Fill and Sign the Business Summary Template Form

IN THE ______________ COURT OF ______________ COUNTY STATE OF ________________       ) )       ) Petitioner/Plaintiff, ) ) ) NO.       Vs. ) )       ) Respondent/Defendant ) ) PLAINTIFF'S BUSINESS SUMMARY OF _____________'S MEDICAL EXPENSES FROM _____________, ___________ MOTOR VEHICLE ACCIDENT Plaintiffs, through counsel, tender the following compilation of ___________________'s medical treatment expenses reasonably incurred by her following the __________________, ____________, collision in issue. Plaintiffs certify that copies of said medical expense bills have been previously provided to counsel for Defendants. Attached are exact copies of same as composite Exhibit "A" to this summary. Plaintiffs offer said business summary of ______________________'s medical treatment expenses as evidence in this cause pursuant to Rule ______, ________ Rules of Evidence pursuant to § ________, ___________ Code Annotated (_______). Respectfully submitted, - 1 - Dated: Name:       Title:       Address:       Address:       City, State, Zip:       Phone:       Fax:       E-Mail:       Attorney No.:       CERTIFICATE OF SERVICE I, ______________________________, do hereby certify that I have this day mailed, U.S. Mail, postage prepaid, a true and correct copy of the above and foregoing to __________________________________, at the following address; ___________________________________________________________________ THIS the ____ day of _____________, 20____. _________________________________ - 2 -