Appendix XI-X Verified Complaint - Nonpayment of Rent
Revised 09/01/2016, CN 11252 (Appendix XI-X) page 1
NOTICE: This is a public document, which means the document as submitted will be available to the public upon request.
Therefore, do not enter personal identifiers on it, such as Social Security number, driver’s license number, vehicle plate
number, insurance policy number, active financial account number, or active credit card number.
Plaintiff or Filing Attorney Information:
Superior Court of New Jersey
Law Division, Special Civil Part
Name of Plaintiff(s)/Landlord(s),
Name of Defendant(s)/Tenant(s).
Other (Required Notices Attached)
Address of Rental Premises: .
(name of owner)
Plaintiff is the owner or (check one) agent, assignee, grantee or prime tenant of the owner.
The landlord did did not acquire ownership of the property from the tenant(s).
The landlord has has not given the tenant(s) an option to purchase the property.
The tenant(s) now reside(s) in and has (have) been in possession of these premises since (date) ,
under (check one)
written or oral agreement
Check here if the tenancy is subsidized pursuant to either a federal or state program or the rental unit is
The landlord has registered the leasehold and notified tenant as required by N.J.S.A. 46:8-27.
The amount that must be paid by the tenant(s) for these premises is $ , payable on the day of each
month or week in advance.
Complete Paragraphs 9A and 9B if Complaint is for Non-Payment of Rent