FORM 5. AUTOMOBILE NEGLIGENCE — INTERROGATORIES TO PLAINTIFF

(These interrogatories should be used in conjunction with the General Personal Injury Negligence Interrogatories to Plaintiff.)

23. At the time of the incident described in the complaint, were you wearing a seat belt? If not, please state why not; where you were seated in the vehicle; and whether the vehicle was equipped with a seat belt that was operational and available for your use.

24. Did any mechanical defect in the motor vehicle in which you were riding at the time of the incident described in the complaint contribute to the incident? If so, describe the nature of the defect and how it contributed to the incident.