APPENDIX XI-B. TENANCY SUMMONS
AND RETURN OF SERVICE (R. 6:2-1)
Plaintiff or Plaintiff’s Attorney Information: Superior Court of New Jersey
Name: _____________________________ Law Division, Special Civil Part
Address: ___________________________ __________________ County
___________________________________ ___________________________
Phone: (___)_________________________ ___________________________
(____)______________________
______________________________, Plaintiff(s) Docket Number: LT - _____________
(to be provided by the court)
versus
Civil Action
______________________________, Defendant(s) SUMMONS
LANDLORD/TENANT
Defendant Information:
Name: __________________________ ___Nonpayment
Address: _________________________ ___Other
_________________________________
Phone:(___)_______________________
NOTICE TO TENANT: The purpose of the attached complaint is to permanently remove you
and your belongings from the premises. If you want the court to hear your side of the case you
must appear in court on this date and time: _____________ at ________ a.m./p.m., or the court
may rule against you. REPORT TO: ___________________________________
If you cannot afford to pay for a lawyer, free legal advice may be available by contacting Legal
Services at ________________. If you can afford to pay a lawyer but do not know one, you may call
the Lawyer Referral Services of your local county Bar Association at _______________.
You may be eligible for housing assistance. To determine your eligibility, you must immediately
contact the welfare agency in your county at __________________, telephone number
____________________.
If you need an interpreter or an accommodation for a disability, you must notify the court immediately.
Si Ud. no tiene dinero para pagar a un abogado, es posible que pueda recibir consejos legales gratuitos
si se comunica con Servicios Legales (Legal Services) al ____________. Si tiene dinero para pagar a
un abogado pero no conoce ninguno puede llamar a Servicios de Recomendación de Abogados (Lawyer
Referral Services) del Colegio de Abogados (Bar Association) de su condado local
al_________________.
Es posible que pueda recibir asistencia con la vivienda si se comunica con la agencia de asistencia
publica (welfare agency) de su condado al _____________________________________, telefono
___________.
Si necesita un interprete o alguna acomodación para un impedimento fisico, tiene que notificárselo
inmediatamente al tribunal.
Date: ___________________ _________________________________________
Clerk of the Special Civil Part
COURT OFFICER’S RETURN OF SERVICE (FOR COURT USE ONLY)
Docket Number: ________________________Date: __________________Time: ______________
WM ___ WF ___ BM ___ BF OTHER _____ HT ____ WT _____ AGE ___ MUSTACHE ___ BEARD ___ GLASSES___
NAME: ____________________________RELATIONSHIP: __________
Description of Premises__________________________________________________________________________________
_____________________________________________________________________________________________________
I hereby certify the above to be true and accurate: _________________________________________________________
Court Officer
[Note: Former Appendix XI-B, consisting of model tenancy complaint and summons forms, deleted, and new
tenancy summons and return of service form adopted July 12, 2002 to be effective September 3, 2002; amended
July 27, 2006 to be effective September 1, 2006.]
