SUPERIOR COURT OF NEW JERSEY
LAW DIVISION
County
Docket Number
Your Name (first, middle, last)
(to be filled in by the court)
Street Address
Town, State, Zip Code
Telephone Number
Plaintiff
V.
Defendant
CIVIL ACTION
Complaint
Plaintiff, , residing at
(your name)
City of ,
(your address) (your city or town)
County of .
(your county)
State Of New Jersey, complaining of defendant, states as follows:
1. On , 20 , , Defendant
(name of person being sued)
(Summarize what happened that resulted in your claim against the defendant. Use
additional pages if necessary.)
Published 4/1/2008, CN 11210-English Page 1 of 3
The defendant in this action resides at ,
(defendant’s address)
In the County of , State Of New Jersey.
(name of county where defendant lives)
2. Plaintiff is entitled to relief from defendant under the above facts.
3. The harm that occurred as a result of defendant’s acts include:
(list each item of damage and injury),
1.
2.
3.
Wherefore, plaintiff requests judgment against defendant for damages, together
with attorney’s fees, if applicable, costs of suit, and any other relief as the court
may deem proper.
Dated: Signature:
CERTIFICATION OF NO OTHER ACTIONS
I certify that the dispute about which I am suing is not the subject of any other
action pending in any other court or a pending arbitration proceeding to the best
of my knowledge and belief. Also, to the best of my knowledge and belief no
other action or arbitration proceeding is contemplated. Further, other than the
parties set forth in this complaint, I know of no other parties that should be made
a part of this lawsuit. In addition, I recognize my continuing obligation to file and
Published 4/1/2008, CN 11210-English Page 2 of 3
serve on all parties and the court an amended certification if there is a change in
the facts stated in this original certification.
Dated: Signature:
OPTIONAL: If you would like to have a judge decide your case, do not include the
following paragraph in your complaint. If you would prefer to have a jury to
decide your case, please sign your name after the following paragraph.
JURY DEMAND
The plaintiff demands trial by a jury on all of the triable issues of this complaint,
pursuant to New Jersey Court Rules 1:8-2(b) and 4:35-1(a).
Dated: Signature:
Published 4/1/2008, CN 11210-English Page 3 of 3
