Illinois > Local County > Dupage > General
Settlement Conference Memorandum - Illinois
| Settlement Conference Memorandum Form. This is a Illinois form and can be used in General Dupage Local County . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT DU PAGE COUNTY, ILLINOIS SETTLEMENT CONFERENCE MEMORANDUM ) ) ) ) ) vs. No. Date of Occ.: _______________________ PL Atty.: _______________________ Loc. of Occ.: _______________________ Phone: _______________________ _______________________ DF Atty.: _______________________ DF Atty.: _______________________ #1 Phone: _______________________ #2 Phone: _______________________ PL's Theory of Liability: ________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Damages of Plaintiff (Name): ________________________________________ (Age) ______ Description of Injuries: _________________________________________________________ Plaintiff's Present Complaints, if any: ______________________________________________ Medical Expenses: Dates Names Hospital Emergency Room On_______________ ______________________ Hospital Confinement (_____to_____) ______________________ Treating Doctor (_____to_____) ______________________ Treating Doctor (_____to_____) ______________________ Consulting Doctor (_____to_____) ______________________ Examining Doctor (_____to_____) ______________________ X-Ray Laboratory (_____to_____) ______________________ Physical Therapy (_____to_____) ______________________ Med. Aids (Described) (_____to_____) ______________________ Future medical and lost time, if any: __________________________________ TOTAL Loss of Earnings: From _____to_____ employed at _________________________________ From _____to_____ employed at _________________________________ Permanent Disability, if any: ______________________________________ TOTAL Miscellaneous Damages: _______________________________________________________________ _______________________________________________________________ TOTAL PL Demand: $__________ DF No. 1 Offer: $__________ Charges $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ $________ DF No. 2 Offer: $________ Judge's Recommendation: $__________ Appendix of Civil Forms C American LegalNet, Inc. www.FormsWorkflow.com
|
|||||||
