Effective 09/01/2021, CN 12778
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, active credit card number or military status.
New Jersey Judiciary
Civil Practice Division
Tenant Case Information Statement (TCIS)
Note: The Judiciary website contains a list of online resources with information related to defending your case, access to legal representation, and
available rental resources. You should review this information and obtain legal counsel if possible.
Docket Number
Name of Defendant(s)/Tenant(s)
Daytime Phone Number(s) of Tenant(s)
Email Address(es)
Attorney Name and Firm (if applicable)
Email Address
Attorney/Defendant Mailing Address
Attorney Daytime Telephone Number
Amount of Monthly Base Rent
The information provided on this form cannot be introduced into evidence
Have you applied (or has the landlord applied on your behalf) for any emergency rental
assistance from any federal, state, or local program related to COVID-19?
Yes No
Have you asked the landlord to apply any or all of your security deposit toward rent?
Yes No
Select the statement that best describes your situation:
The amount of rent my landlord demands in the complaint is not correct.
Yes No
The government helps pay my rent, but the amount that the landlord says I owe is the
government’s portion.
Yes No
Do you have a disagreement with this landlord about the condition of the property or another
issue? Common defenses are posted on the Judiciary’s website:
Yes No
Additional information for the court about this case or my disagreement with the landlord (attach additional pages
if necessary)
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).
I certify that the foregoing statements made by me are true to the best of my knowledge. I am aware that if any of the
foregoing statements made by me are willfully false, I am subject to punishment.
Attorney/Defendant Signature
Print Attorney/Defendant Name