Free CIVIL CASE INFORMATION STATEMENT - New Jersey

Appendix XII-B1

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CIVIL CASE INFORMATION STATEMENT
(CIS)
Use for initial Law Division Civil Part pleadings (not motions) under Rule 4:5-1 Pleading will be rejected for filing, under Rule 1:5-6(c), if information above the black bar is not completed or if attorney's signature is not affixed.
ATTORNEY/PRO SE NAME TELEPHONE NUMBER

FOR USE BY CLERK'S OFFICE ONLY

PAYMENT TYPE: CK CHG/CK NO. AMOUNT: OVERPAYMENT: BATCH NUMBER:

CG

CA

COUNTY OF VENUE

(
FIRM NAME (If applicable)

)
DOCKET NUMBER (When available)

OFFICE ADDRESS

DOCUMENT TYPE

JURY DEMAND YES NAME OF PARTY (e.g., John Doe, Plaintiff) CAPTION NO

CASE TYPE NUMBER (See reverse side for listing)

IS THIS A PROFESSIONAL MALPRACTICE CASE?

YES

NO

IF YOU HAVE CHECKED "YES," SEE N.J.S.A. 2A:53A-27 AND APPLICABLE CASE LAW REGARDING YOUR OBLIGATION TO FILE AN AFFIDAVIT OF MERIT.

RELATED CASES PENDING? YES NO DO YOU ANTICIPATE ADDING ANY PARTIES (arising out of same transaction or occurrence)?

IF YES, LIST DOCKET NUMBERS

NAME OF DEFENDANT'S PRIMARY INSURANCE COMPANY, IF KNOWN YES NO NONE UNKNOWN

THE INFORMATION PROVIDED ON THIS FORM CANNOT BE INTRODUCED INTO EVIDENCE.
CASE CHARACTERISTICS FOR PURPOSES OF DETERMINING IF CASE IS APPROPRIATE FOR MEDIATION DO PARTIES HAVE A CURRENT, PAST OR RECURRENT RELATIONSHIP? YES IF YES, IS THAT RELATIONSHIP NO EMPLOYER-EMPLOYEE FAMILIAL FRIEND/NEIGHBOR BUSINESS

OTHER (explain)

DOES THE STATUTE GOVERNING THIS YES NO CASE PROVIDE FOR PAYMENT OF FEES BY THE LOSING PARTY? USE THIS SPACE TO ALERT THE COURT TO ANY SPECIAL CASE CHARACTERISTICS THAT MAY WARRANT INDIVIDUAL MANAGEMENT OR ACCELERATED DISPOSITION:

DO YOU OR YOUR CLIENT NEED ANY DISABILITY ACCOMMODATIONS? WILL AN INTERPRETER BE NEEDED?

YES

NO

IF YES, PLEASE IDENTIFY THE REQUESTED ACCOMMODATION:

YES ATTORNEY SIGNATURE

NO

IF YES, FOR WHAT LANGUAGE:

Revised 03/2009, CN 10517-English

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CIVIL CASE INFORMATION STATEMENT
(CIS)
Use for initial pleadings (not motions) under Rule 4:5-1

CASE TYPES (Choose one and enter number of case type in appropriate space on the reverse side.)
Track I -- 150 days' discovery
151 175 302 399 502 505 506 510 511 512 801 802 999 NAME CHANGE FORFEITURE TENANCY REAL PROPERTY (other than Tenancy, Contract, Condemnation, Complex Commercial or Construction) BOOK ACCOUNT (debt collection matters only) OTHER INSURANCE CLAIM (INCLUDING DECLARATORY JUDGMENT ACTIONS) PIP COVERAGE UM or UIM CLAIM ACTION ON NEGOTIABLE INSTRUMENT LEMON LAW SUMMARY ACTION OPEN PUBLIC RECORDS ACT (SUMMARY ACTION) OTHER (Briefly describe nature of action)

Track II -- 300 days' discovery
305 509 599 603 605 610 699 CONSTRUCTION EMPLOYMENT (other than CEPA or LAD) CONTRACT/COMMERCIAL TRANSACTION AUTO NEGLIGENCE ­ PERSONAL INJURY PERSONAL INJURY AUTO NEGLIGENCE ­ PROPERTY DAMAGE TORT ­ OTHER

Track III -- 450 days' discovery
005 301 602 604 606 607 608 609 616 617 618 620 CIVIL RIGHTS CONDEMNATION ASSAULT AND BATTERY MEDICAL MALPRACTICE PRODUCT LIABILITY PROFESSIONAL MALPRACTICE TOXIC TORT DEFAMATION WHISTLEBLOWER / CONSCIENTIOUS EMPLOYEE PROTECTION ACT (CEPA) CASES INVERSE CONDEMNATION LAW AGAINST DISCRIMINATION (LAD) CASES FALSE CLAIMS ACT

Track IV -- Active Case Management by Individual Judge / 450 days' discovery
156 280 303 508 513 514 701 ENVIRONMENTAL/ENVIRONMENTAL COVERAGE LITIGATION ZELNORM MT. LAUREL COMPLEX COMMERCIAL COMPLEX CONSTRUCTION INSURANCE FRAUD ACTIONS IN LIEU OF PREROGATIVE WRITS

Mass Tort (Track IV)
248 266 271 272 274 275 276 277 CIBA GEIGY HORMONE REPLACEMENT THERAPY (HRT) ACCUTANE BEXTRA/CELEBREX RISPERDAL/SEROQUEL/ZYPREXA ORTHO EVRA DEPO-PROVERA MAHWAH TOXIC DUMP SITE 278 279 281 282 283 284 601 619 ZOMETA/AREDIA GADOLINIUM BRISTOL-MYERS SQUIBB ENVIRONMENTAL FOSAMAX DIGITEK NUVARING ASBESTOS VIOXX

If you believe this case requires a track other than that provided above, please indicate the reason on Side 1, in the space under "Case Characteristics." Please check off each applicable category:

Verbal Threshold
Revised 03/2009, CN 10517-English

Putative Class Action

Title 59
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