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:
Superior Court of New Jersey
Law Division, Special Civil Part
(to be provided by the court)
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:
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 accommodation for 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.
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
Plaintiff’s Name Typed, Stamped or Printed