Nj Complaint Form PDF Details

If you're looking for the most efficient way to file a complaint with the State of New Jersey, then this blog post is here to provide all the necessary information. From review categories and filing regions to contact details, discover how you can access helpful services such as filling out an online NJ Complaint Form. Learn how simple it can be to report any complaints or grievances that occur in order for your voice to be heard on a state level quickly and securely!

QuestionAnswer
Form NameNj Complaint Form
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namescomplaint civil county, court complaint county, how to nj complaint file, how to nj complaint

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Civil – Law

Case Information Statement 12/23/2020

How to Complete the Civil Case Information Statement

(CIS)

These instructions are intended to guide individuals who are either plaintiffs or defendants in civil cases and who are not represented by an attorney in completing the Civil Case Information Statement (Civil CIS) required by court rules. The Civil CIS must be included with each party’s first pleading in the Civil part of the Law Division. That is, the plaintiff must file it with the complaint and the defendant must file it with the answer. If it is not included, the papers will be returned.

The CIS summarizes your case and alerts the court to any special needs you may have such as the need for an interpreter or the need for a quick trial date because one of your witnesses is expected to be unavailable. The numbers for the various case types are located on the back of the form. Enter the number which best describes your complaint. For example, if you are suing the defendant for a breach of contract, your case number would be 599.

After you have completed the CIS, keep it with the other papers you are planning to file.

Note: These materials have been prepared by the New Jersey Administrative Office of the Courts for use by self-represented litigants. The guides, instructions, and forms will be periodically updated as necessary to reflect current New Jersey statutes and court rules. The most recent version of the forms will be available at the county courthouse or on the Judiciary’s Internet site njcourts.gov. However, you are ultimately responsible for the content of your court papers.

Revised Form Promulgated by 12/23/2020 Notice to the Bar, CN 10517_ps

page 1 of 5

Instructions for Parties Not Represented by an Attorney for Completing the

Civil Case Information Statement (CIS)

Box#

Instruction

 

 

 

 

1.

Print your name.

 

 

 

2.

List a telephone number, including area code, where you can be reached during the day.

 

 

 

3.

Insert the name of the county where the complaint or answer is being filed.

 

 

 

 

4.

Leave the box blank.

 

 

 

5.

If you know the docket number of your case, insert it in the docket number box. If the CIS is

 

being filed with a complaint, the court will assign the docket number before it returns the

 

filed complaint.

 

 

 

 

6.

Enter an address where you wish to receive mail concerning this matter.

 

 

 

7.

Document type means the type of paper you are filing. If you are filing the complaint, print

 

complaint; if you are filing an answer, print answer.

 

 

 

8.

Check the box marked “yes” if you have requested that the matter be heard by a jury.

 

Otherwise, check “no.”

 

 

 

 

9.

Enter your name and indicate whether you are the plaintiff or defendant.

 

 

 

10.

The caption is the name of the case - the name of the plaintiff(s) v. the name of the

 

defendant(s). For example: John Doe, Plaintiff v. Mary Smith, Defendant. Print the name of

 

your case.

 

 

 

11.

The Case Type Number identifies the type of case. On the back of the CIS form is a list of

 

case types. Sometimes it is difficult to pick the number of your case, but you must fill in this

 

section in order for your case to proceed. Choose the one that best describes what your case

 

is about and enter that number. For example, if you are the plaintiff or defendant in a dispute

 

over fulfilling the terms of a contract, the case type is 599; if your case concerns a personal

 

injury, the case type number is 605.

 

 

 

 

12.

Are you alleging claims of sexual abuse? If yes, check the box marked “yes.”

Otherwise,

 

check “no.”

 

 

 

13.

If you believe that your case is a professional malpractice case, check the box marked “yes”

 

and see N.J.S.A. 2A:53A-27 and applicable case law regarding your obligation to file an

 

affidavit of merit.

 

 

 

14.

If you believe that you have any other cases involving the same adversary or arising from the

 

same set of circumstances (related cases pending), check the box marked “yes.” Otherwise,

 

check “no.”

 

 

 

15.

If you checked “yes” to the previous question, enter the docket number(s) of any related

 

cases.

 

 

 

16.

If you believe you will be adding more parties to the case, check “yes.” Otherwise, check

 

“no.”

 

 

 

17.

If you are the plaintiff and know the name of the defendant’s primary insurance company

 

enter it in the box. Otherwise check “unknown.” If you are the defendant and you have

Revised Form Promulgated by 12/23/2020 Notice to the Bar, CN 10517_ps

page 2 of 5

insurance that might cover or partially cover the damages complained of, enter the name of your insurance company.

18.If you and your adversary knew each other before the event giving rise to the law suit occurred, check “yes.” Otherwise, check “no.”

If the answer was “yes”, check the box next to the word(s) that best describe the relationship between the parties.

19.If you believe that the statute governing your case provides for payment of fees by the losing party, (for example, the Law Against Discrimination), check “yes.” Otherwise, check “no.”

20.If you believe that your case has some unusual circumstance which would require special attention, indicate the problem in the space provided. For example, if there is a witness who is ill or who may be unavailable, you should let the court staff know.

21.If you are requesting any accommodation for a disability, check “yes” and indicate what is needed. Otherwise, check “no.”

22.If you are requesting an interpreter, check “yes” and indicate the language for which it is needed. Otherwise, check “no.”

23.This box contains the statement by which you certify that you have removed any confidential personal identifiers from any document you have already submitted to the court and that you will continue to remove such identifiers in any future submission, unless such confidential personal identifiers are required by statute, court rule or court order. If you are filing a name change complaint, N.J.S.A. 2A:52-1 (the applicable New Jersey statute) requires that the social security number be listed on your complaint. Once a name change judgment is entered, your social security number will be removed by the court before the judgment is published in the newspaper.

24.The person whose name appears in Box 1 must sign the CIS in the space marked “Attorney Signature.”

Revised Form Promulgated by 12/23/2020 Notice to the Bar, CN 10517_ps

page 3 of 5

Civil Case Information Statement

(CIS)

Use for initial Law Division

Civil Part pleadings (not motions) under RULE 4:5-1

Pleading will be rejected for filing, under RULE 1:5-6(c), if information above the black bar is not completed or attorney’s signature is not affixed

For Use by Clerk’s Office Only

Payment type: ck cg ca

Chg/Ck Number:

Amount:

Overpayment:

Batch Number:

Attorney/Pro Se Name

Telephone Number

County of Venue

Firm Name (if applicable)

Docket Number (when available)

Office Address

Document Type

Jury Demand

Yes

No

Name of Party (e.g., John Doe, Plaintiff)

Caption

Case Type Number

 

Are sexual abuse claims

Is this a professional malpractice case?

Yes

No

(See reverse side for listing)

 

alleged?

 

 

 

 

 

 

 

 

Yes

No

If you have checked “Yes,” see N.J.S.A. 2A:53A-27 and applicable case law

 

 

regarding your obligation to file an affidavit of merit.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Related Cases Pending?

 

 

If “Yes,” list docket numbers

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you anticipate adding any parties

(arising out of same transaction or occurrence)?

Yes No

Name of defendant’s primary insurance company (if known)

None Unknown

The Information Provided on This Form Cannot be Introduced into Evidence.

Case Characteristics for Purposes of Determining if Case is Appropriate for Mediation

Do parties have a current, past or recurrent relationship?

If “Yes,” is that relationship:

 

 

Yes

No

Employer/Employee

Friend/Neighbor

Other (explain)

Familial

Business

 

 

 

 

 

 

 

 

 

Does the statute governing this case provide for payment of fees by the losing party?

Yes

No

Use this space to alert the court to any special case characteristics that may warrant individual management or accelerated disposition

 

Do you or your client need any disability accommodations?

If yes, please identify the requested accommodation:

 

Yes

No

 

 

 

 

 

Will an interpreter be needed?

If yes, for what language?

 

Yes

No

 

 

 

 

 

I certify that confidential personal identifiers have been redacted from documents now submitted to the court and will be redacted from all documents submitted in the future in accordance with RULE 1:38-7(b).

Attorney Signature:

Revised Form Promulgated by 12/23/2020 Notice to the Bar, CN 10517_ps

page 4 of 5

Side 2

Civil Case Information Statement

(CIS)

Use for initial pleadings (not motions) under RULE 4:5-1

CASE TYPES (Choose one and enter number of case type in appropriate space on the reverse side.)

Track I - 150 days discovery

151

Name Change

506

PIP Coverage

175

Forfeiture

510

UM or UIM Claim (coverage issues only)

302

Tenancy

511

Action on Negotiable Instrument

399

Real Property (other than Tenancy, Contract, Condemnation, Complex

512

Lemon Law

 

Commercial or Construction)

801

Summary Action

502

Book Account (debt collection matters only)

802

Open Public Records Act (summary action)

505

Other Insurance Claim (including declaratory judgment actions)

999

Other (briefly describe nature of action)

Track II - 300 days discovery

305

Construction

603Y

Auto Negligence – Personal Injury (verbal threshold)

509

Employment (other than Conscientious Employees Protection Act (CEPA)

605

Personal Injury

 

or Law Against Discrimination (LAD))

610

Auto Negligence – Property Damage

599

Contract/Commercial Transaction

621

UM or UIM Claim (includes bodily injury)

603N

Auto Negligence – Personal Injury (non-verbal threshold)

699

Tort – Other

Track III - 450 days discovery

005

Civil Rights

608

Toxic Tort

301

Condemnation

609

Defamation

602

Assault and Battery

616

Whistleblower / Conscientious Employee Protection Act

604

Medical Malpractice

 

(CEPA) Cases

606

Product Liability

617

Inverse Condemnation

607

Professional Malpractice

618

Law Against Discrimination (LAD) Cases

Track IV - Active Case Management by Individual Judge / 450 days discovery

156

Environmental/Environmental Coverage Litigation

514

Insurance Fraud

303

Mt. Laurel

620

False Claims Act

508

Complex Commercial

701

Actions in Lieu of Prerogative Writs

513

Complex Construction

 

 

Multicounty Litigation (Track IV)

271

Accutane/Isotretinoin

601

Asbestos

274

Risperdal/Seroquel/Zyprexa

623

Propecia

281

Bristol-Myers Squibb Environmental

624

Stryker LFIT CoCr V40 Femoral Heads

282

Fosamax

625

Firefighter Hearing Loss Litigation

285

Stryker Trident Hip Implants

626

Abilify

286

Levaquin

627

Physiomesh Flexible Composite Mesh

289

Reglan

628

Taxotere/Docetaxel

291

Pelvic Mesh/Gynecare

629

Zostavax

292

Pelvic Mesh/Bard

630

Proceed Mesh/Patch

293

DePuy ASR Hip Implant Litigation

631

Proton-Pump Inhibitors

295

AlloDerm Regenerative Tissue Matrix

632

HealthPlus Surgery Center

296

Stryker Rejuvenate/ABG II Modular Hip Stem Components

633

Prolene Hernia System Mesh

297

Mirena Contraceptive Device

634

Allergan Biocell Textured Breast Implants

299Olmesartan Medoxomil Medications/Benicar

300Talc-Based Body Powders

If you believe this case requires a track other than that provided above, please indicate the reason on Side 1,

in the space under "Case Characteristics.

Please check off each applicable category

Putative Class Action

Title 59

Consumer Fraud

Revised Form Promulgated by 12/23/2020 Notice to the Bar, CN 10517_ps

page 5 of 5

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