Go to Settlement Reporter Form

COOK COUNTY JURY VERDICT REPORTER
ILLINOIS JURY VERDICT REPORTER
 Division Of Law Bulletin Publishing Company
415 North State Street, Chicago, IL 60654
Phone: (312)644-7800 Fax: (312)644-5990

VERDICT REPORTER
  Please fill out this form below for consideration of inclusion in the
  Jury Verdict Reporter publications.
  To avoid delay in publishing, fill out fully including first names of parties, and
  addresses, phone numbers, and specialty of all experts. When you submit
  your case report to us electronically, you will automatically be sent a
  confirming email. Thank you.

Mandatory Fields are indicated by an *
First *
Middle Initial
Last *
Firm Name
Title
Street Address 1
Address 2
City
State
Zip
Phone *
Fax
Confirmation Email *
Web Address

TITLE OF CASE:  (full name of all parties)
CASE NUMBER:
TRIAL DATES:
JUDGE:
COUNTY:
VERDICT:
GROSS Amount: Less pct. pltf. negligence.
Net Award: 
ITEMIZATION (IF MADE):
SPECIAL INTERROGATORIES:
ANSWERS:
PLTF. LAW FIRM:
Trial atty(s):
PLTF. LAW FIRM:
Trial atty(s):
DEFT. LAW FIRM:
Trial atty(s):
DEFT. LAW FIRM:
Trial atty(s):

INSURANCE COMPANY:
(Also note amount of policy if less than award)
FACTS OF CASE:
Date of occurrence:
Place:
Pltf. direction:
Deft. direction:
What happened:
DEFENSE CONTENDED:
INJURIES/DAMAGE:
MEDICAL WITNESSES: (TREATING PHYSICIANS)
If the space provided is not sufficient for all of the case's medical witnesses, please input the remaining witnesses in either the "Other noteworthy features" or the "Continue on this text area" (or both) text input fields at the bottom of this form.
CALLED BY PLTF.:
CALLED BY DEFT.:
EXPERT WITNESSES:
(INCL. MEDL. EXPERTS, WITH ADDRESSES, PHONE NOS., SPECIALTY)
If the space provided is not sufficient for all of the case's expert witnesses, please input the remaining witnesses in either the "Other noteworthy features" or the "Continue on this text area" (or both) text input fields at the bottom of this form. Please be sure to include for each extra witness the name, specialty, address, phone and for whom they appeared.
For pltf.:
Name Specialty
City State Street Phone
Name Specialty
City State Street Phone
Name Specialty
City State Street Phone
For deft.:
Name Specialty
City State Street Phone
Name Specialty
City State Street Phone
Name Specialty
City State Street Phone
SPECIALS: Doctor bills:  Hospital: 
Lost income: $  for  as a 
                          (amount)     (time)        (occupation)
Property damage:
Other: (specify)
LAST DEMAND:
ASKED OF JURY:
LAST OFFER:
ARBITRATION AWARD:
Pltf.´s age at time of acdt.: Deft.´s age at time:
Pltf.´s sex: Deft.´s sex:
Pltf.´s occupation now:  Deft.´s occupation: 
Other noteworthy features:
Date of report:
Signed:
Continue on this text area if necessary:
E-mail address for Internal review & revision:
+ Law Bulletin Publishing Company + 415 North State Street + Chicago, IL 60654 + 312.644.7800
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