Yes ____ No If your answer to question 2 is yes, then answer question 3. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 3. Was [name of defendant]'s use of excessive force a substantial factor in causing harm to [name of plaintiff]? ____ Yes ____ No If your answer to question 3 is yes, then answer question 4. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. VF-3010. Excessive Use of Force--Unreasonable Arrest or Other Seizure (42 U.S.C. § 1983) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 4. What are [name of plaintiff]'s damages? [a. Past economic loss [lost earnings [lost profits [medical expenses [other past economic loss Total Past Economic Damages: [b. Future economic loss [lost earnings [lost profits [medical expenses [other future economic loss $ $ $ $ ] ] ] ] ] ] $ $ $ $ $ ] ] ] ] ] Total Future Economic Damages: $ [c. Past noneconomic loss, including [physical pain/mental suffering:] $ [d. Future noneconomic loss, including [physical VF-3010. Excessive Use of Force--Unreasonable Arrest or Other Seizure (42 U.S.C. § 1983) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 pain/mental suffering:] TOTAL Signed: Dated: $ $ ] Presiding Juror After [this verdict form has/all verdict forms have] been signed, notify the [clerk/bailiff/court attendant] that you are ready to present your verdict in the courtroom. _____________________________________________________________________________ New September 2003; Revised April 2007, December 2010; Renumbered from CACI No. VF-3001 December 2012; Revised December 2016