VF-4200. Actual Intent to Hinder, Delay or Defraud Creditor--Affirmative Defense--Good Faith Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 We answer the questions submitted to us as follows: 1.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 plaintiff] have a right to payment from [name of debtor]? ____ 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 [name of debtor] [transfer property/incur an obligation] to [name of defendant]? ____ 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 debtor] [transfer the property/incur the obligation] with the intent to hinder, delay or defraud one or more of [his/her/its] creditors? ____ 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. 4. Was [name of debtor]'s conduct a substantial factor in causing [name of VF-4200. Actual Intent to Hinder, Delay or Defraud Creditor--Affirmative Defense--Good Faith Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 plaintiff]'s harm? ____ Yes ____ No If your answer to question 4 is yes, then answer question 5. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 5. Did [[name of defendant]/[name of third party]] receive the property from [name of debtor] in good faith? ____ Yes ____ No If your answer to question 5 is yes, then answer question 6. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 6. Did [[name of defendant]/[name of third party]] receive the property from [name of debtor] for a reasonably equivalent value? If your answer to question 6 is yes, stop here, answer no further questions, and have the presiding juror sign and date this form. If you answered no, then answer question 7. 7. What are [name of plaintiff]'s damages? TOTAL $ VF-4200. Actual Intent to Hinder, Delay or Defraud Creditor--Affirmative Defense--Good Faith 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 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 December 2011; Revised June 2016, December 2016