Promulgated by Directive #26-19 (12/20/2019), CN 11823
New Jersey Judiciary
Municipal Court of New Jersey
Complaint Information Form
Instructions: Please complete the following information to the best of your ability. This information will help in the preparation of the
complaint.
Your Name (you are the complainant)
Street Address
City
State
Zip
Telephone Number
Email Address
Defendant’s Name
Street Address
City
State
Zip
Telephone Number (if known)
Driver’s License (if known)
State
Is the person you are charging an elected public official or a candidate for elected public office?
Yes
No
If yes, provide any information regarding what elected office the person is a candidate for or currently holds.
If this is a motor vehicle complaint list:
License Plate # of Other Vehicle
State
Description of vehicle (if known)
Names and addresses of witnesses (use additional paper if necessary)
Name
Address
For Court Use Only
Court Administrator/Deputy Initials:
Date:
Corresponding Complaint Numbers:
(Every request requires the filing of a complaint.)
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Revised 04/2017, CN 11822
New Jersey Judiciary
Municipal Court of New Jersey
Certification in Support of Probable Cause
State of New Jersey
Municipal Court Name
County of
Court Address
City
Zip
Date of Incident
Location of Incident
Municipality
I offer the following facts and information to establish probable cause in this complaint against
(Defendant’s name) , whom I would like to charge with (list Statutes
or Ordinances):
How do you know the identity of the person you are charging?
Describe the incident in detail:
Certification: I certify that the foregoing statements made by me are true. I am aware that if any of the
foregoing statements made by me are willfully false, I am subject to punishment.
Date
Signature of Complaining Witness
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Stafford Township
Ocean
260 East Bay Ave
Manahawkin
08050
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