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Filing # 190156755 E-Filed 01/19/2024 05:26:11 PM
IN THE CIRCUIT COURT OF THE
NINTH JUDICIAL CIRCUIT, IN AND
FOR OSCEOLA COUNTY,
FLORIDA
ASBEL ALEXANDER LLERENA,
CASE NO.: 2020 CA 002872 AN
Plaintiff,
v.
ADRIAN RODRIGUEZ CHAVEZ AND
GRANNY'S GARDEN II, INC.,
Defendants.
_______________________________/
VERDICT FORM
We, the jury, return the following verdict:
1. Was there negligence on the part of ADRIAN CHAVEZ?
YES NO
If your answer to question 1 is NO, your verdict is for defendant, and you should not proceed
further except to date and sign this verdict form and return it to the courtroom. If your answer to
question 1 is YES, please answer question 2.
2. Was there negligence on the part of Plaintiff, ASBEL LLERENA?
YES NO
If your answer to question 2 is YES, please answer question 3. If your answer to question 2 is
NO, please skip question 3 and answer question 4.
3. State the percentage of any negligence that you apportion to:
ADRIAN CHAVEZ __________%
Plaintiff, ASBEL __________%
LLERENA
Total must be 100%
In determining the amount of damages, do not make any reduction because of the negligence,
if any, of Plaintiff, ASBEL LLERENA. If you find that Plaintiff, ASBEL LLERENA, was negligent,
the court in entering judgment will make an appropriate reduction in the damages awarded.
Please answer question 4.
4. What is the total amount of damages sustained by Plaintiff, ASBEL
LLERENA, for medical expenses
a)in the past? $
b) in the future? $
Please answer question 5.
5. What is the total amount of Plaintiff, ASBEL LLERENA’S, damages for
lost earnings and out of pocket expenses?
a) Lost earnings in the past. $
b) Out of pocket expenses in the past and future. $
Please answer question 6.
6. Did Plaintiff, ASBEL LLERENA, sustain a permanent injury within a
reasonable degree of medical probability as a result of the incident complained
of?
YES NO
If your answer to question 6 is NO, you should not proceed any further
except to total the damages (insert below), date, and sign the verdict form, and
return it to the courtroom. If your answer to question 6 is YES, please answer
question 7.
7. What is the total amount of damages of Plaintiff, ASBEL LLERENA, for
pain and suffering, disability, disfigurement or scarring, physical impairment,
mental anguish, inconvenience, aggravation of a disease or physical defect, or
loss of capacity for the enjoyment of life
a) in the past? $
b) in the future? $
TOTAL DAMAGES $
(add lines 4a, 4b, 5a, 5b, and, if applicable, 7a, and 7b)
SO SAY WE ALL, this ______ day of _______, 2______.
____________________________________
FOREPERSON
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Filing # 190156755 E-Filed 01/19/2024 05:26:11 PM IN THE CIRCUIT COURT OF THE NINTH JUDICIAL CIRCUIT, IN AND FOR OSCEOLA COUNTY, FLORIDA ASBEL ALEXANDER LLERENA, CASE NO.: 2020 CA 002872 AN Plaintiff, v. ADRIAN RODRIGUEZ CHAVEZ AND GRANNY'S GARDEN II, INC., Defendants. _______________________________/ VERDICT FORM We, the jury, return the following verdict: 1. Was there negligence on the part of ADRIAN CHAVEZ? YES NO If your answer to question 1 is NO, your verdict is for defendant, and you should not proceed further except to date and sign this verdict form and return it to the courtroom. If your answer to question 1 is YES, please answer question 2. 2. Was there negligence on the part of Plaintiff, ASBEL LLERENA? YES NO If your answer to question 2 is YES, please answer question 3. If your answer to question 2 is NO, please skip question 3 and answer question 4. 3. State the percentage of any negligence that you apportion to: ADRIAN CHAVEZ __________% Plaintiff, ASBEL __________% LLERENA Total must be 100% In determining the amount of damages, do not make any reduction because of the negligence, if any, of Plaintiff, ASBEL LLERENA. If you find that Plaintiff, ASBEL LLERENA, was negligent, the court in entering judgment will make an appropriate reduction in the damages awarded. Please answer question 4. 4. What is the total amount of damages sustained by Plaintiff, ASBEL LLERENA, for medical expenses a)in the past? $ b) in the future? $ Please answer question 5. 5. What is the total amount of Plaintiff, ASBEL LLERENA’S, damages for lost earnings and out of pocket expenses? a) Lost earnings in the past. $ b) Out of pocket expenses in the past and future. $ Please answer question 6. 6. Did Plaintiff, ASBEL LLERENA, sustain a permanent injury within a reasonable degree of medical probability as a result of the incident complained of? YES NO If your answer to question 6 is NO, you should not proceed any further except to total the damages (insert below), date, and sign the verdict form, and return it to the courtroom. If your answer to question 6 is YES, please answer question 7. 7. What is the total amount of damages of Plaintiff, ASBEL LLERENA, for pain and suffering, disability, disfigurement or scarring, physical impairment, mental anguish, inconvenience, aggravation of a disease or physical defect, or loss of capacity for the enjoyment of life a) in the past? $ b) in the future? $ TOTAL DAMAGES $ (add lines 4a, 4b, 5a, 5b, and, if applicable, 7a, and 7b) SO SAY WE ALL, this ______ day of _______, 2______. ____________________________________ FOREPERSON