VF-3201. Consequential Damages Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 We answer the questions submitted to us as follows: 1. Was [name of defendant]'s conduct a substantial factor in causing damages to [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. Did the damages result from [name of plaintiff]'s requirements and needs? ____ 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. Did [name of defendant] have reason to know of those requirements and needs at the time of the [sale/lease] 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-3201. Consequential Damages Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 4. Could [name of plaintiff] reasonably have prevented the damages? ____ Yes ____ No If your answer to question 4 is no, then answer question 5. If you answered yes, stop here, answer no further questions, and have the presiding juror sign and date this form. 5. 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 September 2003; Revised December 2010 What is the amount of [name of plaintiff]'s damages? $ Presiding Juror