Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_05-cv-01171/USCOURTS-cand-3_05-cv-01171-5/pdf.json

Nature of Suit Code: 110
Nature of Suit: Insurance
Cause of Action: 28:1332 Diversity-Insurance Contract

---

U

nite

d

States District C

o

u

rt

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

U

nite

d

States District C

o

u

rt

For the Northern District of California

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

SPENCER STECZ,

Plaintiff,

 v.

STATE FARM MUTUAL AUTOMOBILE

INSURANCE COMPANY,

Defendant.

 /

No. C 05-01171 CRB

VERDICT FORM

We, the jury in the above-entitled case, find the following:

1. Did defendant prove its false statement affirmative defense?

Answer “Yes” or “No.”

Answer: YES ____, NO _____

2. Did defendant prove its concealment of information affirmative defense?

Answer “Yes” or “No.”

Answer: YES ____, NO _____

If your answer to questions 1 or 2 is “Yes,” please stop here. If you answer to questions 1

and 2 is “No,” please continue to question 3.

Case 3:05-cv-01171-CRB Document 63 Filed 10/03/06 Page 1 of 2
U

nite

d

States District C

o

u

rt

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

G:\CRBALL\2005\1171\verdictform2.wpd 2

3. What are the loss of use damages, if any, suffered by plaintiff as a result of

defendant’s breach of the insurance contract?

$_______________

Dated: 

 

JURY FOREPERSON

Case 3:05-cv-01171-CRB Document 63 Filed 10/03/06 Page 2 of 2