Fill and Sign the Answers Interrogatories Form

- 1 - ANSWERS TO DEFENDANT'S FIRST INTERROGATORIES TO PLAINTIFF Comes now ________________, Plaintiff in the above styled and numbered cause, and files this his Answers to Defendant's First Interrogatories to Plaintiff, and in support thereof would show unto the Court the following, to wit: 1. State your full name, place and date of birth, all other names you have used, your social security number and all of your present and former addresses. ANSWER: My full name is ________________. I was born in _______ on _________, 20___; my social security number is ________________; my current address is ________________. I previously lived at 2. State whether you have ever had any formal or informal training (for business or personal benefit) involving the use of mechanical tools, vehicles, aircraft, heavy equi pment, engines, or other equipment which were powered by electricity, gasoline, diesel fuel, fossil fuels, compressed air, hydraulic systems or steam and, if so, state the name of the institution or person offering such training, the type of equipment used during such training and the duration of such training. ANSWER: None. 3. State whether you have ever been convicted of or pleaded guilty to any crime either in civilian or military life for any offense and, if so, state the nature of t he crime, date of conviction or plea, place of conviction or plea, the name of the arresting authority a nd sentence, fine or punishment imposed. ANSWER: None. 4. State the name an address of each and every firm or person other than defendant which has employed plaintiff and provide the dates of employment and the nature of the employment. ANSWER: None. 5. State whether plaintiff has ever been a member of earned forces of the United States, of any state, or any other country, or any police force or security agency, whether voluntary or professional, and if so please give the branch of the service or police or security force in which plaintiff served, the service number and the dates of enlistment, conscript ion or hire. ANSWER: I was drafted into the United States Army in _______. I spent ____ months in the Army and was stationed at ___________, ____________ in the chemical corp. My service number is ________________. - 2 - 6. State the name and address of all of your family doctors, past and present and give the years during which you were treated by each. ANSWER: From ______ to ________ I was treated by Dr. ________________. From _________ to present I have been treated by Dr. ______________________. 7. State whether you have ever suffered a traumatic injury to the head, neck, face or ear and if so the date upon which such injury was sustained and identify any health care provider giving treatment for such injury. ANSWER: None. 8. Identify specifically each and every injury, disease or condition which you claim in this action was caused by defendant and as to each, provide: (a) a complete description of the nature and extent, including the duration and permanency, if any, of each such condition including any and all past or present symptoms. (b) the date upon which such symptoms first appeared; (c) the date each such condition was diagnosed, ANSWER: _______ I have sustained a loss of hearing. It is very difficult for me to understand words while other people are talking. Prior to __________, 20_____.