INTERROGATORIES, DEFENDANT'S, PERSONAL INJURY                         FORM 8.50

(Usual Court Heading)

INTERROGATORIES AND DEMANDS BY

TO

SET NO.

PLEASE TAKE NOTICE, That the undersigned demand answers to the following Interrogatories under oath:

TO:

1. State the names and addresses of all persons who were at the scene of the accident at the time that it occurred.

2. State the names and addresses of all persons arriving at the scene of the accident within 2 hours after its occurrence.

3. In addition to the names and addresses listed in response to the foregoing Interrogatories 1 and 2, state the name and address of any additional person who has personal knowledge or information as to:

a. The manner of occurrence of the accident;

b. The conduct, activity or physical condition of any person involved in the accident during the 24 hour period immediately before the accident;

c. The physical condition of any physical item involved in the accident during the 24 hour period immediately before the accident;

d. Events occurring before the accident which you claim show how the accident happened or were in the chain of causal events leading up to the accident.

4. Which of the persons named in answer to Interrogatories 1, 2, and 3 have you, or anyone acting in your behalf, interviewed about the accident?

5. Have you a statement (as the term "statement" is defined at Rule 26(b)(3)) from any of the persons named in your answers to Interrogatories 1, 2, and 3? If so, as to each statement:

a. State the name of the person from whom the statement was taken;

b. State the date of the statement;

c. State the name, address, and occupation of each person who was present when the statement was made;

d. Attach to your answers a copy of any statement given by the party asking you these questions.

6. Were any photographs taken of the accident scene or any physical item involved in the accident? If so, state:

a. Subject matter of each photograph;

b. Date taken;

c. By whom taken;

d. Who has the negatives and prints thereof at this time.

7. If your were hospitalized as a result of the accident, list:

a. The name and address of the hospital;

b. The dates of your hospitalization in each hospital;

c. The amount of the hospital bill for each separate period of hospitalization.

8. If you incurred medical expenses for goods or services other than hospital services referred to in your answer to Interrogatory 7 above, list:

a. The name and address of each person or organization rendering such services or goods;

b. The general nature of the services or goods;

c. The cost of the services or goods.

9. In regard to any items listed in your answers to Interrogatories 7 and 8: demand is herewith made that you allow us to inspect and copy the bills for such goods or services. Inspection is to be made at least 60 days after receipt of these interrogatories and at such time and date and place as is mutually agreeable to your attorneys and the undersigned attorney. This demand is made pursuant to Rule 34.

(As an alternative to this demanded inspection you may instead simply send us photocopies of the bills and we will pay the reasonable cost of the photocopies.

10. Demand is herewith made that you allow us to inspect and copy any hospital or medical records of yourself in regard to any person or organization listed in your answers to interrogatories 7 and 8. Inspection is to be made at least 60 days after receipt of these interrogatories, and at such time and date and place as is mutually agreeable to your attorneys and to the undersigned attorney. This demand is made pursuant to Rule 34.

(As an alternative to this demanded inspection, you may instead simply send us a signed medical authorization, authorizing us to inspect medical and hospital records. A form is attached for your use. Sagmiller v. Carlsen, 219 N.W.2d 885 at 897 holds that once suit is brought, the medical privilege does not prevent discovery of medical and hospital records.)

11. Were x-rays taken of your body after the accident? If so, then state:

a. Who took the x-rays;

b. Where the x-rays are now, to the best of your belief.

12. If you claim any injury, then state in detail what that injury is or was.

13. If you claim that at the present time there exists any pain, limitation of movement, or other symptoms of injury, then state in detail what the pain, limitation of movement, or other symptom is.

14. Specify exactly the injuries or condition you claim to be permanent.

15. If you claim that any prior physical condition was aggravated or accelerated by the accident, state what the prior physical condition was and the manner in which you believe the prior condition was aggravated or accelerated.

16. State your full name, your birth date, and your place of birth.

17. State your present height, weight, color of hair, color of eyes, occupation, and social security number.

18. State your present address and how long you have lived at that address.

19. State any other address you have had in the past five years and the period of time you have lived at each.

20. State any other name or different spelling of your name which you have used.

21. Are you married at the present time? If so:

a. Give your spouse's full name;

b. Give the date and place of your marriage;

c. State whether your spouse is now living with you, and if not, then state when the separation occurred and your spouse's present address.

22. Were you previously married? If so, state for each previous spouse:

a. The name and present residence address of each spouse;

b. The dates of commencement and termination of each marriage;

c. The manner in which each marriage was terminated;

d. If the marriage was terminated by divorce, state the place and date of divorce.

23. Have you ever pleaded guilty or been convicted of any crime other than traffic violations? If so, state:

a. The nature of the offense;

b. The date;

c. The Court involved.

24. At the time of the incident referred to in the Complaint:

a. Did you have any restrictions endorsed on your motor vehicle drivers' license? (If you had no drivers' license, so state).

b. If you had restrictions, specify them (e.g., corrective lenses, medications, etc.)

25. Have you ever been involved in any other legal action as a defendant or plaintiff? If so, state the name of the other party involved, the date and place of the legal action, and a general description of such legal action.

26. If you were employed at the time of the accident, state the name and address of your employer. If self-employed, so state it.

27. What was the nature of your work at the time of the accident? Specify what your exact duties were.

28. For what period prior to the accident had you done such work?

29. State exact wage, salary, commissions, or earnings, before deductions, which you were earning at the time of the accident. Specify whether you were paid by the hour, day, week, month, or any other basis of payment.

30. State the number of hours you were working per day and per week at the time of the accident.

31. Was the week at the time of the accident an ordinary working week? If not specify whether the work you did was above or below normal and give particulars as to why the week was not a normal one.

32. Since the accident complained of, have you lost any time from work? If so, state for each loss of time:

a. The inclusive dates;

b. The reason for such lost time.

33. If not wholly self-employed, state the name and address of your immediate supervisor at your employment at the time of the accident.

34. If you have not yet returned to work, have you tried to return to work or find other work? Give the date and place at which you first attempted work or sought employment after the accident.

35. Since the accident, have you put in a claim for unemployment compensation? If so, give date and place.

36. How much wages, profits, commissions or earnings do you claim lost as a result of the accident?

37. Is your work now of a different type than the type you did on the date of the accident? If so:

a. When did you commence your present employment or line of work?

b. What is your present employment or line of work?

38. What is your wage, salary, commission or earnings that you are presently earning?

39. As a result of the accident complained of, are you now unable to perform, or are you restricted in the performance of any duties or activities of your past or present employment for yourself or others?

40. If the answer to the above question is yes, then state:

a. The nature and extent of each disability or restriction;

b. The manner in which your employment is adversely affected.

41. For the five years immediately preceding the date of the incident referred to in the Complaint, if you have been employed by others, state:

a. The name and address of each of your employers;

b. The dates of commencement and termination of each employment;

c. Specific description of the services or work performed for each employment.

42. With respect to each of the past five years, state your yearly gross income.

43. Demand is herewith made that you allow us to inspect, and copy, copies of your federal income tax returns for the last five years. Inspection is to be made at least 60 days after receipt of these interrogatories and at such time and date and place as is mutually agreeable to your attorneys and the undersigned attorney. This demand is made pursuant to Rule 34. As an alternative to such inspection, you may simply send us photocopies of such tax returns and we will pay the reasonable cost of the photocopies.

44. Have you sustained any additional financial losses as a result of the incident complained of, other than those covered by preceding interrogatories? If so, state:

a. The nature and amount of such losses;

b. The date of the losses;

c. The names and addresses of any persons to whom any money so claimed as an additional loss was paid.

45. Have you ever suffered any injuries in an accident before the accident referred to in your Complaint? If so, state:

a. The date of such injury;

b. A description of the injury;

c. Whether the claim was made against any other person as a result of the accident, and if so, against whom?

46. Have you ever suffered any illness requiring hospitalization before the accident referred to in your complaint? If so, state:

a. The date of the illness;

b. A description of the illness.

47. Have you had any accident or illness after the accident complained of in your Complaint? If so, state:

a. The date and the nature of the accident or illness and,

b. Whether medical care was received and who furnished it.

48. Have you entered into any:

a. Covenant not to sue, release or settlement of liability in regard to the occurrence which is the subject matter of this litigation;

b. Agreement in which some other person guarantees a recovery to you of a stated amount in regard to this litigation or any agreement in which some other person has loaned you funds in regard to this litigation.

49. If (A) you have answered in the affirmative that there was an agreement or contract, in response to the foregoing interrogatory, and (B) a copy of said contract or agreement is not attached to your answers to these interrogatories, then in that event, state:

a. The person with whom you have such agreement or contract;

b. The date of the agreement or contract;

c. The exact terms and all words of the agreement or contract.

50. Has any expert made an investigation or examination in regard to any matters complained of in this action?

51. If your answer to the foregoing interrogatory was in the affirmative, for each such expert state:

a. His name and address;

b. His profession, business or occupation and the field in which he allegedly is an expert;

c. The name and address of the person or firm who hired him;

d. The date or dates on which his investigation was made.

52. Has any expert submitted a written report to you, your attorneys or insurers, of any investigation or examination in regard to any matters complained of in this action?

53. If your answer to the foregoing interrogatory was in the affirmative, for each such report state:

a. The name of the expert submitting the report;

b. The date the report was dated;

c. Whether the report contains statements as to facts which were observed by the expert;

d. The name and address of all firms or persons having copies of the report in their possession.

54. State the name of each person whom you expect to call as an expert witness at the trial. For each such person named, state:

a. His name;

b. His address;

c. The subject matter on which he is expected to testify;

d. The substance of the facts to which he is expected to testify;

e. The substance of the opinions to which he is expected to testify;

f. A summary of the grounds for each opinion.

g. Attach a copy of his report to you as a part of your answer to the interrogatory.

55. In addition to any persons named in the foregoing interrogatory, state the name of any other experts who have been retained or specially employed by you in anticipation of litigation or preparation for trial, even though you do not expect to call them as witnesses or you have not yet decided whether they will be called as witnesses.

NOTICE

Pursuant to Rule 33 of the Rules of Civil Procedure, you are required to answer these interrogatories within 30 days after the service of these interrogatories (unless a different time is otherwise provided by rule or court order).

Your attention is further directed to Rule 26(e) of the Rules of Civil Procedure. If after answering these interrogatories you obtain new information, then please supplement your answers, in accordance with that rule, which provides:

1. If you obtain new information, you must supplement your answer to any interrogatory directly addressed to:

a. The identity and location of persons having knowledge of discoverable matters, or

b. The identity of each person expected to be called as an expert witness at trial, the subject matter on which he is expected to testify, and the substance of his testimony.

2. You must amend your interrogatory answer if you obtain new information upon the basis of which:

a. You know the response was incorrect when made; or

b. You know the response is no longer correct, and the failure to amend the response is in substance a concealment of new information.

Dated .

By: