STATE OF NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE COUNTY OF MECKLENBURG DISTRICT/SUPERIOR COURT DIVISION ___________CVD/CVS_____________ ___________________________________ ) Plaintiff ) ) ADVISORY VERDICT OF JURY UNABLE vs. ) TO REACH UNANIMOUS VERDICT ) ) ____________________________________ ) Defendant ) 1. ISSUE ONE, e.g.; (Was the plaintiff injured or damaged as a result of the negligence of the defendant?) 2. ISSUE TWO, e.g.; (What amounts, if any, is the plaintiff entitled to recover for injuries or damages?) 3. COMMENTS: II-A-3g (8/94) Form CCF-22