More examples in Forms/Medical & Injury Forms
Personal Injury Interrogatories Example
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1. Do you own any interest in real estate? if so, as to each such interest, state: (a). the location of the real estate (b). the nature of your interest in the real estate (c). the date you acquired such interest (d). the amount which you paid to acquire such interest (e). whether there are any mortgages on such real estate. If there are any such mortgages, as to each mortgage, state: i). the identity of the mortgage ii). the amount of the original mortgage obligation iii). the outstanding obligations of the mortgage 2. Have you conveyed any interest in any real estate to anyone within the last 12 months? If so, as to each such conveyance, state: (a). the description of the real estate (b). the interest which you conveyed (c). the identity of the person to whom you conveyed that interest (d). the consideration which you received 3. Do you hold as mortgagee a mortgage in any real estate? If so, as to each such mortgage, state: (a). the description of the real estate (b). the date on which you acquired the mortgage (c). the original principal amount of the mortgage (d). the outstanding balance due on the mortgage (e). the identity of the mortgagor 4. Do you own any automobiles, trucks, vessels, aircraft, or other vehicles? If so, as to each such vehicle, state: (a). the make, model, and year of the vehicle (b). the identity of the registered owner of the vehicle (c). the governmental agency registering the vehicle and the registration number (d). the location of the vehicle 5. Is anyone indebted to you in amount in excess of $100.00? if so, as to each such indebtedness, state: (a). the identity of the individual or entity which is indebted to you (b). the amount of such indebtedness (c). the date on which the indebtedness is due Interrogatories 6. Do you have any savings, money market, or checking accounts, or certificates of deposit? If so, as to each such account or certificate, state: (a). the identity of the depository institution for the account or certificate of deposit (b). the title and registered owner or holder of the account or certificate of deposit (c). the current balance of the account or certificate of deposit 7. Do you have or use any safe deposit box or other similar storage facility? If so, as to each such facility, state: (a). the identity of the institution in which you rent, lease, or use such a facility (b). the box or other identifying number for such facility (c). the name under which such facility is rented, leased, or used (d). the contents of such facility 8. Do you own or have any interest in any stocks, bonds, mutual funds, money market funds, or other securities or negotiable instruments? If so, as to each such interest, state: (a). a full description of the stock, bond, security, or negotiable instrument (b). the par or face value of such stock bond, security, or negotiable instrument (c). the registered and beneficial holders of the stock certificate, bond, security, or negotiable instrument (d). the dates on which interest or dividends are payable (e). the maturity date of any bond (f). the identity of the custodian of any and all documents evidencing the interest (g). the location of any and all such documents 9. Do you own any jewelry, furniture, office equipment, precious metals or stones, television sets, radios, record players, antiques or collectibles, electrical appliances, power or hand tools, photographic equipment, works of art, furs, musical instrument, rare books or map, collections of coins or stamps, silver or china, or other personality with an individual or collective value exceeding $250.00? If so, as to each such item, state: (a). a full and complete description of such item and its present condition (b). the location of such item (c). whether or not such item is subject to any security interest (d). the identity of the holder of any such interest 10. Are you a beneficiary of any trust fund? If so, as to each trust fund, state: (a). the nature of the trust (b). the nature of your interest therein (c). the identity of each trustee 11. Do you own any patents, inventions, trade names, trade secrets, trademarks, service marks, or copyright? If so, as to each such item, state: (a). a full and complete description of each item (b). the number of any other identifying features of such item 12. Do you own any warehouse receipts, bills of lading, or other documents of title? If so, as to each such item, state: (a). the identity of such item (b). the location of such item (c). whether or not such item is subject to any such security interest (d). the identity of the holder of any such security interest 13. Are you the plaintiff in any lawsuit which pending or in which a verdict of judgment has not been satisfied in whole or part? 14. Have you applied for a loan or mortgage within the last three years? If so, as to each such loan or mortgage application, state: (a). where you applied for such loan (b). whether or not you were granted such loan (c). the amount granted for such loan (d). what you did with the proceeds of such loan, if any 15. In the last three years, have you acted as co-maker, guarantor, or endorser of any loan? If so, provide full details as to each such loan and your relationship thereto, including the amount of the loan. 16. Have you issued or furnished any financial statements within the last three years? If so, as to each such financial statement, state: (a). the identity of such financial statement (b). to whom such financial statement was issued 17. Are you a party to a contract of any kind? If so, as to each such contract, state: (a). the identity of such contract (b). the nature of such contract (c). the identity of the person or entity with whom you entered into the contract 18. Does any governmental body owe you any money? If so, provide full and complete details thereof. 19. Have you made any claim under any policy of insurance within the last three years? If so, as to each such claim, state: (a). the name of the insurer (b). the policy number (c). the facts given rise to such claim (d). whether or not such claim has been paid 20. Do you own or have interest in any partnerships or limited partnerships? If so, as to each such interest, state: (a). a full and complete description of the partnership or limited partnership, including but not limited to, its name, purpose, assets, registered address, and the identity of each of its general partners (b). the identity of the agreement or agreements governing the affairs of the partnership (c). the nature and extent of the interest (d). the value of the interest, if any (e). the name under which the interest is owned or otherwise held by you 21. Do you own or have any interest in any business, corporation, partnership, or joint venture other than those identified in responses to the foregoing interrogatories? If so, as to each, state: (a). the identity of the business, corporation, partnership, or joint venture (b). a full and complete description of you interest in same 22. Do you own or have interest in any asset or item of value individually or collectively worth in excess of $500.00 other than those identified in response to the foregoing interrogatories? If so, as to each such asset or item, state: (a). a full and complete description of the asset or item (b). the nature of your interest in the assets or item (c). the value of the asset or item 23. Are you unable to pay any of your debts or obligations? If so, provide full and complete details thereof. IMA LAWYER
Attorney for Plaintiff
Attorney for Plaintiff