CIVIL CASE INFORMATION STATEMENT WORKSHEET

(New Jersey Law Division – Civil Part CIS shadow, CN 10517 (App. XII-B1))

[// GUIDANCE: Use this to gather data before completing the official NJ CIS. Submit the CIS with the initial pleading per R. 4:5-1.]

1. CAPTION

text
SUPERIOR COURT OF NEW JERSEY
LAW DIVISION, CIVIL PART, COUNTY OF [COUNTY]

[PLAINTIFF/PETITIONER NAME], Plaintiff/Petitioner,
v. Docket No.: [TBD BY CLERK]
[DEFENDANT/RESPONDENT NAME], Defendant/Respondent.

2. CASE TYPE CODE & TRACK (CIS)

• CIS Case Type Code: [CODE] Description: [TEXT]
• Track: [ ] I [ ] II [ ] III [ ] IV (complex/commercial)

3. SPECIAL CASE CHARACTERISTICS (CIS-style prompts)

• Is this a complex commercial matter? [YES/NO]
• MCL (multicounty litigation) involved? [YES/NO] – If yes, which: [TEXT]
• Does this case involve allegations of discrimination/harassment (e.g., LAD) or sexual abuse? [YES/NO] – Notes: [TEXT]
• Insurance carrier(s) on risk: [TEXT]

4. AMOUNT / RELIEF (WORKSHEET)

• Monetary relief: $[AMOUNT] (exclusive of fees/costs)
• Non-monetary / equitable relief: [DESCRIBE]

5. ADR / MEDIATION EXPECTATION (worksheet prompt)

• Is this case appropriate for mediation/ADR? [YES/NO] – Notes: [TEXT]

6. JURY DEMAND

• [ ] Jury requested
• [ ] Non-jury

7. RELATED CASES (CIS-style)

• [ ] Yes (list docket numbers/courts): [DETAILS]
• [ ] No

8. PARTIES & COUNSEL

• Plaintiff/Petitioner(s): [NAME / ADDRESS / PHONE / EMAIL]
• Defendant/Respondent(s): [NAME / ADDRESS / PHONE / EMAIL]
• Additional parties: attach list if needed.
• Attorney: [NAME], NJ Bar [NUMBER], Firm: [FIRM], Address: [ADDRESS], Phone: [PHONE], Email: [EMAIL]
• [ ] Self-represented party

9. SERVICE & SPECIAL NOTES (WORKSHEET)

• Service addresses and method (sheriff/process server/certified mail): [DETAILS]
• Interpreter needed: [YES/NO] – Language: [SPECIFY]
• Accommodation needed (ADA/disability): [YES/NO] – Describe: [SPECIFY]

10. CERTIFICATION & SIGNATURE (CIS-style)

text
I certify that the foregoing information is true to the best of my knowledge. I understand this CIS must be served on all parties with the initial pleading under R. 4:5-1.

Date: [DATE]

____________________________________
[ATTORNEY NAME], NJ Bar [NUMBER] / Pro Se
Attorney for [PARTY]
[// GUIDANCE: File and serve the official NJ CIS (CN 10517) with the initial pleading. Include the correct case type code, track, and any required special case information.]***