Opinion ID: 1702522
Heading Depth: 1
Heading Rank: 62

Heading: standard interrogatories forms

Text: FORM 1. GENERAL PERSONAL INJURY NEGLIGENCE  INTERROGATORIES TO PLAINTIFF (If answering for another person or entity, answer with respect to that person or entity, unless otherwise stated.) 1. What is the name and address of the person answering these interrogatories, and, if applicable, the person's official position or relationship with the party to whom the interrogatories are directed? 2. List the names, business addresses, dates of employment, and rates of pay regarding all employers, including self-employment, for whom you have worked in the past ten 10 years. 3. List all former names and when you were known by those names. State all addresses where you have lived for the past ten 10 years, the dates you lived at each address, your sSocial sSecurity number, your date of birth, and, if you are or have ever been married, the name of your spouse or spouses. 4. Do you wear glasses, contact lenses, or hearing aids? If so, who prescribed them;, when were they prescribed;, when were your eyes or ears last examined;, and what is the name and address of the examiner? 5. Have you ever been convicted of a crime, other than any juvenile adjudication, which under the law under which you were convicted was punishable by death or imprisonment in excess of one 1 year, or that involved dishonesty or a false statement regardless of the punishment? If so, state as to each conviction, the specific crime, and the date and the place of conviction. 6. Were you suffering from physical infirmity, disability, or sickness at the time of the incident described in the complaint? If so, what was the nature of the infirmity, disability, or sickness? 7. Did you consume any alcoholic beverages or take any drugs or medications within twelve 12 hours before the time of the incident described in the complaint? If so, state the type and amount of alcoholic beverages, drugs, or medication which were consumed, and when and where you consumed them. 8. Describe in detail how the incident described in the complaint happened, including all actions taken by you to prevent the incident. 9. Describe in detail each act or omission on the part of any party to this lawsuit that you contend constituted negligence that was a contributing legal cause of the incident in question. 10. Were you charged with any violation of law (including any regulations or ordinances) arising out of the incident described in the complaint? If so, what was the nature of the charge; what plea, or answer, if any, did you enter to the charge; what court or agency heard the charge; was any written report prepared by anyone regarding this charge, and, if so, what is the name and address of the person or entity that prepared the report; do you have a copy of the report; and was the testimony at any trial, hearing, or other proceeding on the charge recorded in any manner, and, if so, what was is the name and address of the person who recorded the testimony? 11. Describe each injury for which you are claiming damages in this case, specifying the part of your body that was injured, the nature of the injury, and, as to any injuries you contend are permanent, the effects on you that you claim are permanent. 12. List each item of expense or damage, other than loss of income or earning capacity, that you claim to have incurred as a result of the incident described in the complaint, giving for each item the date incurred, the name and business address of the person or entity to whom each was paid or is owed, and the goods or services for which each was incurred. 13. Do you contend that you have lost any income, benefits, or earning capacity in the past or future as a result of the incident described in the complaint? If so, state the nature of the income, benefits, or earning capacity, and the amount and the method that you used in computing the amount. 14. Has anything been paid or is anything payable from any third party for the damages listed in your answers to these interrogatories? If so, state the amounts paid or payable, the name and business address of the person or entity who paid or owes said amounts, and which of those third parties have or claim a right of subrogation. 15. List the names and business addresses of each physician who has treated or examined you, and each medical facility where you have received any treatment or examination for the injuries for which you seek damages in this case; and state as to each the date of treatment or examination and the injury or condition for which you were examined or treated. 16. List the names and business addresses of all other physicians, medical facilities, or other health care providers by whom or at which you have been examined or treated in the past ten 10 years; and state as to each the dates of examination or treatment and the condition or injury for which you were examined or treated. 17. List the names and addresses of all persons who are believed or known by you, your agents, or your attorneys to have any knowledge concerning any of the issues in this lawsuit; and specify the subject matter about which the witness has knowledge. 18. Have you heard or do you know about any statement or remark made by or on behalf of any party to this lawsuit, other than yourself, concerning any issue in this lawsuit? If so, state the name and address of each person who made the statement or statements, the name and address of each person who heard it, and the date, time, place, and substance of each statement. 19. State the name and address of every person known to you, your agents, or your attorneys, who has knowledge about, or possession, custody, or control of, any model, plat, map, drawing, motion picture, video tape videotape, or photograph pertaining to any fact or issue involved in this controversy; and describe as to each, what item such person has, the name and address of the person who took or prepared it, and the date it was taken or prepared. 20. Do you intend to call any expert witnesses at the trial of this case? If so, state as to each such witness the name and business address of the witness, the witness's qualifications as an expert, the subject matter upon which the witness is expected to testify, the substance of the facts and opinions to which the witness is expected to testify, and a summary of the grounds for each opinion. 21. Have you made an agreement with anyone that would limit that party's liability to anyone for any of the damages sued upon in this case? If so, state the terms of the agreement and the parties to it. 22. Please state if you have ever been a party, either plaintiff or defendant, in a lawsuit other than the present matter, and, if so, state whether you were plaintiff or defendant, the nature of the action, and the date and court in which such suit was filed. FORM 2. GENERAL PERSONAL INJURY NEGLIGENCE  INTERROGATORIES TO DEFENDANT (If answering for another person or entity, answer with respect to that person or entity, unless otherwise stated.) 1. What is the name and address of the person answering these interrogatories, and, if applicable, the person's official position or relationship with the party to whom the interrogatories are directed? 2. List all former names and when you were known by those names. State all addresses where you have lived for the past ten 10 years, the dates you lived at each address, your sSocial sSecurity number, and your date of birth. 3. Have you ever been convicted of a crime, other than any juvenile adjudication, which under the law under which you were convicted was punishable by death or imprisonment in excess of one 1 year, or that involved dishonesty or a false statement regardless of the punishment? If so, state as to each conviction, the specific crime, and the date and the place of conviction. 4. Describe any and all policies of insurance which you contend cover or may cover you for the allegations set forth in plaintiff's complaint, detailing as to such policies: the name of the insurer, the number of the policy, the effective dates of the policy, the available limits of liability, and the name and address of the custodian of the policy. 5. Describe in detail how the incident described in the complaint happened, including all actions taken by you to prevent the incident. 6. Describe in detail each act or omission on the part of any party to this lawsuit that you contend constituted negligence that was a contributing legal cause of the incident in question. 7. State the facts upon which you rely for each affirmative defense in your answer. 8. Do you contend any person or entity other than you is, or may be, liable in whole or part for the claims asserted against you in this lawsuit? If so, state the full name and address of each such person or entity, the legal basis for your contention, the facts or evidence upon which your contention is based, and whether or not you have notified each such person or entity of your contention. 9. Were you charged with any violation of law (including any regulations or ordinances) arising out of the incident described in the complaint? If so, what was the nature of the charge; what plea, or answer, if any, did you enter to the charge; what court or agency heard the charge; was any written report prepared by anyone regarding the charge, and, if so, what is the name and address of the person or entity who prepared the report; do you have a copy of the report; and was the testimony at any trial, hearing, or other proceeding on the charge recorded in any manner, and, if so, what was is the name and address of the person who recorded the testimony? 10. List the names and addresses of all persons who are believed or known by you, your agents, or your attorneys to have any knowledge concerning any of the issues in this lawsuit; and specify the subject matter about which the witness has knowledge. 11. Have you heard or do you know about any statement or remark made by or on behalf of any party to this lawsuit, other than yourself, concerning any issue in this lawsuit? If so, state the name and address of each person who made the statement or statements, the name and address of each person who heard it, and the date, time, place, and substance of each statement. 12. State the name and address of every person known to you, your agents, or your attorneys who has knowledge about, or possession, custody, or control of, any model, plat, map, drawing, motion picture, video tape videotape, or photograph pertaining to any fact or issue involved in this controversy; and describe as to each, what item such person has, the name and address of the person who took or prepared it, and the date it was taken or prepared. 13. Do you intend to call any expert witnesses at the trial of this case? If so, state as to each such witness the name and business address of the witness, the witness's qualifications as an expert, the subject matter upon which the witness is expected to testify, the substance of the facts and opinions to which the witness is expected to testify, and a summary of the grounds for each opinion. 14. Have you made an agreement with anyone that would limit that party's liability to anyone for any of the damages sued upon in this case? If so, state the terms of the agreement and the parties to it. 15. Please state if you have ever been a party, either plaintiff or defendant, in a lawsuit other than the present matter, and, if so, state whether you were plaintiff or defendant, the nature of the action, and the date and court in which such suit was filed. FORM 3. MEDICAL MALPRACTICE  INTERROGATORIES TO PLAINTIFF (These interrogatories should be used in conjunction with the General Personal Injury Negligence Interrogatories to Plaintiff.) 23. Do you contend that you have experienced any injury or illness as a result of any negligence of this defendant? If so, state the date that each such injury occurred, a description of how the injury was caused, and the exact nature of each such injury. 24. What condition, symptom, or illness caused you to obtain medical care and treatment from this defendant? 25. Do you claim this defendant neglected to inform or instruct or warn you of any risk relating to your condition, care, or treatment? If so, state of what, in your opinion, the defendant failed to inform, instruct, or warn you. 26. If you contend that you were not properly informed by this defendant regarding the risk of the treatment or the procedure performed, state what alternative treatment or procedure, if any, you would have undergone had you been properly informed. 27. State the date and place and a description of each complaint for which you contend the defendant refused to attend or treat you. 28. State the date you became aware of the injuries sued on in this action, and describe in detail the circumstances under which you became aware of each such injury; state the date you became aware that the injuries sued on in this action were caused or may have been caused by medical negligence; and describe in detail the circumstances under which you became aware of the cause of said injuries. 29. State the name and address of every person or organization to whom you have given notice of the occurrence sued on in this case because you, your agents, or your attorneys believe that person or organization may be liable in whole or in part to you. FORM 4. MEDICAL MALPRACTICE  INTERROGATORIES TO DEFENDANT (These interrogatories should be used in conjunction with the General Personal Injury Negligence Interrogatories to Defendant.) NOTE: When the word Plaintiff is mentioned, these interrogatories are directed to be answered regarding (name of plaintiff/patient). 16. Please give us your entire educational background, starting with your college education and chronologically indicating by date and place each school, college, course of study, title of seminars, length of study, and honors received by you up to the present time, including internships, residencies, degrees received, licenses earned or revoked, medical specialty training, board memberships, authorship of any books, articles, or texts, including the names of those writings and their location in medical journals, awards or honors received, and continuing medical education. 17. Please give us your entire professional background up to the present time, including dates of employment or association, the names of all physicians with whom you have practiced, the form of employment or business relationship such as whether by partnership, corporation, or sole proprietorship, and the dates of the relationships, including hospital staff privileges and positions, and teaching experience. 18. With respect to your office library or usual place of work, give us the name, author, name of publisher, and date of publication of every medical book or article, journal, or medical text, to which you had access, which deals with the overall subject matter described in paragraph ([whatever paragraph number that concerns negligence)] of the complaint. (In lieu of answering this interrogatory you may allow plaintiff's counsel to inspect your library at a reasonable time.) 19. If you believe there was any risk to the treatment you rendered to the plaintiff, state the nature of all risks, including whether the risks were communicated to the plaintiff; when, where, and in what manner they were communicated; and whether any of the risks in fact occurred. 20. Tell us your experience in giving the kind of treatment or examination that you rendered to the plaintiff before it was given to the plaintiff, giving us such information as the approximate number of times you have given similar treatment or examinations, where the prior treatment or examinations took place, and the successful or unsuccessful nature of the outcome of that treatment or those examinations. 21. Please identify, with sufficient particularity to formulate the basis of a request to produce, all medical records of any kind of which you are aware which deal with the medical treatment or examinations furnished to the plaintiff at any time, whether by you or another person or persons. 22. Please state whether any claim for medical malpractice has ever been made against you alleging facts relating to the same or similar subject matter as this lawsuit, and, if so, state as to each such claim the names of the parties, the claim number, the date of the alleged incident, the ultimate disposition of the claim, and the name of your attorney, if any. FORM 5. AUTOMOBILE NEGLIGENCE  INTERROGATORIES TO PLAINTIFF (These interrogatories should be used in conjunction with the General Personal Injury Negligence Interrogatories to Plaintiff.) 23. At the time of the incident described in the complaint, were you wearing a seat belt? If not, please state why not; where you were seated in the vehicle; and whether the vehicle was equipped with a seat belt that was operational and available for your use. 24. Did any mechanical defect in the motor vehicle in which you were riding at the time of the incident described in the complaint contribute to the incident? If so, describe the nature of the defect and how it contributed to the incident. FORM 6. AUTOMOBILE NEGLIGENCE  INTERROGATORIES TO DEFENDANT (These interrogatories should be used in conjunction with the General Personal Injury Negligence Interrogatories to Defendant.) 16. Do you wear glasses, contact lenses, or hearing aids? If so, who prescribed them, when were they prescribed, when were your eyes or ears last examined, and what is the name and address of the examiner? 17. Were you suffering from physical infirmity, disability, or sickness at the time of the incident described in the complaint? If so, what was the nature of the infirmity, disability, or sickness? 18. Did you consume any alcoholic beverages or take any drugs or medications within 12 hours before the time of the incident described in the complaint? If so, state the type and amount of alcoholic beverages, drugs, or medication which were consumed, and when and where you consumed them. 19. Did any mechanical defect in the motor vehicle in which you were riding at the time of the incident described in the complaint contribute to the incident? If so, describe the nature of the defect and how it contributed to the incident. 20. List the name and address of all persons, corporations, or entities who were registered title owners or who had ownership interest in, or right to control, the motor vehicle that the defendant driver was driving at the time of the incident described in the complaint,; and describe both the nature of the ownership interest or right to control the vehicle, and the vehicle itself, including the make, model, year, and vehicle identification number. 21. At the time of the incident described in the complaint, did the driver of the vehicle described in your answer to the preceding interrogatory have permission to drive the vehicle? If so, state the names and addresses of all persons who have such permission. 22. At the time of the incident described in the complaint, was the defendant driver engaged in any mission or activity for any other person or entity, including any employer? If so, state the name and address of that person or entity and the nature of the mission or activity. 23. Was the motor vehicle that the defendant driver was driving at the time of the incident described in the complaint damaged in the incident, and, if so, what was the cost to repair the damage? FORM 7. MARRIAGE DISSOLUTION  INTERROGATORIES TO PARTY 1. Employment. a. State the names and addresses of your present employers for the past 5 years (indicating your present employer), and describe your position and duties for each position. (If you have not been employed in the last 5 years, answer paragraphs a, b, c, and d as per your last employer.) b. State the commencement of your present employment your Social Security number and date of birth. c. Describe your position or job. State whether you have been engaged in any business, commercial, or professional activity within the past 5 years, and if so, state the names and addresses of such activities (including active or passive investment activity). For each, list the names and addresses of all other individuals and entities having an interest in such business. d. State the names and addresses of your employers for the past three years. Do you receive any benefits (perks) from your employment, including but not limited to: use of an automobile or automobile allowance; health, life, or other insurance; expense accounts; telephone expenses; reimbursement for travel, food, or lodging; or memberships in any clubs or associations? If so, list in detail the items that you receive and the approximate amounts paid to you or for your benefit for each of the last 5 years. e. State all of your education after high school, including but not limited to vocational or specialized training, indicating the name of the educational institution and the dates of attendance or training and listing the degrees and certificates obtained. State further the work skills you presently possess. 2. Income. (For the purpose of these questions, the definition of income shall be that as contained in section 61.30, Florida Statutes.) a. State your gross annual earned income, from all sources whether earned, passive, or investment income, for each of the last three 5 years. This total also should reflect any revenue or capital gains you have received from any sales. Identify the sources and amounts from each source. b. State when how often and on what days you are paid and indicate, itemizing your gross salary and wages and all deductions for each pay period your gross salary and wages, itemize the deductions from your gross salary or wages and your net salary or wages. c. Set forth any additional compensation, or expense reimbursement, including, but not limited to, overtime, bonuses, profit sharing, insurance, expense account, automobile, or automobile allowance, which that you have received or anticipate receiving from your employer or anticipate receiving. d. State your total annual income in each of the past three years. e. Itemize all other income or support payments received. 3. Assets. a. Describe by legal description and addresses all real property which you own, or in which you have an interest, setting forth the percentage of your interest in each parcel. For each parcel, state date of purchase, purchase price and present market value. b. List the names and addresses of all persons or entities which own an interest with you in the parcels of real property described in the foregoing sub-paragraph and describe such interest. c. List all of the items of tangible personal property, including, but not limited to, motor vehicles, furniture, boats, jewelry or art objects which are owned by you or in which you have an interest. State your estimate of value for each item. d. List the names and addresses of the persons who own an interest with you in the items of tangible personal property described in the foregoing sub-paragraphs and describe such interest. e. List all accounts in which you have deposited money in your name or jointly with another person within the last 12 months. f. As to the accounts set forth in the foregoing answer, set forth the account numbers, the cash balances and the persons and their addresses who are authorized to withdraw funds in said accounts. g. List all intangible personal property, including but not limited to, stocks, bonds and mortgages owned by you or in which you have had an interest within the last two years. State percentage of your interest and the present value of such interest. h. List the names and addresses of persons or entities indebted to you and the nature and amount of their obligations to you. i. List all other assets which you own, having an interest in or the use and benefit of, setting forth your interest and value thereof. j. Describe in detail, including the cash value, all insurance policies of which you are the owner or beneficiary, including, but not limited to, health, disability and life insurance. As to each policy, list the issuing insurance company and policy number. a. State the location (street address and legal description) of any real property in which you have an interest or which you own, use, or hold under deed, lease, or contract. For each property state: the interest you hold; the names and addresses of any other persons or entities holding any interest therein; the date of your acquisition; the purchase price; the present market value; the market value on the date of separation; and the market value on the date of filing the petition for dissolution of marriage. b. List all of the items of tangible personal property, including but not limited to motor vehicles, furniture, airplanes, boats, jewelry, collectibles, and art objects that are owned by you or in which you have any interest, and state your estimate of the value for each item. List the names and addresses of any person or entity who owns an interest with you in the items of tangible personal property described herein, and describe such interest. c. List all intangible personal property owned by you or in which you have had an actual, vested, or contingent interest within the last 5 years, including but not limited to: partnership and business interests, good will, stocks, bonds, receivables, choses in action, and debts owed to you by another entity or person. As to each, state the percentage of your interest; the present value of such interest; the amounts you claim are owed in the choses in action and debts; and the names and addresses of the persons or entities who are indebted to you or against whom you are claiming a chose in action. d. List all policies of insurance that you hold, own, or have any interest in, stating as to each policy: the name of the insurance company and the agent; the number of the policy; the type of insurance; the face value of the life insurance or annuity policy; the date of acquiring the policy; the beneficiary; the cash surrender value; the loan value; and the amount and nature of any loans outstanding against the policy. If the owner is someone other than yourself, state the name and address of such person or entity. e. State whether you are the beneficiary of any estate, trust, insurance policy, or annuity. If so, describe the nature and amount of each of these benefits and the value of the interest, indicating whether that interest is vested or contingent. f. State whether you have established a trust, and if so, provide the date the trust was established and state the names and addresses of the trustees, the beneficiaries, and the persons who possess the trust documents. List each asset that is held in the trust, stating its present fair market value. 4. Retirement or Deferred Income Plans. a. Are you an owner, participant, or alternate payee in any pension, profit sharing, deferred compensation, or retirement plan? If so, please state the following: (1) A description of the type of plan, whether profit sharing, defined benefit, defined contribution, IRA, Keogh, or other. (2) The account balance of any money held for your benefit or to which you are entitled, and your accrued monthly benefit. (3) The location and last valuation date of said asset, the amount currently vested, and the schedule of vesting. (4) The precise name of the plan and the name and address of the plan administrator or trustee. (5) An itemization of any loans that you have made against the plan during the last 5 years, the outstanding balance of the loans, and the amounts of the loans. 5. Financial Account Information. a. List all accounts, including checking, money market, brokerage, or any other investments that you have had any legal or equitable interest in, regardless of whether the interest is or was held in your own name individually, in your name with another person, or in any other name, within the last 5 years. Give the name and address of each institution, the name in which each account is or was maintained, the account numbers, and the names of each person authorized to make withdrawals from the accounts. State the present balance in each account, giving the largest balance during the last 12 months. b. State whether, during the past 5 years, you have prepared any financial statements, loan applications, or lists of your assets and liabilities. If so, for each document state: the date of preparation; the purpose for which the document was prepared; the name and address of the person or firm who prepared the document; and the names and addresses of any persons or financial institutions to whom the statements, applications, or lists were presented. c. State the names, addresses, and telephone numbers of your accountant and any other persons who possess your financial records, and as to each state which records they possess. d. State the location of all safes, vaults, or other similar depositories in which you maintained property at any time during the period commencing 1 year before the initiation of the action pending before this court until the date of furnishing answers to this interrogatory. State the names and addresses of all banks or other depositories where you had a safe deposit box; where you were a signatory or co-signatory on a safe deposit box; where you have access to a safe deposit box; or where you maintained property in a safe deposit box at any time during the period commencing 1 year before the initiation of the action before this court until the date of your answering this interrogatory. Provide the name and address of each other person who has had access to any such depository during the same time period. List any items removed from any depository by you or your agent during that time, together with the present location and fair market value of each item. 46. Liabilities. a. List all of your liabilities, debts, and other obligations, indicating for each: whether it is secured or unsecured, and, if secured, the nature of the security, setting forth the payment schedule as to each and the name and address of each creditor, the name and address of the creditor; the nature of the security, if any; the payment schedule; the current status of your payments; and the total amount of arrearage, if any. b. List all credit cards issued to you. Give the balance owed and present minimum monthly payment owed to each of such credit card companies and the account number for each account. charge accounts and credit cards upon which you are a signatory, which you use, or which are issued to you. For each account listed give the account number, the current status of your payments, the balance presently owed, and the minimum monthly payments. c. As to each creditor, set forth the current status of your payments and total amount of arrearage, if any. 57. Living Expenses. a. Attach a completed Financial Statement, in accordance with Rule 1.611, Fla. R.Civ.P. See Form 1.975, Fla.R.Civ.P. b. State the amount of money contributed monthly, directly or indirectly, for the support of your spouse or other dependents for the past year next preceding the answers to these interrogatories. Complete the attached financial affidavit and, if applicable, the attached child support worksheet. 68. Miscellaneous. a. State your full name, current address, date of birth and social security number. List all other assets that you own, have an interest in, or have the use or benefit of, setting forth for each your interest in the asset and its value. For each, set forth the date of your acquisition, receipt, or inheritance, or the date of your first being given use or benefit; the party from whom it was received; the value on the date of your acquisition or use; the value on the date of marriage; the value on the date of the filing of the petition for dissolution of marriage; and the present value. b. State the condition of your health and the name and address of all health care providers who have examined or treated you within the last 12 months. State the same information for each child, if any. If you are claiming a special equity in any assets, list the asset, the amount claimed as special equity, and all facts upon which you rely in your claim. c. If the mental or physical condition of a spouse or child is an issue, identify the person and state the name and address of all health care providers involved in the treatment of that person.