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 Telephone Number Superior Court of New Jersey Law Division, Special Civil Part Small Claims Section County Docket No: (to be provided by the court) From Plaintiff Name Address Telephone Number Civil Action Complaint Check One: Contract Security Deposit Rent Personal Injury or Property Damage (other than motor vehicle) To Defendant Name Address Telephone Number 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 other 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 An accommodation for disability Yes Yes No No Indicate Language Indicate Disability 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. I certify that confidential personal identifiers have 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 Revised 09/04/2012, CN 10532 (Appendix XI-C) American LegalNet, Inc. www.FormsWorkFlow.com