Enter the dollar amount in the space provided for each type of negligence. Enter in whole dollars only. For example, one dollar should be entered as $1. If necessary use a comma separator for thousands of dollars. For example, four thousand nine hundred and ninety nine dollars should be entered as $4,999.

Information:

• Defendant is 70% responsible for the injury
• Plaintiff is 30% responsible for his own injury
• Plaintiff’s total damages are $100,000

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