i ILED lt{ oPEl{ couRT

APR

I 7 2015

cASE No. oz-0858

VERDICT FORM

In determining the amount of damages, do not make any reduction because of the
not
negligence, if an of pluiotiff Angela R. Crowe. The Court has found that Plaintiff was
negligent in any way, and therefore no such reduction should be made.
Please answer questions 1-4.

What is the total amount of Ms. Crowe's damages for loss of earning capacitY?

In the

b.

To be sustained in the future

2.

bfc, 0c')
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$e

What is the total amount of Ms. Crowe's other economic damages, including
medical expenses?

a.

lncurred in the past

$ ltoL

b.

To be incurred in the future

s6

3.

4.

past

Ooo

What is the total amount of Plaintiff Joan Antonuccio's damages for lost income
as a result of her role as legal gUardian and caretaker for Ms. Crowe?

a.

In the past

b.

To be sustained in the future

3soc>o
.t

What is the total amount of Ms. Crowe's noneconomic damages for pain and
suffering, disability, physical impairment, disfigurement, mental anguish,
inconvenience, aggrcvation of a disease or physical defect, and loss of capacity
for the enjoyment of life?

o 000

&.

In the past

b.

To be sustained in the future

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TOTAL
TOTAL DAMAGES OF PLAINTIFFS:
(Add lnes I.a, l.b, 2.a, 2.b, 3.a, 3.b, 4.a, and 4.b)
SO SAY WE

ALL this 17th day of April,zDls.

Foreperson

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