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STATEMENT OF DAMAGES G.L. c. 218, 19A (a) Docket No.: Division: Plaintiff(s) Trial Court of Massachusetts District Court Department Defendant(s) INSTRUCTIONS: THIS FORM MUST BE COMPLETED AND FILED

How to fill out massachusetts statement of damages

How to fill out Massachusetts statement of damages:

1. Gather all necessary information and documentation related to the damages incurred. This may include medical bills, repair estimates, photographs, and any other evidence that supports the claim.
2. Begin by completing the heading section of the form, which includes the case name, court, and docket number. Ensure that all information provided is accurate and matches the details of the case.
3. In the "Plaintiff Information" section, provide your full legal name, address, and contact information. If you have an attorney representing you, include their information as well.
4. Next, fill out the "Defendant and/or Defendant's Insurance Information" section. Include the name, address, and contact information of the party responsible for the damages. If they have insurance, provide the insurance company's name and contact details.
5. In the "Vehicle Operator Information" section, provide details about the person who was operating the vehicle at the time of the incident, such as their name, address, driver's license number, and insurance information.
6. Proceed to the "Insurance Information" section, where you provide details about your insurance coverage, including the policy number and insurance company's contact information.
7. In the "Medical Information" section, provide a detailed account of any medical treatment you received as a result of the incident. Include the names and addresses of healthcare providers, dates of treatment, a description of the services rendered, and the associated costs.
8. In the "Property Damage Information" section, list any property that was damaged during the incident. Include descriptions, estimated repair or replacement costs, and any relevant receipts or estimates.
9. If there are any other damages you are seeking compensation for, such as lost wages or pain and suffering, provide a detailed description and any supporting documentation in the "Other Damages" section.
10. Finally, sign and date the statement of damages, certifying that the information provided is true and accurate to the best of your knowledge.

Who needs Massachusetts statement of damages?

1. Individuals who have suffered damages and are seeking compensation in a Massachusetts court case.
2. Plaintiffs who are involved in personal injury or property damage claims.
3. Any party who wishes to document and present the details of the damages incurred in a Massachusetts court proceeding.

For pdfFiller’s FAQs

What is massachusetts statement of damages?

The Massachusetts statement of damages is a legal document that outlines the financial losses incurred by a plaintiff in a civil case.

Who is required to file massachusetts statement of damages?

The plaintiff in a civil case is required to file the Massachusetts statement of damages.

How to fill out massachusetts statement of damages?

The Massachusetts statement of damages can be filled out by providing detailed information about the financial losses suffered due to the actions of the defendant.

What is the purpose of massachusetts statement of damages?

The purpose of the Massachusetts statement of damages is to help the court determine the appropriate amount of compensation that should be awarded to the plaintiff.

What information must be reported on massachusetts statement of damages?

The Massachusetts statement of damages must include details of medical expenses, lost wages, property damage, and any other financial losses incurred as a result of the defendant's actions.

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