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SMALL CLAIMS COMPLAINT (Motor Vehicle)

Name of Attorney for Plaintiff (if any) Address Telephone No.

Name of Court Address Telephone No.

From Plaintiff:
Name: Address

SUPERIOR COURT OF NEW JERSEY LAW DIVISON SPECIAL CIVIL PART County

Telephone No.

To Defendant:
Name: Address Telephone No.

CIVIL ACTION COMPLAINT Motor Vehicle
COMPLAINT

Plaintiff says the negligence of the defendant operator and/or defendant owner caused a motor vehicle accident resulting in property damage to plaintiff's vehicle, in the following accident:
1. Date of Accident:_____________________ 2. Name of Defendant(s): a) Owner:____________________________ b) Operator:__________________________ 3. Place of Accident: a) Street:____________________________________ b) Municipality:______________________________ c) County:___________________________________

Demand: $_________________ IMPORTANT: Plaintiffs and defendants must bring all witnesses, photos, estimates, documents, other evidence and an interpreter, if necessary, to the hearing. Subpoena forms are available at the Clerk's office to require the attendance of witnesses. Plaintiff will use an interpreter fluent in the __________________________ language at the hearing. 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. _________________
Date

________________________________
Plaintiff Signature

________________________________
Plaintiff Name ­ Typed, Stamped or Printed

Revised 07/13/2000, CN 10533-English

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