Free Form 5.120.1 - Oregon

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR __________________ COUNTY Case name: __________________________________, Plaintiff, v. __________________________________, Defendant. ) ) ) ) ) ) ) ) ) ) )

Case No. UNIFORM NOTICE OF ENTRY OF VERDICT/JUDGMENT INCLUDING AN AWARD OF PUNITIVE DAMAGES

Written notification hereby is given to the Department of Justice, Crime Victims' Assistance Section, 1162 Court St NE., Salem, Oregon 97301, that a [check appropriate box] G verdict that includes an award of punitive damages G judgment based on a verdict that includes an award of punitive damages was entered in favor of ______________________, plaintiff/defendant/other [circle appropriate designation] in the above-captioned matter, on _______________________[insert date]. This notice is given pursuant to ORS 31.735(3) and UTCR 5.120.

Date OSB# (if applicable)

Signature Type or print name

Form 5.120.1 - UNIFORM NOTIFICATION OF ENTRY OF VERDICT/ENTRY OF JUDGMENT INCLUDING AN AWARD OF PUNITIVE DAMAGES - UTCR 5.120(1) (8-1-05)

UTCR App. Page 18