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Civil Case Information Statement 10500 - New Jersey
| Civil Case Information Statement Form. This is a New Jersey form and can be used in Appellate Division Superior Court Statewide . |
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Civil Case Information Statement Form 1. 2. 3. Enter the caption or title of the case as it appears on the papers from the trial court or State agency from which you are appealing. Enter the number assigned the case by the trial court or agency from which you are appealing. Check the appropriate box indicating if you were the "Plaintiff", "Defendant", or "Other" below. As you are representing yourself pro se, enter your own name, address, including any email address, and daytime telephone number. If you are not an attorney at law admitted to practice in the State of New Jersey, the only "CLIENT" whom you can represent is yourself. Enter the names, addresses, including any email addresses, and telephone numbers of the attorneys who represented the other parties in the trial court or agency and the names of their clients. Briefly summarize the terms of the judgment, order or decision which is the subject of this appeal, including its date, and attach a copy. Answer whether there are any claims against any party below which have not been disposed of. If the answer is "No", then you may properly proceed with the filing of a notice of appeal. If the answer is "Yes", then you should immediately move for leave to appeal unless the trial court has certified the determination as final pursuant to Court Rule 4:42-2. If the determination does not disposes of all the claims as to all parties, and the trial court has not certified it as final pursuant to Court Rule 4:42-2, then leave to appeal must be sought. Answer whether any claims were dismissed without prejudice. If the answer is "Yes", explain any agreement concerning future disposition of those claims. Check the appropriate box. Briefly summarize the facts and the procedural history of the case. List the issues which you plan to raise in your appeal. If applicable, answer whether the trial judge issued oral or written findings or an opinion and, if so, set forth on what date. Answer whether you or anyone you know of has an appeal that is pending or about to be brought before this court which involves substantially the same case as your appeal. If you cannot answer "Yes" or "No", you may answer "Unknown". Answer whether you know of any other appeal that is pending or about to be brought before this court which involves an issue similar to or related to an issue in your appeal. If you do not have this information available and cannot answer "Yes" or "No", you may answer "Unknown". 4. 5. 6. 7. 8. 9. 10. 11. 12. Revised: 01/03/2011, CN 10500 (Appellate Civil CIS) American LegalNet, Inc. www.FormsWorkFlow.com 13. 14. 15. 16. 17. 18. 19. 20. Answer whether there was a prior appeal in this court involving this same case or controversy. List the case name and Appellate Division docket number for any appeal indicated in 11, 12 or 13 above. Check the appropriate box as to whether you think the case may benefit from a Civil Appeals Settlement Program conference and explain your answer. Read and note the statement you are certifying to concerning confidential personal identifiers. (Rule 1:38-7 can be found on the Judiciary's website.) Enter your name on the line. Enter your name on the line as you are representing yourself pro se. Enter the date on the line. Sign your name on the line. Revised: 01/03/2011, CN 10500 (Appellate Civil CIS) American LegalNet, Inc. www.FormsWorkFlow.com New Jersey Judiciary Superior Court - Appellate Division CIVIL CASE INFORMATION STATEMENT Please type or clearly print all information. TITLE IN FULL TRIAL COURT OR AGENCY DOCKET NUMBER Attach additional sheets as necessary for any information below. EMAIL ADDRESS: DEFENDANT OTHER (SPECIFY) CLIENT APPELLANT'S ATTORNEY PLAINTIFF NAME STREET ADDRESS CITY STATE ZIP TELEPHONE NUMBER RESPONDENT'S ATTORNEY * NAME EMAIL ADDRESS: CLIENT STREET ADDRESS CITY STATE ZIP TELEPHONE NUMBER * Indicate which parties, if any, did not participate below or were no longer parties to the action at the time of entry of the judgment or decision being appealed. GIVE DATE AND SUMMARY OF JUDGMENT, ORDER, OR DECISION BEING APPEALED AND ATTACH A COPY: Are there any claims against any party below, either in this or a consolidated action, which have not been disposed of, including counterclaims, cross-claims, third-party claims and applications for counsel fees? If so, has the order been properly certified as final pursuant to R. 4:42-2? (If not, leave to appeal must be sought. R. 2:2-4,2:5-6) (If the order has been certified, attach, together with a copy of the order, a copy of the complaint or any other relevant pleadings and a brief explanation as to why the order qualified for certification pursuant to R. 4:42-2.) Were any claims dismissed without prejudice? If so, explain and indicate any agreement between the parties concerning future disposition of those claims. YES YES NO NO YES NO Is the validity of a statute, regulation, executive order, franchise or constitutional provision of this State being questioned? (R. 2:5-1(h)) GIVE A BRIEF STATEMENT OF THE FACTS AND PROCEDURAL HISTORY: YES NO Revised: 01/03/2011, CN: 10500 (Appellate Civil CIS) page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com TO THE EXTENT POSSIBLE, LIST THE PROPOSED ISSUES TO BE RAISED ON THE APPEAL AS THEY WILL BE DESCRIBED IN APPROPRIATE POINT HEADINGS PURSUANT TO R. 2:6-2(a)(5). (Appellant or cross-appellant only.): IF YOU ARE APPEALING FROM A JUDGMENT ENTERED BY A TRIAL JUDGE SITTING WITHOUT A JURY OR FROM AN ORDER OF THE TRIAL COURT, COMPLETE THE FOLLOWING: 1. Did the trial judge issue oral findings or an opinion? If so, on what date? ___________________ 2. Did the trial judge issue written findings or an opinion? If so, on what date? ___________________ 3. Will the trial judge be filing a statement or an opinion pursuant to R. 2:5-1(b)? YES YES YES NO NO NO Caution: Before you indicate that there was neither findings nor an opinion, you should inquire of the trial judge to determine whether findings or an opinion was placed on the record out of counsel's presence or whether the judge will be filing a statement or opinion pursuant to R. 2:5-1(b). DATE OF YOUR INQUIRY: ____________________ 1. IS THERE ANY APPEAL NOW PENDING OR ABOUT TO BE BROUGHT BEFORE THIS COURT WHICH: (A) Arises from substantially the same case or controversy as this appeal? (B) Involves an issue that is substantially the same, similar or related to an issue in this appeal? 2. WAS THERE ANY PRIOR APPEAL INVOLVING THIS CASE OR CONTROVERSY? IF
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