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Case 3:12-cv-00071-SI Document 147 Filed 01/07/13 Page 1 of 2

Steven A. Kraemer, OSB No. 882476 E-mail: [email protected] Gregory R. Roberson, OSB No. 064847 E-mail: [email protected] HART WAGNER LLP 1000 S.W. Broadway, Twentieth Floor Portland, Oregon 97205 Telephone: (503) 222-4499 Facsimile: (503) 222-2301

Of Attorneys for Defendants

IN THE UNITED STATES DISTRICT

FOR THE DISTRICT OF OREGON

PRISON LEGAL NEWS, a project of the HUMAN RIGHTS DEFENSE CENTER, No. 3:12-cv-0071-SI Plaintiffs,

v. DEFENDANTS’ PROPOSED COLUMBIA COUNTY; COLUMBIA FORM COUNTY SHERIFF'S OFFICE; JEFF DICKERSON, individual and in his capacity as Columbia County Sheriff,

Defendants.

We, the , being first duly empanelled, do find:

1. What are Plaintiff’s damages, if any? $______

2. Did Plaintiff fail to mitigate its damages?

ANSWER: Yes _____ No _____ If your answer is “yes,” please enter the amount of Plaintiff’s damages that would have been mitigated in the space provided below. This amount must be less than the amount you answered in Question No. 1. $______Page 1 – DEFENDANTS’ PROPOSED VERDICT FORM

Case 3:12-cv-00071-SI Document 147 Filed 01/07/13 Page 2 of 2

Do not reduce the damages by this amount, if any, because the court will do so when entering .

3. If you did not award Plaintiff damages, you must award Plaintiff nominal damages. Please enter an amount of up to $1.00 in the space provided below. $______nominal damages

4. Was Sheriff Jeff Dickerson’s conduct malicious, oppressive or in reckless disregard of Plaintiff’s First and/or Fourteenth Amendment rights?

ANSWER: Yes _____ No _____ If your answer is “No,” do not answer any further questions. Have your presiding juror sign and date this verdict form. If your answer is “Yes,” proceed to the next question.

5. Should punitive damages be awarded against Sheriff Jeff Dickerson? If your answer is “No,” do not answer any further questions. Have your presiding juror

sign and date this verdict form. If your answer is “Yes,” proceed to the next question. ANSWER: Yes _____ No _____

6. What amount of punitive damages, if any, do you award the Plaintiff? $______punitive damages

Please have your presiding juror sign and date this Verdict Form.

DATED this ___ day of February, 2013.

Presiding Juror

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