VF-3906. Damages for Wrongful Death (Parents' Recovery for Death of a Minor Child) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 We answer the questions submitted to us as follows: 1. What are [name of plaintiff]'s economic damages? [a. [b. [c. Past financial support that [name of decedent] would have contributed to the family: $ ] ] Future financial support that [name of decedent] would have contributed to the family: $ Past losses of gifts or benefits that [name of plaintiff] would have expected to receive from [name of decedent]: Future losses of gifts or benefits that [name of plaintiff] would have expected to receive from [name of decedent]: [Name of decedent]'s funeral and burial expenses: Past household services that [name of decedent] would have provided: Future household services that [name of decedent] would have provided: $ ] [d. $ $ $ $ ] ] ] ] [e. [f. [g. 2. What are [name of plaintiff]'s noneconomic damages? VF-3906. Damages for Wrongful Death (Parents' Recovery for Death of a Minor Child) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 [a. The loss of [name of decedent]'s love, companionship, comfort, care, assistance, protection, affection, society, and moral support from [insert date of death] to the present: $ The loss of [name of decedent]'s love, companionship, comfort, care, assistance, protection, affection, society, and moral support from today forward: $ Presiding Juror ] [b. ] Signed: Dated: 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 April 200; Revised December 2010, December 2016