APPENDIX TO RULE 1.1

COURT OF COMMON PLEAS

COLUMBIANA COUNTY, OHIO

                                                 )

                                                )

                    Plaintiff                )            Case No.: ______________________________

                                                )

            VS.                              )            (Type): ________________________________

                                                )

                                                )            Judge: _________________________________

                   Defendant            )

                                                )                          PRE-TRIAL STATEMENT OF:

                                                                          ________________________________

1.)   Brief description of case (e.g. pedestrian struck while crossing in crosswalk):

2.)   Brief description of injuries or damages (e.g. fractured leg or front end damage, etc.):

3.)   List items by item ascertainable damages such as medical expenses, lost wage, property

      damage, etc., that have been provided to you:

                  ITEM OF DAMAGE                                                      AMOUNT

                                                                                    $                                                                     

                                                                                    $                                                                    

____________________________________             $                                                                   

____________________________________             $                                                                  

                                     _________________              $                                                         ______         

                                                            TOTAL             $                                                                     

4.)   Report on the status of the following:

a.)   Depositions:                                                   

b.)   Interrogatories:                                                      

c.)   Physical examinations:                                          

d.)   Exchange of medical reports:                                        

e.)   Exchange of expert witness reports:                                        

f.)    Wage or employment verification:                                          

5.)   State any special problems with respect to trial of case:

6.)   Stipulations:

                                                                                    Counsel for Plaintiff/Defendant

Dated: