Fill and Sign the New Jersey Collision Form

JOHN LAWYER, ESQ. 12 Main Street Anywhere, USA Attorney for Plaintiff ________________________________ JANE DOE, : SUPERIOR COURT OF NEW JERSEY : [INSERT] COUNTY : LAW DIVISION : Plaintiff, : DOCKET NO. vs. : : CIVIL ACTION : ABC TRANSIT CORP. : COMPLAINT, JURY DEMAND, : AND TRIAL ATTORNEY : DESIGNATION : : Defendant. : ________________________________ : Plaintiff, Jane Doe, residing at [insert address], by way of complaint against the defendant state: FIRST COUNT On [insert date], plaintiff was in A stop and go @ traffic on [insert]. She was [insert accident information], when her car was rammed in the rear by a bus driven by an unidentified driver. The bus was a ABC Transit Corp. vehicle, identified by the number. As a result of the accident, plaintiff incurred painful and severe physical injuries, which required medical treatment. Said injuries have caused her great pain and suffering, will continue to do so in the future, and are permanent in nature. Defendant = s employee was negligent in the operation of the bus because she failed to safely control the vehicle. Notice of claim was served on the defendant and the Attorney General, on [insert date], by regular and certified mail. By letter dated [insert date], plaintiff forwarded answers to the A Claims for Damages Against ABCTransit @ provided by defendant = s claims department. More than [insert] months have passed and plaintiff = s claims remains unsatisfied. WHEREFORE, Plaintiff demands judgment against the defendant, ABC Transit Corp., for damages, interest and costs of suit. JURY DEMAND The Plaintiff, Jane Doe hereby demand trial by a jury on all triable issues of this Complaint. Dated: _______________________________ JOHN LAWYER DESIGNATION OF TRIAL COUNSEL Pursuant to rule 4:25-4, John Lawyer, is hereby designated as trial counsel for Plaintiffs, Jane Doe, in the above matter. Dated: ___________________________ JOHN DOE CERTIFICATION OF NO OTHER ACTION Pursuant to rule 4:5-1, it is hereby stated that the matter in controversy is not the subject of any other action pending in any other Court or of a pending Arbitration Proceeding to the best of my knowledge or belief. Also, to the best of my belief, no other action or Arbitration Proceeding is contemplated. Further, other than the parties set forth in this pleading, we know of no other parties that should be joined in the above action. In addition, we recognize the continuing obligation of each party to file and serve on all parties and the Court an amended Certification if there is a change in the facts stated in this original Certification. Dated: ___________________________ JOHN LAWYER