Fill and Sign the Claims Complaint Nj Form

APPENDIX XI-D. SMALL CLAIMS COMPLAINT (MOTOR VEHICLE) Name and Address of Attorney for Plaintiff Name and Address of Court Phone No. Phone No. From Plaintiff: SUPERIOR COURT OF NEWJERSEY Name _________________________________ LAW DIVISION, SPECIAL CIVIL PART Address _______________________________ ___________________________COUNTY City ______________ State _____ Zip ______ Phone No. _____________________________ SMALL CLAIMS SECTION CIVIL ACTION v. COMPLAINT To Defendant: Motor Vehicle Name _________________________________ Address _______________________________ City ______________ State _____ Zip ______ Phone No. _____________________________ 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 vehicle, 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, estimates, documents, other evidence and an interpreter, if necessary, to the hearing. Subpoena forms are available at the Clerk's office to require the attendance of witnesses. Plaintiff will use an interpreter fluent in the _______ language at the hearing. 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. Dated: ___________________________ ________________________________________ Plaintiff's Signature ________________________________________ Plaintiff's Name--Typed, Stamped, or Printed [Adopted effective January 2, 1989; amended June 29, 1990, effective September 4, 1990; amended July 10, 1998 to be effective September 1, 1998; amended July 5, 2000, effective September 5, 2000.]