Litigant Information Sheet Form PDF Details

In the realm of the New Jersey Judiciary system, the Confidential Litigant Information Sheet stands as a critical document required to be completed by plaintiffs, defendants, or their attorneys in certain legal proceedings. This form, governed by the rules designated as R. 5:4-2(g) and informed by the statutes N.J.S.A. 2A:17-56.60 and R. 5:7-4, serves a multifaceted purpose aimed at assuring the accuracy of court records. The comprehensive nature of the form mandates the disclosure of personal and sensitive information ranging from basic identification details such as names and social security numbers, to more specific data including employment information, driver's license numbers, and even details concerning any active domestic violence orders. It delves further to collect information regarding children involved in the legal matter, including their health coverage. Moreover, the form reinforces the confidentiality of the information provided by explicitly stating that it will not be shared with the opposing party, thus maintaining the privacy of the litigants. Completing this form in its entirety, without leaving any blanks—using "N/A" where necessary—ensures that the judiciary has a full account of the litigant's situation. This direct approach not only streamlines the legal process but also plays a pivotal role in the protection and handling of sensitive information, underpinning the significance of accuracy and honesty in judicial proceedings. The requirement for a certification by the litigant that the statements made are true, under the penalty of punishment for willful falsehoods, underscores the seriousness with which this information is handled within the judicial framework.

QuestionAnswer
Form NameLitigant Information Sheet Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesconfidential litigant form nj, cn 10486, confidential litigant information sheet, jersey judiciary 5

Form Preview Example

New Jersey Judiciary

Confidential Litigant Information Sheet (R. 5:4-2(g))

To assure accuracy of court records - To be filled out by Plaintiff, or Defendant, or Attorney

Collection of the following information is pursuant to N.J.S.A. 2A:17-56.60 and R. 5:7-4.

Confidentiality of this information must be maintained

Please complete the entire form, leaving no blank spaces. If something does not apply to you, enter “N/A”. This form is confidential and will not be shared with the other party.

Docket Number:

CS Number:

Do you have an active Domestic Violence Order with the other party in this case?

Yes

No

 

 

 

 

 

Plaintiff

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Defendant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name (last, first, middle initial)

 

 

 

 

 

 

 

 

Name (last, first, middle initial)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Social Security Number

 

 

 

 

 

Date of Birth

 

 

 

 

 

Social Security Number

 

 

 

 

 

 

 

 

Date of Birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address: Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address: Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

State

Zip

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

State

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Plaintiff Telephone Number

 

 

 

Employer Telephone Number

 

Defendant Telephone Number

 

 

 

Employer Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Plaintiff Email Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Defendant Email Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Name (or other income source)

 

 

 

 

 

 

 

 

Employer Name (or other income source)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Address: Street

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Address: Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

State

Zip

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

State

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Professional, Occupational, Recreational Licenses

 

 

 

 

 

Professional, Occupational, Recreational Licenses

 

 

 

 

(include types and license numbers)

 

 

 

 

 

 

 

 

 

 

 

 

 

(include types and license numbers)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Driver's License Number

 

 

 

 

State of Issuance

 

 

 

 

 

Driver's License Number

 

 

 

 

 

 

 

State of Issuance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sex

Race/Ethnicity

 

 

 

Height

Weight

Eyes

Hair

 

Sex

 

Race/Ethnicity

 

 

 

 

 

Height

Weight

Eyes

Hair

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Auto: License Plate

State

 

Make

 

Model

 

Year

 

Auto: License Plate

State

Make

 

Model

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attorney Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attorney Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attorney Address: Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attorney Address: Street

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

State

Zip

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

State

Zip

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Children Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name (last, first, middle initial)

 

 

 

 

 

Date of Birth

 

Race

 

Sex

 

 

 

Social Security Number

1.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

3.

4.

Health Coverage for Children - available through parent filling out this form ( Plaintiff /

Defendant)

Health Care Provider:

 

Policy Number:

 

Group Number:

Health Care Provider:

 

Policy Number:

 

Group Number:

Health Care Provider:

 

Policy Number:

 

Group Number:

I certify that the foregoing statements made by me are true to the best of my knowledge. I am aware that if any of the foregoing statements made by me are wilfully false, I am subject to punishment.

Date

Signature

 

 

Revised: 08/2020 CN 10486

page 1 of 1

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