DAG Reporting

Reporting Dates Fiscal Calendar Year

1st Qtr (Oct-Dec) * 2nd Qtr (Jan-Mar) * 3rd Qtr (Apr-Jun) * 4th Qtr (Jul-Sep)

First Name:*

MI:

Last Name:*

Case Number:

Reporting Year:

Case Style:

Court:

Reporting Quarter:

Agency Board:

State:

Phone:

Email Address:*

DAG Address:

DAG City:

DAG State:

DAG Zip:

Firm Name:

Managing Attorney First Name:

MI:

Managing Attorney Last Name:

Managing Phone:

Is the case settled?

Trial date set?

Potential Amount:

Settled Amount:

Trial Verdict:

Notes: