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


SETTLEMENT REPORTER

  Please fill out this form below for consideration of inclusion in the
  Jury Verdict settlement publications.

  Pursuant to our regular procedure of reporting interesting and legally
  important settlements in our monthly Settlements By Categories publication,
  we would appreciate your returning this form fully completed for maximum
  interest and usefulness at your earliest convenience. 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:
CASE NUMBER:
COUNTY:
DATE CLOSED:
AMOUNT OF SETTLEMENT: (PRESENT CASH VALUE ONLY)
                         
PLTF.´S AGE: (at time of acdt.)
PLTF.´S SEX:
DATE OF ACCIDENT:
PLACE:
 
SPECIFIC NEGLIGENCE OR PRODUCT:
 
INJURIES/DAMAGE:
SPECIALS: Medicals 
LOST INCOME:
OCCUPATION:
WHAT EACH DEFT. PAID:
 
INSURANCE COMPANY(IES):
 
PLAINTIFF FIRM(S) AND ATTORNEY(S):
 
DEFENSE FIRM(S) AND ATTORNEY(S):
 
COMMENTS:
Signed:
Firm:
Phone:
E-mail address for Internal review & revision:
+ Law Bulletin Publishing Company + 415 North State Street + Chicago, IL 60654 + 312.644.7800
© 2014 by Law Bulletin Publishing Company. Content on this site is protected by the copyright laws of the United States. The copyright laws prohibit any copying, redistributing, or retransmitting of any copyright-protected material. The content is NOT WARRANTED as to quality, accuracy or completeness, but is believed to be accurate at the time of compilation. By using this site you agree to the Terms, Conditions and Disclaimer.