Fill and Sign the Akize Nan Ka Sivil Yo Epi Ki Pa Reprezante Pa Yon Avoka L Y Ap Ranpli Deklarasyon Sou Form

Revizyon Fòm ki pwomilge disi le 07/01/2019 ak Avi ba Bawo Avoka yo, CN 10517_ps-Haitian Creole paj 1 nan 5 Revised Form Promulgated by 07/01/2019 Notice to the Bar , CN 10517_ps- Haitian Creole page 1 of 5 Dwa - Sivil Deklarasyon sou enfòmasyon ka sivil Jiyè 01, 2019 Fason Pou Ranpli Deklarasyon Sou Enfòmasyon Ka Sivil (Civil Case Information Statement - CIS) How to Complete the Civil Case Information Statement (CIS) – Haitian Creole Eksplikasyon sa yo la pou sèvi kòm gid pou endividyèl ki swa se moun ki pote plent la oswa akize nan ka sivil yo epi ki pa reprezante pa yon avoka lè y ap ranpli Deklarasyon sou Enfòmasyon Ka Sivil ( Civil Case Information Statement, CIS Sivil) ki obligatwa dapre règ tribinal la. CIS Sivil la dwe enkli avèk premye siplikasyon chak pati nan pati Sivil la nan Divizyon Dwa a. Sa vle di, moun ki pote plent la dwe prezante li avèk plen t la, epi akize a dwe prezante li avèk repons la. Si li pa enkli, yap retounnen tout dokiman yo. CIS la rezime ka w epi li enfòme tribinal la sou nenpòt bezwen espesyal ou gen dwa gen tankou nesesite pou yon entèprèt oswa nesesite pou yon pwosè rapid pask e youn nan temwen ou prevwa pou pa disponib. Nimewo pou plizyè kalite ka yo kapab jwenn sou lòt bò fòm la. Enkri nimewo a ki pi byen dekri plent ou. Pa egzanp, si w ap pote plent kont akize pou yon brèch nan kontra a, nimewo ka w ta 599 . Apre w fin ranpl i CIS la, kenbe li avèk lòt papye w gen lentansyon prezante Remak: Se Biwo Administratif Tribinal Nyoudjèze ( New Jersey Administrative Office of the Courts ) ki prepare dokiman sa yo pou itilizasyon pa moun yo k ap reprezante tèt yo . Direktiv, enstriksyon, ak fòm yo pral mete ajou detanzantan lè li nesesè pou reflete lwa ak règ tribinal Nyoudjèze. Dènye vèsyon fòm yo pral disponib nan palè jistis konte a oswa sou sit entènèt Jidisyè a njcourts.gov (nan lang angle). Sepandan, se oumenm ki finalman responsab pou kontni papye tribinal ou. Tout plent, petisyon ak lòt papye ki soumèt ba tribinal la fèt pou an angle Complaints, motions and other papers submitted to the court should be in English Revizyon Fòm ki pwomilge disi le 07/01/2019 ak Avi ba Bawo Avoka yo, CN 10517_ps-Haitian Creole paj 2 nan 5 Revised Form Promulgated by 07/01/2019 Notice to the Bar , CN 10517_ps- Haitian Creole page 2 of 5 Enstriksyon pou pati ki pa gen yon avoka pou ede yo ranpli Deklarasyon Sou Enfòmasyon Ka Sivil (CIS) Kare # Eksplikasyon 1. Ekri non ou nan lèt majiskil. 2. Ekri yon nimewo telefòn, ki enkli kòd rejyonal la, kote nou kapab kontakte ou pandan lajounen. 3. Ekri non konte a kote plent la prezante oswa kote repons la ap prezante. 4. Kite kaz la vid. 5. Si w konnen nimewo dosye w, mete li nan kaz nimewo dosye a. Si CIS la ap prezante avèk yon plent, tribinal la pral asi yen yon nimewo dosye anvan li retounen plent la ki te prezante. 6. Ekri yon adrès kote w vle resevwa lapòs konsènan zafè sa a. 7. Tip dokiman vle di kalite dokiman w ap prezante. Si w ap prezante plent la, enprime plent lan; si w ap prezante repons la, enprime repons la. 8. Tcheke kare ki make “ Yes ” (wi) si w te mande pou yon jiri tande zafè a. Sinon, tcheke “ No ” (non) 9. Ekri non ou epi endike si w se moun k ap pote plent la oswa akize a. 10. Tit la se non ka a – non moun k ap pote plent la kont non akize a (yo). Pa egzanp: John Doe, Moun k ap Pote Plent la kont Mary Smith, Akize a. Enprime non ka w. 11. Nimewo Tip Ka a idantifye tip ka a. Wap jwenn nan do fòm CIS la lis tip ka yo. Pafwa li difisil pou chwazi nimewo ka w, men ou dwe ranpli seks yon sa a pou ka w kontinye. Chwazi sa a ki pi byen dekri enfòmasyon konsènan ka w epi ekri nimewo sa a. Pa egzanp, si w se moun k ap pote plent la oswa si w se akize a nan yon dispit konsènan yon vyolasyon nan kontra, tip ka a se 599; si ka w konsènan yon domajman pèsonèl, nimewo tip ka a se 605. 12. Si w kwè ka w se yon ka ne glijans pwofesyonèl, tcheke kare ki make “Yes” (wi) epi ale nan N.J.S.A . 2A:53A -27 ak lwa aplikab la ki chita sou a nsyen desizyon tribinal la konsènan obligasyon ou pou prezante yon fòm afidavi merit. 13. Si w kwè ke w gen nenpòt lòt ka ki konsène menm advèsè a oswa ki sòti nan men m seri sikonstans yo, tcheke kare ki make “Yes” (wi). Sinon, tcheke “No” (non). 14. Si w te tcheke “Yes” (wi) nan kesyon anvan an, ekri nimewo d osye (yo) nenpòt ka ki gen rapò ak ka a. 15. Si w kwè ou pral ajoute plis moun nan ka a, tcheke “wi.” Sinon, tcheke “No” (non). Revizyon Fòm ki pwomilge disi le 07/01/2019 ak Avi ba Bawo Avoka yo, CN 10517_ps-Haitian Creole paj 3 nan 5 Revised Form Promulgated by 07/01/2019 Notice to the Bar, CN 10517_ps - Haitian Creole page 3 of 5 16. Si w se moun k ap pote plent la epi si w konnen konpayi asirans pr ensipal akize a, ekri li nan kare la a. Si w pa konnen li, tcheke “pa konnen.” Si w se akize a epi si w gen asirans ki ta ka kouvri tout domaj oswa yon pati domaj yo ki mansyone nan plent la, ekri non konpayi asirans ou. 17. Si w ak advèsè w te konnen yo un ak lòt anvan evènman ki pwovoke pwosè a, tcheke “wi.” Sinon, tcheke “No” (non). Si repons la se te “Yes” (wi), tcheke kare ki akote mo (yo) ki pi byen dekri relasyon an ant pati yo. 18. Si w kwè ke lwa ki gouvènen ka w a egzije pati ki pèdi pwosè a pou peye frè yo (pa egzanp, Lalwa Kont Diskriminasyon), tcheke “wi.” Sinon, tcheke “No” (non). 19. Si w kwè ka w gen kèk sikonstans iregilye ki ta mande atansyon espesyal , endike pwoblèm la nan espas ki founi a. Pa egzanp, si gen yon temwen ki malad oswa ki gen dwa pa disponib, ou dwe fè t pou notifye pèsonèl tribinal la. 20. Si wap fè nenpòt demann pou akomode yon andikap , tcheke “Yes” (wi) epi endike kisa wap mande a. Sinon, tcheke “No” (non). 21. Si w fè demann pou yon entèprèt, tcheke “Yes” (wi) epi endike lang ki nesesè a. Sinon, tcheke “No” (non). 22. Kare sa a gen ladan deklarasyon ki di ke w sètifye ke w retire tout en fòmasyon konfidansyèl ki ta ka idantifye w sou nenpòt dokiman ou te soumèt deja ba tribinal la epitou w pral kontinye retire idantifyan sa yo pou tout soumisyon alavni yo, sof si lalwa ta egzije idantifyan konfidansyèl sa yo , règ tribinal oswa òdonans tribinal la. Si w ap prezante yon plent pou chanje non, N.J.S.A. 2A:52 -1 (lwa aplikab Nyoudjèze a) egzije pou nime wo sekirite sosyal la parèt sou plent la . Depi tribinal la pwononse yon jijman sou chanjman non an, tribinal la pral retire nimewo sekirite sosyal ou anvan jijman an pibliye nan jounal la. 23. Non moun lan ki parèt nan Kare 1 a fèt pou siyen CIS la nan espas ki make “Attorney Signature” (Siyati Avoka). Appendix XII-B1 Civil Case Information Statement (CIS) Use for initial Law Division Civil Part pleadings (not motions) under Rule 4:5 -1 Pleading will be rejected for filing, under Rule 1:5- 6(c), if information above the black bar is not completed or attorney’s signature is not affixed For Use by Clerk’s Office Only Payment type: ck cg ca Chg/ Ck Number: Amount : Overpayment : Batch Number : Attorney/Pro Se Name Telephone Number County of Venue Firm Name (if applicable) Docket Number (when available) Office Address Document Type Jury Demand Yes No Name of Party (e.g., John Doe, Plaintiff) Caption Case Type Number (See reverse side for listing) Is this a professional malpractice case? Yes No If you have checked “Yes,” see N.J.S.A. 2A:53 A-27 and applicable case law regarding your obligation to file an affidavit of merit. Related Cases Pending? If “Yes,” list docket numbers Yes No Do you anticipate adding any parties Name of defendant’s primary insurance company (if known) (arising out of same transaction or occurrence)? None Yes No Unknown The Information Provided on This Form Cannot be Introduced into Evidence. Case Characteristics for Purposes of Determining if Case is Appropriate for Mediation Do parties have a current, past or recurrent relationship? If “Yes, ” is that relationship: Yes No Employer/Employee Friend/Neighbor Other (explain) Familial Business Does the statute governing this case provide for payment of fees by the losing party? Yes No Use this space to alert the court to any special case characteristics that may warrant individual management o r accelerated disposition Do you or your client need any disability accommodations? If yes, please identify the requested accommodation : Yes No Will an interpreter be needed? If yes, for what language? Yes No 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). Attorney Signature: Revizyon Fòm ki pwomilge disi le 07/01/2019 ak Avi ba Bawo Avoka yo, CN 10517_ps -Haitian Creole paj 4 nan 5 Revised Form Promulgated by 07/01/2019 Notice to the Bar, CN 10517_ps - Haitian Creole page 4 of 5 Side 2 CIVIL CASE INFORMATION STATEMENT (CIS) Use for initial pleadings (not motions) under Rule 4:5 -1 CASE TYPES (Choose one and enter number of case type in appropriate space on the reverse side.) Track I - 150 days' discovery 151 NAME CHANGE 175 FORFEITURE 302 TENANCY 399 REAL PROPERTY (other than Tenancy, Contract, Condemnation, Complex Commercial or Construction) 502 BOOK ACCOUNT (debt collection matters only) 505 OTHER INSURANCE CLAIM (including declaratory judgment actions) 506 PIP COVERAGE 510 UM or UIM CLAIM (coverage issues only) 511 ACTION ON NEGOTIABLE INSTRUMENT 512 LEMON LAW 801 SUMMARY ACTION 802 OPEN PUBLIC RECORDS ACT (summary action) 999 OTHER (briefly describe nature of action) Track II - 300 days' discovery 305 CONSTRUCTION 509 EMPLOYMENT (other than CEPA or LAD) 599 CONTRACT/COMMERCIAL TRANSACTION 603N AUTO NEGLIGENCE – PERSONAL INJURY (non -verbal threshold) 603Y AUTO NEGLIGENCE – PERSONAL INJURY (verbal threshold) 605 PERSONAL INJURY 610 AUTO NEGLIGENCE – PROPERTY DAMAGE 621 UM or UIM CLAIM (includes bodily injury) 699 TORT – OTHER Track III - 450 days' discovery 005 CIVIL RIGHTS 301 CONDEMNATION 602 ASSAULT AND BATTERY 604 MEDICAL MALPRACTICE 606 PRODUCT LIABILITY 607 PROFESSIONAL MALPRACTICE 608 TOXIC TORT 609 DEFAMATION 616 WHISTLEBLOWER / CONSCIENTIOUS EMPLOYEE PROTECTION ACT (CEPA) CASES 617 INVERSE CONDEMNATION 618 LAW AGAINST DISCRIMINATION (LAD) CASES Track IV - Active Case Management by Individual Judge / 450 days' discover y 156 ENVIRONMENTAL/ENVIRONMENTAL COVERAGE LITIGATION 303 MT. LAUREL 508 COMPLEX COMMERCIAL 513 COMPLEX CONSTRUCTION 514 INSURANCE FRAUD 620 FALSE CLAIMS ACT 701 ACTIONS IN LIEU OF PREROGATIVE WRITS Multicounty Litigation (Track IV) 271 ACCUTANE/ISOTRETINOIN 297 MIRENA CONTRACEPTIVE DEVICE 274 RISPERDAL/SEROQUEL/ZYPREXA 299 OLMESARTAN MEDOXOMIL MEDICATIONS /BENICAR 281 BRISTOL -MYERS SQUIBB ENVIRONMENTAL 300 TALC -BASED BODY POWDERS 282 FOSAMAX 601 ASBESTOS 285 STRYKER TRIDENT HIP IMPLANTS 623 PROPECIA 286 LEVAQUIN 624 STRYKER LFIT CoCr V40 F EMORAL HEADS 289 REGLAN 625 FIREFIGHTER HEARING LOSS LITIGATION 291 PELVIC MESH/GYNECARE 626 ABILIFY 292 PELVIC MESH/BARD 627 PHYSIOMESH FLEXIBLE COMPOSITE MESH 293 DEPUY ASR HIP IMPLANT LITIGATION 628 TAXOTERE/DOCETAXEL 295 ALLODERM REGENERATIVE TISSUE MATRIX 629 ZOSTAVAX 296 STRYKER REJUVENATE/ABG II MODULAR HIP STEM COMPONENTS 630 PROCEED MESH/PATCH If you believe this case requires a track other than that provided above, please indicate the reason on Side 1, in the space under "Case Characteristics. Please check off each applicable category Putative Class Action Title 59 Revizyon Fòm ki pwomilge disi le 07/01/2019 ak Avi ba Bawo Avoka yo, CN 10517_ps -Haitian Creole paj 5 nan 5 Revised Form Promulgated by 07/01/2019 Notice to the Bar, CN 10517_ps - Haitian Creole page 5 of 5