VER DISTRICT COURT CLARK COUNTY, NEVADA v. ) ) Plaintiff, ) ) ) ) ) Defendants. ) ____________________________________) CASE NO. DEPT NO. A STP VERDICT FORM – SHORT JURY TRIAL We, the jury in the above entitled action, find for the Defendant and against the Plaintiff; or Plaintiff and against the Defendant and assess the total amount of the Plaintiff’s damages as follows: Medical bills…………………………. . Past pain and suffering………………. $ . Future pain and suffering……………. $ . TOTAL……………………………... DATED this $ $ . day of , 2005. By FOREPERSON STP FORM 11 (1 of 1) American LegalNet, Inc. www.USCourtForms.com