Ill. Pattern Jury Instr. (Civil) 45.04B

Form B--Contributory Fault of Decedent Only

We, the jury, find for the Estate of ____, deceased, and against the following defendants:

____________________

Defendant 1 Yes _____ No _____

____________________

Defendant 2 Yes _____ No _____

We further find the following:

First: We find that the total amount of damages suffered by the Estate of ____, deceased, is

$______, itemized as follows:

[Loss of money, benefits, goods and services]: $__________$

[Grief, sorrow and mental suffering]: $__________

[Loss of society] and [loss of sexual relations]: $__________

[(Other damages: insert from 30.04, 30.04.01,

30.05, 30.05.01, 30.06, 30.07, 30.09

or as applicable)] $__________

PLAINTIFF'S TOTAL DAMAGES $__________

Second: Assuming that 100% represents the total combined [negligence][fault][responsibility] of

all [persons] [or entities] whose [negligence][fault][responsibility] proximately caused the death

of [decedent], we find the percentage of [negligence][fault][responsibility] attributable to each as

follows:

a) ___________________ _____%

Decedent

b) __________________ _____%

Defendant 1

c) ___________________ _____%

Defendant 2

Third: After reducing the plaintiff's total damages from paragraph “First” by the percentage of

[negligence] [[(other damage reducing defense)]] if any, of [decedent] from line (a) in paragraph

“Second,” we award [plaintiff] recoverable damages in the amount of $_______.

_________________________________ ___________________________

Foreperson

_________________________________ ___________________________

Add additional lines for juror signatures.

Verdict Form, Notes and Comment revised May 2014.