Fillable SMALL CLAIMS COMPLAINT (Motor Vehicle) (NJ Judiciary)

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SMALL CLAIMS COMPLAINT (Motor Vehicle) (NJ Judiciary)

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SMALL CLAIMS COMPLAINT (Motor Vehicle)
Revised 09/04/2012, CN 10533-English (Appendix XI-D)
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:
Court
Name
Name of Court
NJ Attorney ID Number
Address
Telephone Number
Telephone Number
From Plaintiff
Superior Court of New Jersey
Name
Law Division, Special Civil Part
Address
Small Claims Section
County
Telephone Number
Docket No:
To Defendant
(to be provided by the court)
Name
Civil Action
Complaint
Motor Vehicle
Address
Telephone Number
COMPLAINT
Plaintiff says the negligence of the defendant operator and/or defendant owner caused a motor vehicle accident resulting
in property damage to plaintiff's vehicl
e, in the following accident:
1.
Date of Accident: .
3.
Place of Accident:
2.
Name of Defendant(s)
a)
Street: .
a)
Owner: .
b)
Municipality: .
b)
Operator: .
c)
County: .
Demand: $
.
IMPORTANT: Plaintiffs and defendants must bring all witnesses, photos, and documents, and other evidence to the
hearing. Subpoena forms are available at the Clerk’s office to require the attendance of witnesses.
At the trial Plaintiff will require:
An interpreter
Yes No
Indicate Language
An accommodation for disability
Yes No
Indicate Disability
I certify that the matter in controversy is not the subject of any other court action or arbitration proceeding, now pending
or contemplated, and that no other parties should be joined in this action.
I certify that confiden
tial 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).
Date
Plaintiff’s Signature
Plaintiff’s Name Typed, Stamped or Printed
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SMALL CLAIMS COMPLAINT (Motor Vehicle) (NJ Judiciary)

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Completed 21 July 2020

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