Form 10533 Appendix XI-D "Small Claims Complaint (Motor Vehicle)" - New Jersey

What Is Form 10533 Appendix XI-D?

This is a legal form that was released by the New Jersey Superior Court - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 4, 2012;
  • The latest edition provided by the New Jersey Superior Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 10533 Appendix XI-D by clicking the link below or browse more documents and templates provided by the New Jersey Superior Court.

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Download Form 10533 Appendix XI-D "Small Claims Complaint (Motor Vehicle)" - New Jersey

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SMALL CLAIMS COMPLAINT (Motor Vehicle)
NOTICE: This is a public document, which means the document as submitted will be available to the public upon request. Therefore,
do not enter personal identifiers on it, such as Social Security number, driver’s license number, vehicle plate number, insurance policy
number, active financial account number, or active credit card number.
Plaintiff or Filing Attorney Information:
Court
Name
Name of Court
NJ Attorney ID Number
Address
Address
Telephone Number
ext.
Telephone Number
ext.
From Plaintiff
Superior Court of New Jersey
Law Division, Special Civil Part
Name
Small Claims Section
Address
County
Docket No:
Telephone Number
ext.
(to be provided by the court)
To Defendant
Name
Civil Action
Address
Complaint
Motor Vehicle
ext.
Telephone Number
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:
.
3. Place of Accident:
2. Name of Defendant(s)
a) Street:
.
a) Owner:
.
b) Municipality:
.
b) Operator:
.
c) County:
.
Demand: $
.
IMPORTANT: Plaintiffs and defendants must bring all witnesses, photos, and documents, and other evidence to the
hearing. Subpoena forms are available at the Clerk’s office to require the attendance of witnesses.
At the trial Plaintiff will require:
An interpreter
Yes
No
Indicate Language
An accommodation for disability
Yes
No
Indicate Disability
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.
I certify that confidential personal identifiers have been redacted from documents now submitted to the court, and will be
redacted from all documents submitted in the future in accordance with Rule 1:38-7(b).
Date
Plaintiff’s Signature
Plaintiff’s Name Typed, Stamped or Printed
Revised 09/04/2012, CN 10533-English (Appendix XI-D)
Save
Print
Clear
SMALL CLAIMS COMPLAINT (Motor Vehicle)
NOTICE: This is a public document, which means the document as submitted will be available to the public upon request. Therefore,
do not enter personal identifiers on it, such as Social Security number, driver’s license number, vehicle plate number, insurance policy
number, active financial account number, or active credit card number.
Plaintiff or Filing Attorney Information:
Court
Name
Name of Court
NJ Attorney ID Number
Address
Address
Telephone Number
ext.
Telephone Number
ext.
From Plaintiff
Superior Court of New Jersey
Law Division, Special Civil Part
Name
Small Claims Section
Address
County
Docket No:
Telephone Number
ext.
(to be provided by the court)
To Defendant
Name
Civil Action
Address
Complaint
Motor Vehicle
ext.
Telephone Number
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:
.
3. Place of Accident:
2. Name of Defendant(s)
a) Street:
.
a) Owner:
.
b) Municipality:
.
b) Operator:
.
c) County:
.
Demand: $
.
IMPORTANT: Plaintiffs and defendants must bring all witnesses, photos, and documents, and other evidence to the
hearing. Subpoena forms are available at the Clerk’s office to require the attendance of witnesses.
At the trial Plaintiff will require:
An interpreter
Yes
No
Indicate Language
An accommodation for disability
Yes
No
Indicate Disability
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.
I certify that confidential personal identifiers have been redacted from documents now submitted to the court, and will be
redacted from all documents submitted in the future in accordance with Rule 1:38-7(b).
Date
Plaintiff’s Signature
Plaintiff’s Name Typed, Stamped or Printed
Revised 09/04/2012, CN 10533-English (Appendix XI-D)