New Jersey Residential Eviction Complaint (Appendix XI-X) - Preparation Worksheet
NEW JERSEY RESIDENTIAL EVICTION COMPLAINT — PREPARATION WORKSHEET (APPENDIX XI-X)
Use the Judiciary's current Form A, Appendix XI-X to file a residential possession case. This worksheet organizes the facts and calculations for that form; it is not the court complaint or summons. The same Judiciary packet contains Form B (summons), Form C (Landlord Case Information Statement), and Form D (lease and registration certification). Check the current packet before filing.
Property address and unit: [________________________________]
County: [________________________________] Prepared on: [__/__/____]
1. Parties and case type — Form A caption and items 1–3
Plaintiff/landlord legal name: [________________________________]
Owner of record, if different: [________________________________]
Plaintiff's relationship to owner: ☐ Owner ☐ Agent ☐ Assignee ☐ Grantee ☐ Sublessor
Owner's organization: ☐ Individual ☐ Sole proprietorship ☐ General partnership ☐ Professional corporation ☐ LLC ☐ Other: [____________]
Defendant tenant name(s): [________________________________]
Tenant phone/email, if known: [________________________________]
Ground shown on Form A: ☐ Nonpayment of rent ☐ Other cause (attach required notices)
Plaintiff or attorney address, email, telephone, and attorney ID if applicable: [____________________________________________________________]
2. Property, lease, and notices — Form A items 4–13
Did landlord acquire ownership from a tenant? ☐ Yes ☐ No ☐ Unknown
Was tenant given an option to buy? ☐ Yes ☐ No ☐ Unknown
Is property owner occupied with no more than two rental units? ☐ Yes ☐ No ☐ Unknown
Rental property registered? ☐ Yes ☐ No ☐ Exempt ☐ Unknown
Tenant received registration copy? ☐ Yes ☐ No ☐ Unknown
If exempt from registration, identify the claimed exemption: [________________________________]
Tenant in possession without landlord's consent? ☐ Yes ☐ No ☐ Unknown
Lease: ☐ Oral ☐ Written. If written, attach it or the relevant portions required by Form A.
Written lease length: [____] pages. Attached sections addressing additional rent or rental-assistance notice and eviction grounds: [________________________________]
Federal/state subsidy or public housing: ☐ Yes ☐ No ☐ Unknown. Program/type: [____________]
Notices to tenant and/or housing authority required for this cause: ☐ Served and attached ☐ Not served ☐ Not applicable. Identify each notice and actual service date: [____________________________________________________________]
3. Nonpayment figures — Form A items 14–23
Base rent: $[____________] ☐ per month ☐ per week. Rent due day: [____]
List only the tenant's unpaid base rent. Keep amounts owed by a housing provider separate, as Form A instructs.
| Rent period | Tenant base rent due | Tenant payments/credits | Unpaid tenant base rent |
|---|---|---|---|
| [____________] | $[____] | $[____] | $[____] |
| [____________] | $[____] | $[____] | $[____] |
| [____________] | $[____] | $[____] | $[____] |
| [____________] | $[____] | $[____] | $[____] |
| Total base rent due from tenant | $[____] |
Municipality: [________________________________] Rent control/leveling applies? ☐ Yes ☐ No ☐ Unknown
Written lease specifies late fees, attorney fees, or other charges as additional rent? ☐ Yes ☐ No ☐ Unknown
If claimed, identify each permissible additional-rent charge, period, lease provision, and legal basis:
| Charge and period | Lease provision | Amount | Basis for including it |
|---|---|---|---|
| [____________] | [____________] | $[____] | [____________] |
| [____________] | [____________] | $[____] | [____________] |
| Total permissible additional rent | $[____] |
Filing fees actually paid: $[____]
Total currently claimed on Form A item 20: $[____] = base rent + permissible additional rent + filing fees.
Written rent ledger exists? ☐ Yes ☐ No. If yes, attached? ☐ Yes ☐ No
Next rent due date: [__/__/____] Next tenant base rent amount: $[____]
Amount to dismiss if trial occurs before next due date: $[____] (Form A item 20 total)
Amount to dismiss if trial occurs on or after next due date: $[____] (preceding amount plus next rent due)
Form A says these dismissal amounts exclude late fees and attorney fees for Section 8 and public housing tenants. It also states that payment may be made to the landlord or clerk before trial, while payment on the trial date must be made by 4:30 p.m. to obtain dismissal. In a nonpayment case, § 2A:42-10.16a provides a separate three-business-day payment period after warrant posting or lockout. Confirm the current form and amounts before filing or communicating a cure figure.
4. Other cause — Form A item 24
Cause selected from Form C's holdover-cause list: [________________________________]
Facts, dates, persons, and lease term or document supporting that cause: [____________________________________________________________]
Required notice(s), service method/date, and attachments: [____________________________________________________________]
If more room is needed, prepare an attachment for the official form: [________________________________]
5. Verification and accompanying court forms
The landlord or authorized partner/officer signing Form A should check the completed official complaint against personal knowledge and identify any other pending or contemplated action and any party who should be joined. Remove confidential personal identifiers from the filing. The Judiciary's Form A supplies the required verification text and signature block; sign that form, not this worksheet.
Person who will verify Form A and capacity: [________________________________]
Other action, arbitration, or missing party to disclose on Form A: ☐ None ☐ Details: [________________________________]
Interpreter needed at trial? ☐ Yes, language: [____________] ☐ No
Disability accommodation needed? ☐ Yes, describe: [____________] ☐ No
| Judiciary filing item | Prepared / attached | Notes |
|---|---|---|
| Current Appendix XI-X Form A complaint and its verification | ☐ | [____________] |
| Current Form B summons | ☐ | [____________] |
| Current Form C Landlord Case Information Statement | ☐ | [____________] |
| Current Form D lease and registration certification | ☐ | [____________] |
| Written lease or required relevant portions | ☐ N/A ☐ | [____________] |
| Required notices and proof of service | ☐ N/A ☐ | [____________] |
| Rent ledger, if one exists | ☐ N/A ☐ | [____________] |
| Other required case-specific attachments | ☐ N/A ☐ | [____________] |
Prepared by: [________________________________] Date: [__/__/____]
Official source
About this template
- Last updated
- October 29, 2026
- Jurisdiction
- New Jersey
- Category
- Landlord & Tenant
Legal authority
- N.J. Ct. R. 6:3-4(c) (mandatory Appendix XI-X residential possession complaint)
- N.J.S.A. § 2A:42-10.16a (Post-warrant or lockout payment period in nonpayment cases)
Landlord-tenant paperwork governs who can stay in a property, on what terms, and what happens when something goes wrong. Leases, notices to quit, security deposit demands, and habitability complaints all have state and often city-specific requirements for timing, content, and service. Getting the paperwork right is what makes an eviction actually succeed or a security deposit actually come back, because judges regularly dismiss cases over small procedural mistakes.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
The statutes this template relies on are listed under Legal authority.
N.J.S.A. § 2A:42-10.16a(a) (P.L.2019, c.316) (checked October 29, 2026): "a period of three business days after the date on which a warrant for removal is posted to the unit or a lockout is executed due to nonpayment of rent"
N.J. Ct. R. 6:3-4(c) and Appendix XI-X (checked October 20, 2026): "Effective September 1, 2025, Rule 6:3-4(c) was amended to require that complaints in summary actions for possession of residential premises be in the form set forth in Appendix XI-X to the Rules of Court."
New Jersey Judiciary Form A, Appendix XI-X (revised 09/2025) (checked October 20, 2026): "The date that the next rent is due is (date)"
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