Following Pre-Trial proceedings, pursuant to Rule 16, F.R. Civ.P.and Local Rule 9, IT IS ORDERED: 

1. The parties are:(list) 

Each of these parties has been served and has appeared. All other parties named in the pleadings and not identified in the preceding paragraph are now dismissed. 

The pleadings which raise the issues are: (list) 

2. Federal jurisdiction and venue are invoked upon the grounds: (Concise statement of facts necessary to confer federal jurisdiction and venue. State whether the facts requisite to federal jurisdiction are denied or admitted.) 

3. The trial is estimated to take _____ trial days. 

(Where counsel cannot agree set forth each side's estimate.) 

4. The trial is to be a jury (non-jury) trial. 

(If a jury trial add): 

At least one week prior to the trial date counsel shall deliver to the Court and opposing counsel: (a) proposed jury instructions as required by Local Rule 13.2 and (b) any special instructions requested to be put to prospective jurors on voir dire. 

(If non-jury trial add): 

At least one week prior to the trial date each counsel shall submit to the Court and opposing counsel the findings of fact and conclusions of law the party expects the Court to make upon proof at the time of trial as required by Local Rule 13.5. 

5. The following facts are admitted and require no proof (set forth admitted facts). 

6. The following facts, though stipulated, shall be without prejudice to any evidentiary objection: (set forth facts not to be contested though not admitted). 

7. The following issues of facts, and no others, remain to be litigated at the trial: (set forth facts to be litigated). 

(State only ultimate facts. Only facts susceptible to conflicting proof should be within this category.) 

8. The following issues of law, and no others, remain to be litigated at the trial: (set forth issues of law.) 

(N.B. Counsel are urged to reach agreement as to the issues of fact and law and how to state them. Where agreement is impossible, the Pre-Trial Conference Orders should set forth the proposed issues with the parenthetical notation as to which party wishes so stated and which party disagrees. Separate proposed pretrial conference orders will not be accepted. Issues in third-party pleadings should be stated separately and so identified.) 

9. All discovery is complete. (If discovery is not complete only that discovery reserved in the Pre-Trial Conference Order will be allowed.) 

10. The Joint Exhibit List of the parties has been filed herewith under separate cover as required by Local Rule 9.7. All exhibits may be admitted without objection, except those exhibits listed below: 

Plaintiff objects to Exhibit Nos. ______ 

Defendant objects to Exhibit Nos.______ 

The objections are separately stated and attached hereto. 

11. Witness lists of the parties have heretofore been filed with the Court. 

(Except for good cause shown only the witness identified in the lists will be permitted to testify (other than for impeachment or rebuttal.) 

12. Each party intending to present evidence by way of deposition testimony has marked such depositions in accordance with Local Rule 9.4.9. For this purpose, the following depositions have been lodged with the Clerk as required by Local Rule 8.1.2: (list) 

13. The following law and motion matters are pending or contemplated: (state "none" or list) 

14. Bifurcation of the following issues for trial is ordered. 

(State "none" or identify those issues to tried at the first trial and those to be tried later.) 

15. The foregoing admissions having been made by the parties, and the parties having specified the foregoing issues of fact and law remaining to be litigated, this Pre-Trial Conference Order shall supercede the pleadings and govern the course of the trial of this cause, unless modified to prevent manifest injustice. 

Dated:_________________, 19_____


Approved as to form and content. 

Attorney for Plaintiff 

Attorney for Defendant