Fill and Sign the Justia Small Claims Complaint and Summons Motor Vehicle Form

CIVIL – SCP - Small Claims – Non -Motor Vehicle Revised 11 /17/2014, CN 10151 page 6 of 9 Instructions for Completing Form A Small Claims Complaint - Contract or Tort A. Fill in the required information at the top of the form. In the section below t he Docket No. , check the one it em that applies to your type of claim: • Contract : Your case involves a written or oral agreement between you and another per son or company. • Security Deposit : You want to recover the money you gave a landlord to secure a place for you to le ase. • Rent Owed : You are a landlord trying to collect the money owed to you by a tenant. • Tort other than a motor vehicle : You are asking to be paid for injuries to you or your property resulting from an event other than a motor vehicle accident. NOTE: You cannot use this pa cket if you are asking to be paid for injuries to you or your property resulting from a motor vehicle accident. You can obtain a motor vehicle packet from the court. B . In the section labeled Complaint, type or print the amount of money you believe you are owed after the word Demand . In the blank spaces in the center of the complaint, you must explain the reasons you ar e suing the Defendant in detail. (Note: You may attach more sheets if you need to.) Some reasons you might sue a person or company are: • a person or company did not comply with a written or oral contract; • you paid money as a down payment and want it returned; • your property was damaged or lost; • merchandise you bought is defective; • work you paid for was faulty or not completed; • you want to be paid for work you did; • someone wrote you a bad check; • you gave a landlord a security deposit that was not returned. C. Complete the information regarding interpreters or accommodation for a d isability. D. If the Complaint (Form A) or any of the copies of papers that you attach to the complaint conta in a Social Security number, driver’s license number, vehicle plate number, insurance poli cy number, active financial account number or active credit card number, you must redact (black out) this inf ormation so that it cannot be seen, unless any such personal identifier is required to be included by statut e, rule, administrative directive or court order. If an active financial account is the subject of your case and cann ot otherwise be identified, you may use the last four digits of the account to identify it. NOTE: Do not redact (black out) this information in the original paper s that you are keeping since you may have to show them to the court at some point. E. Date and sign the form. IMPORTANT NOTE: You cannot sue in Small Claims Court for a malpractice claim against a doctor, dentist, lawyer or other professional. You cannot sue in Small Claims Court or in Special Civil Part for: • a claim for child support and/or alimony • a claim arising from a probate matter, such as a will. SMALL CLAIMS COMPLAINT (Contract, Security Deposit, Rent, or Tort) 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: Name NJ Attorney ID Number Address Superior Court of New Jersey Telephone Number Law Division, Special Civil Part Small Claims Section County Docket No: From Plaintiff (to be provided by the court) Name Civil Action Complaint Address Telephone Number To Defendant Check One: Name Contract Address Security D eposit Rent Telephone Number Personal Injury or Property Damage (other than motor vehicle) COMPLAINT Demand: $ plus costs. Type or print the reasons you, the Plaintiff(s), are suing the Defendant( s): Attach additional sheets if necessary. IMPORTANT: Plaintiffs and defendants must bring all witnesses, photos, and documents, and ot her 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 Disabili ty I certify that the matter in controversy is not the subject of any other c ourt action or arbitration proceeding, now pending or contemplated, and that no other parties should be joined in this action. I certify that confidential personal identifiers h ave 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 page 7 of 9 Revised 11/17/2014 , CN 10151 Revised 09/04/2012, CN 10532 (Appendix XI -C) ext. ext. ext.