1. society
2. social institution
3. divorce

CIVIL-LAW
Name Change – Adult
8/16/2006
HOW TO USE THIS ONLINE
This form can be filled out on screen, saved to your local
drive, and printed out on your local printer or it can be
printed out on your local printer for completion by hand
or typewriter.
The information you enter is NOT
submitted electronically.
Effective 09/01/2006, CN 10551-English
page 1 of 23
CIVIL-LAW
Name Change – Adult
8/16/2006
HOW TO ASK THE COURT TO CHANGE YOUR NAME
(Superior Court of New Jersey - Law Division - Civil Part)
WHO SHOULD USE THIS PACKET?
You can use this packet to ask for a court order to change your name. There is another packet for
information on changing the name of your child under the age of 18. Please note that, if you are a
divorced woman seeking to resume using a name you used before your marriage or to assume a
new surname, you may want to contact the Family Division in the county in which your judgment
of divorce was entered. However, you are not precluded from using this packet.
Note: These materials have been prepared by the New Jersey Administrative Office of the Courts
for use by self-represented litigants. The guides, instructions, and forms will be periodically
updated as necessary to reflect current New Jersey statutes and court rules. The most recent
version of the forms will be available at the county courthouse or on the Judiciary’s Internet site
(www.judiciary.state.nj.us). However, you are ultimately responsible for the content of your court
papers.
SEND YOUR COMPLETED FORMS TO:
Effective 09/01/2006, CN 10551-English
page 2 of 23
CIVIL-LAW
Name Change – Adult
8/16/2006
THINGS TO THINK ABOUT BEFORE YOU TRY
TO REPRESENT YOURSELF IN COURT
TRY TO GET A LAWYER
The court system can be confusing and it is a
good idea to get a lawyer if you can. The law,
the proofs necessary to present your case, and
the procedural rules governing cases in the Law
Division, Civil Part are complex. Since valuable
claims or potentially heavy judgments may be at
stake, most litigants appearing in the Law
Division, Civil Part have a lawyer. If you are
being sued, please contact your insurance
company to see if they might provide a lawyer
for you. Most likely your opponent will be
represented by a lawyer. It is recommended that
you make every effort to obtain the assistance of
a lawyer. If you cannot afford a lawyer, you
may contact the legal services program in your
county to see if you qualify for free legal
services. Their telephone number can be found
in your local yellow pages under “Legal Aid” or
“Legal Services.”
If you do not qualify for free legal services and
need help in locating an attorney, you can
contact the bar association in your county. That
number can also be found in your local yellow
pages. Most county bar associations have a
Lawyer Referral Service. The County Bar
Lawyer Referral Service can supply you with the
names of attorneys in your area willing to handle
your particular type of case and will sometimes
consult with you at a reduced fee. There are also
organizations of minority lawyers throughout
New Jersey, as well as organizations of lawyers
who handle specialized types of cases. Ask your
county court staff for a list of lawyer referral
services that include these organizations.
If you decide to proceed without an attorney,
these materials explain the procedures that must
be followed to have your papers properly filed
and considered by the court. These materials do
not provide information on the law governing
your claims or defenses; information on how to
conduct pretrial discovery; information on
alternative dispute resolution procedures, such
as arbitration or mediation, that may be available
or required in your case; information on the
Effective 09/01/2006, CN 10551-English
kinds of evidence you need to prove your claims
or defense at trial; or information on other
procedural and evidentiary rules governing civil
law suits.
WHAT YOU SHOULD EXPECT IF YOU
REPRESENT YOURSELF
While you have the right to represent yourself in
court, you should not expect special treatment,
help or attention from the court. The following is
a list of some things court staff can and cannot
do for you. Please read it carefully before asking
court staff for help.
− We can explain and answer questions about
how the court works.
− We can tell you what the requirements are to
−
−
−
−
−
−
−
−
−
−
−
have your case considered by the court.
We can give you some information from
your case file.
We can provide you with samples of court
forms that are available.
We can provide you with guidance on how
to fill out forms.
We can usually answer questions about
court deadlines.
We cannot give you legal advice. Only your
lawyer can give you legal advice.
We cannot tell you whether or not you
should bring your case to court.
We cannot give you an opinion about what
will happen if you bring your case to court.
We cannot recommend a lawyer, but we can
provide you with the telephone number of a
local lawyer referral service.
We cannot talk to the judge for you about
what will happen in your case.
We cannot let you talk to the judge outside
of court.
We cannot change an order issued by a
judge.
KEEP COPIES OF ALL PAPERS
Make and keep copies of all completed forms
and documents related to your case.
page 3 of 23
CIVIL-LAW
Name Change – Adult
8/16/2006
OVERVIEW
The following is a brief overview of the process for having your name changed by a court. The details
follow. There are three basic steps that you must take to have your name changed by the court:
1. You must fill out forms to send to the court with a filing fee. (If you are changing the names of
multiple family members, there is only one fee.) The forms are contained in this packet and include a
complaint, an order fixing the date of hearing, a final judgment and a case information statement.
2. When the court returns the complaint and the order fixing the date of hearing to you, the forms will
contain a docket number and will tell you in what newspaper you must publish the date of hearing.
You must contact the newspaper to have the order fixing the date for the hearing published at least
two weeks before the hearing date, and you must notify other interested parties. You will have to
provide the court with proof that the appropriate parties have been notified of your intent to change
your name.
3. After you appear in court at the hearing, you will have to publish the final judgment in the newspaper
and send copies of the certified final judgment to the Department of Treasury and the Registrar of
Vital Statistics and the Division of Motor Vehicles.
DEFINITIONS OF WORDS USED IN THIS PACKET
Affidavit of Publication - An affidavit of publication is a sworn statement made by a newspaper
stating that the newspaper has published the information regarding your name change.
Certification - A certification is a written statement you make when you file your papers with the court
in which you state that all the information contained in the papers is true to the best of your knowledge.
Civil Case Information Statement (CIS) The CIS is a form that summarizes your case for the court.
Court rules require that a CIS be filed with a verified complaint.
Docket Number - A docket number is the number the court assigns to your case so that it may be
identified and located easily. Once you have a docket number, you must include it on all your
communications with the court.
File - To file means to give the appropriate forms and fee to the court to begin the court’s consideration
of your case.
Final Judgment - The final judgment is a document signed by the judge which orders the name to be
changed.
Order Fixing Date of Hearing - An order fixing the date of hearing is a signed paper from the judge
indicating the date when you must come to court on your case and stating the name of the newspaper in
which you will have to publish your hearing date.
Proof of Mailing - Proof of mailing is the green card you get back from the Post Office that proves that
the material you sent by certified mail, return receipt requested, was received by the person to whom
you sent it.
Verified Complaint - A verified complaint is a document in which you tell the court the facts of your
case and state what relief you want the court to give you. You certify that the information is true to the
best of your knowledge.
Effective 09/01/2006, CN 10551-English
page 4 of 23
CIVIL-LAW
Name Change – Adult
8/16/2006
The numbered steps listed below tell you what forms you will need to fill out and what to do with
them.
Each form should be typed or printed clearly on 8 ½ “x 11” white paper only. Forms may not be
filed on a different size or color paper.
STEPS TO OBTAIN A COURT ORDER TO CHANGE YOUR NAME
STEP 1:
FILL OUT THE VERIFIED
COMPLAINT (Form A).
The Verified Complaint (Form A) tells the
court what your name is, what you want to
change it to, and why you want it changed. If
you have ever been convicted of a crime, or if
there are charges pending against you, you must
include this information in your Verified
Complaint. You must sign the certification
which states that the information in the
complaint is true to the best of your knowledge.
STEP 2:
FILL OUT THE ORDER
FIXING DATE OF HEARING AND THE
FINAL JUDGMENT FORMS (Forms B and
C).
Enter the information requested. Note that
there are places on the Order Fixing Date of
Hearing and Final Judgment that the court will
complete.
STEP 3:
FILL OUT THE CIVIL CASE
INFORMATION STATEMENT (CIS) (Form
F).
This form summarizes your case for the
court. The case type number for a name change
is 151.
STEP 4:
MAKE A CHECK OR
MONEY
ORDER
PAYABLE
TO
TREASURER, STATE OF NEW JERSEY IN
THE AMOUNT OF $200.00.
This is the fee for filing your papers.
Note: If you are changing the names of
multiple family members, the $200.00 fee
covers all name change applications.
Effective 09/01/2006, CN 10551-English
STEP 5:
CHECK
YOUR
COMPLETED FORMS AND MAKE
COPIES.
Check your forms and make sure they are
complete. Remove all instruction sheets. Make
sure you have signed all the forms wherever
necessary. You also need to make three copies
of each form. Two of the copies will be sent to
the court; the other is for your records.
Checklist - In Step 6 you will be directed to
mail your documents to the court. The following
checklist will help insure your package is
complete:
− The original of each of the forms you filled
out: Verified Complaint (Form A), Order
Fixing Date of Hearing (Form B), Final
Judgment (Form C) and the Civil Case
Information Statement (Form F)
− Two copies of each of these forms: Verified
Complaint, Order Fixing Date of Hearing,
Final Judgment and the Civil Case
Information Statement.
− The filing fee in the amount of $200. It must
be a check or money order payable to the
Treasurer, State of New Jersey.
− A stamped envelope addressed to yourself
so that the court will be able to return the
forms to you.
STEP 6:
MAIL OR DELIVER THE
FORMS TO THE COURT.
You may mail or deliver to the court the
original and 2 copies of all the forms: Verified
Complaint (Form A), Order Fixing Date of
Hearing(Form B), Final Judgment (Form C)
and the Civil Case Information Statement (Form
F) to the court in person or you may mail them.
The court address can be found on the front of
this packet or on the Judiciary’s website,
www.njcourtsonline.com. If you mail the
papers, we recommend that you use certified
mail, return receipt requested.
page 5 of 23
CIVIL-LAW
Name Change – Adult
8/16/2006
STEP 7:
REVIEW
COPIES
RETURNED FROM COURT.
The court will return copies of the Verified
Complaint and Order Fixing Date of Hearing to
you. Once you receive them, there will be a
docket number written on all the copies. The
docket number is very important because it
identifies your case. It also lets the court know
how to find your case. You must use the docket
number on all future papers you send to the
court about your case. The court will fill in the
date on the Order Fixing Date of Hearing. That
is the day you will appear before the judge to get
the final judgment. The court will also indicate
the name of a newspaper in which you are to
have the notice of your hearing date published.
IF YOU DO NOT HAVE PENDING
CRIMINAL OR DELINQUENT CHARGES
IN NEW JERSEY, SKIP TO STEP 9.
STEP 8:
NOTIFY THE STATE OR
COUNTY PROSECUTOR OF YOUR
APPLICATION FOR A NAME CHANGE.
If you have criminal charges pending
against you in New Jersey, you must send a
copy of the Verified Complaint and Order
Fixing Date of Hearing by certified mail, return
receipt requested to the Prosecutor of the
county where the matter is being heard. If the
charges were brought by the Office of the
Attorney General, you must send another copy
of the Verified Complaint and Order Fixing
Date of Hearing by certified mail, return
receipt requested to the Director of the Division
of Criminal Justice in Trenton, New Jersey, at
least 20 days before the hearing. Mail a copy
to:
Director of Criminal Justice
R. J. Hughes Justice Complex
25 W. Market Street
P. O. Box 085
Trenton, NJ 08625-0085
STEP 9:
PUBLISH
THE
FIXING DATE OF HEARING.
Effective 09/01/2006, CN 10551-English
ORDER
In the Order Fixing Date of Hearing that
you receive back from the court, the judge will
have specified the name of a local newspaper.
You must have the Order Fixing Date of
Hearing published in the newspaper the judge
chooses. It must be published in the newspaper
at least two (2) weeks before the date of the
hearing. You should talk to the newspaper about
how to publish legal notices. Included in this
packet as Attachment E is a sample of the
newspaper notice.
STEP 10:
SEND
AFFIDAVIT
OF
PUBLICATION TO THE COURT.
Once you have published the Order Fixing
Date of Hearing, the newspaper will send you an
affidavit of publication, which is proof that you
had the newspaper publish the Order Fixing
Date of Hearing. You must send the original of
this affidavit of publication document to the
court immediately after you get it from the
newspaper. Keep a copy of it for your files.
IF YOU HAVE MAILED COPIES TO THE
COUNTY
PROSECUTOR
OR
THE
ATTORNEY
GENERAL,
COMPLETE
STEP 11.
STEP 11:
COMPLETE PROOF OF
MAILING (FORM D) AND SEND TO
COURT.
After you have mailed the required copies of
the Verified Complaint and signed Order Fixing
Date for Hearing, the post office will send you a
green card (called a certified mail receipt) that
shows the mail was delivered. Once you get it
back, fill out the form called Proof of Mailing
(Form D) and check each entity to whom you
sent a copy of the complaint and order. Be sure
to attach the original green certified mail
receipt(s) to the original proof of mailing. Send
the proof of mailing to the court. Keep a copy of
it for your files.
STEP 12:
APPEAR IN COURT ON
THE DATE SET BY THE JUDGE FOR
YOUR HEARING.
page 6 of 23
CIVIL-LAW
Name Change – Adult
8/16/2006
STEP 13:
PUBLISH
THE
FINAL
JUDGMENT IN THE NEWSPAPER.
After the hearing, the court will record the
original Final Judgment signed by the judge. As
soon as you receive your copy of the Final
Judgment, you must send it to be published in
the newspaper chosen by the judge. However,
the newspaper published version of the final
judgment shall not include your social security
number. The Final Judgment must appear in the
newspaper no more than 20 days after the date
on the judgment. After you have it published,
the newspaper will send you an original affidavit
of the publication.
STEP 14:
SEND THE AFFIDAVIT OF
PUBLICATION TO THE COURT.
You must send the original affidavit of
publication to the court at the address found on
the front of this packet within 45 days after the
date of the judgment.
STEP 15:
ORDER
A
CERTIFIED
COPY OF FINAL JUDGMENT.
You must order from the court a certified
copy of the Final Judgment, by mail or in
person. There is no charge for the first certified
copy. Additional copies can be ordered for $5.00
each. Keep this for your files. Copies of the
certified Final Judgment must be sent to the
Department of Treasury (Step 16), the Registrar
of Vital Statistics (Step 17), and presented in
person at any Motor Vehicle Agency or
Regional Service Center (Step 18).
STEP 16:
SEND
COPY
OF
CERTIFIED FINAL JUDGMENT TO THE
DEPARTMENT OF TREASURY.
Mail a copy of the certified Final Judgment
to the Department of Treasury within 45 days
after the date of the Judgment. You must include
a check or money order payable to the
Treasurer, State of New Jersey in the amount of
$50. Mail the copy of the certified Final
Judgment with the check or money order and a
stamped self-addressed envelope to:
Department of Treasury
Division of Revenue
Judgment Name Change Unit
P. O. Box 453
Trenton, NJ 08646
STEP 17:
NOTIFY THE REGISTRAR
OF VITAL STATISTICS OF THE STATE.
You should send a copy of the certified
Final Judgment to the Registrar of Vital
Statistics of the State in which you were born.
You can locate the address of that office by
contacting them by telephone. Directory
assistance can provide you with the telephone
number of that office. They are located in the
capital city of the State in which your were born.
That office will tell you if there is a filing fee. If
you were born in New Jersey, the address for
this office is:
Bureau of Vital Statistics
P. O. Box 370
Trenton, NJ 08625
In New Jersey there is also a $27.00 fee if
you want to receive a corrected birth certificate.
STEP 18:
NOTIFY
THE
MOTOR
VEHICLES COMMISSION .
If you are a licensed driver, a registered
owner of a vehicle, or possesses a handicapped
or non-driver identification card, you must
present the Final Judgment in person at any
Motor Vehicle Agency or Regional Service
Center within two weeks of the date of the Final
Judgment. Additional information is available at
the MVC web site at www.njmvc.gov regarding
the list of acceptable documents to satisfy the 6
points of identification.
++++++
Effective 09/01/2006, CN 10551-English
page 7 of 23
Clear All Forms
Print All Forms
FORM A
SUPERIOR COURT OF NEW JERSEY
LAW DIVISION
County
Your Name (first, middle, last)
Docket Number
(to be filled in by the court)
Street Address
Town, State, Zip Code
CIVIL ACTION
Telephone Number
In the Matter of the Application of
Verified Complaint
Your Name (first, middle, last)
Including Certification of Plaintiff
To Assume the Name of
for Name Change
Name You Wish To Assume (first, middle, last)
The plaintiff,
(your name, first, middle, last)
, whose place of residence is
, in the City of
(street address)
County of
, in the State of New Jersey, says:
1. I am the Plaintiff in this matter.
2. I am (check one) am
□ am not □ a citizen of the United States of America.
3. My social security number is
4. I was born on
, in
(date, month, year)
5. I am the (check one) son
(place of birth)
.
.
□ daughter □ of
and
.
6. I was raised by
and
7. I have since childbirth been identified by the name of
Effective 09/01/2006, CN 10551-English
.
(first, middle, last)
.
page 8 of 23
FORM A
8. I (check one) have
□ have never □ been married.
9. I have no unsatisfied judgments of record, or suits pending against me, except:
(enter any recorded judgments or pending suits)
10. I have never been convicted of a crime, and have no criminal charges pending against me,
except:
(please supply county, municipality, nature, date of crime and/or pending charges)
11. This application is not being made with the intent to avoid creditors or criminal prosecution or for
other fraudulent purpose.
12. I (check one) have
□ have not □ been any previous applications to assume another name.
13. I desire to assume the name of:
(first, middle, last)
.
14. I request this name change for the following reasons:
Effective 09/01/2006, CN 10551-English
page 9 of 23
FORM A
WHEREFORE, plaintiff demands judgment pursuant to N.J.S.A. 2A:52-1 to -4.
Signature of Plaintiff
Certification
I certify that the foregoing statements are true. I am aware that if any of the foregoing statements
made by me are wilfully false, I am subject to punishment.
Signature of Plaintiff
Dated:
Effective 09/01/2006, CN 10551-English
page 10 of 23
FORM B
SUPERIOR COURT OF NEW JERSEY
LAW DIVISION
County
Your Name (first, middle, last)
Docket Number
Street Address
(to be filled in by the court)
Town, State, Zip Code
Telephone Number
In the Matter of the Application of
CIVIL ACTION
Your Name (first, middle, last)
To Assume the Name of
Order Fixing Date
Of Hearing
Name You Wish To Assume (first, middle, last)
Application being made to the Court by
for a judgment authorizing (check one)
,
(your name, first, middle, last)
□ his □ her to assume another name and for
the entry of an order fixing a date for the hearing of such application,
DO NOT WRITE BELOW; THE COURT WILL FILL IN THE INFORMATION
IT IS ON THIS
the
day of
day of
, 20
, 20
, ORDERED that
, at
a.m., or as soon thereafter as the matter can be heard, at the Court House in the City
of
, County of
, State of New Jersey, be
fixed as the time and place for the hearing of such application and of any objections
that me be made thereto.
Effective 09/01/2006, CN 10551-English
page 11 of 23
FORM B
IT IS FURTHER ORDERED that a notice of such application be published in
once, at least two (2) weeks preceding
the date set for the hearing.
J.S.C.
,
NOTE: Copies of the verified complaint and order fixing the date of the hearing
must be sent to the newspaper for publication and served on the County
Prosecutor and/or the Office of the Attorney General if there are criminal
charges pending.
Effective 09/01/2006, CN 10551-English
page 12 of 23
FORM C
SUPERIOR COURT OF NEW JERSEY
LAW DIVISION
County
Your Name (first, middle, last)
Docket Number
(to be filled in by the court)
Street Address
Town, State, Zip Code
Telephone Number
In the Matter of the Application of
CIVIL ACTION
Your Name (first, middle, last)
To Assume the Name of
Final Judgment
Name You Wish To Assume (first, middle, last)
, having made application to this Court
(your name, first, middle, last)
□
□
by duly verified complaint for a judgment authorizing (check one)
him
her to
assume the name of
, and it appearing to
(name you wish to assume)
the Court that all the provisions of N.J.S.A. 2A:52-1-4 and the Current N.J. Court Rules
relating thereto have been complied with:
IT IS on this
day of
(leave date blank for court to complete)
ORDERED AND ADJUDGED that
was born on
(month, day, year )
Effective 09/01/2006, CN 10551-English
, who
, and whose social security number is
(leave date blank for court to complete)
,
(your name)
-
-
(your social security number)
be and hereby is authorized to assume the name of
and after
,20
(name you wish to assume)
,
from
;and
page 13 of 23
FORM C
DO NOT WRITE BELOW THIS LINE; THE COURT WILL COMPLETE.
IT IS FURTHER ORDERED that within twenty days hereof plaintiff shall cause a
copy of this Final Judgment to be published once in____________________________;
and within forty-five days after entry of Judgment, plaintiff shall file proof of publication
of this Final Judgment with the deputy Clerk of the Superior Court (at the court address
found at the back of this packet for the court in which you filed your verified complaint)
and a certified copy of this Final Judgment with the Department of Treasury pursuant to
the provisions of the Statute and Rules in such case made and provided; and
IT IS FURTHER ORDERED that the published version of the final judgment shall
not release the plaintiff’s social security number.
J.S.C.
Dated:
Effective 09/01/2006, CN 10551-English
.
page 14 of 23
FORM D
SUPERIOR COURT OF NEW JERSEY
LAW DIVISION
County
Your Name (first, middle, last)
Docket Number
(to be filled in by the court)
Street Address
Town, State, Zip Code
Telephone Number
CIVIL ACTION
In the Matter of the Application of
Your Name (first, middle, last)
To Assume the Name of
Proof of Mailing
Name You Wish To Assume (first, middle, last)
On
, I, the undersigned, mailed a copy of the Complaint for
Change of Name and Order Fixing Date of Hearing in accordance with the rules of Civil
Practice and Procedure, by certified United States Mail, return receipt requested to
(check and complete all that apply):
__ the Division of Criminal Justice of New Jersey
__ the Prosecutor of
County
NOTE: The green return mail receipt(s) are attached.
I certify that the foregoing statements made by me are true. I am aware that if any of
the foregoing statements made by me are wilfully false, I am subject to punishment.
,
Your Signature
Dated:
Effective 09/01/2006, CN 10551-English
.
page 15 of 23
ATTACHMENT E
SAMPLE NEWSAPER NOTICE
IN THE MATTER OF THE APPLICATION OF
,
Your name (first, middle, last)
TO ASSUME THE NAME OF
.
Name you wish to assume (first, middle, last)
TO WHOM IT MAY CONCERN:
Take notice that the undersigned will apply to
(county where name change action is filed)
County Superior Court on the
day of
20
, at
.
9 o’clock in the morning, at the Court House in the City of
(name of city)
New Jersey, for a judgment authorizing __________________________ to assume the
(your name, first middle, last)
name of _________________________________________________.
(your name to assume, first, middle, last)
Your Name (first, middle, last)
Street Address
Town, State, Zip Code
Effective 09/01/2006, CN 10551-English
page 16 of 23
CIVIL – LAW – 7/26/2006
CASE INFORMATION STATEMENT – FORM F
HOW TO COMPLETE THE CIVIL CASE INFORMATION
STATEMENT (CIS)
These instructions are intended to guide individuals who are either plaintiffs or
defendants in civil cases and who are not represented by an attorney in completing the Civil Case
Information Statement (Civil CIS) required by court rules. The Civil CIS must be included with
each party’s first pleading in the Civil part of the Law Division. That is, the plaintiff must file it
with the complaint and the defendant must file it with the answer. If it is not included, the papers
will be returned.
The CIS summarizes your case and alerts the court to any special needs you may have
such as the need for an interpreter or the need for a quick trial date because one of your witnesses
is expected to be unavailable. The numbers for the various case types are located on the back of
the form. Enter the number which best describes your complaint. For example, if you are suing
the defendant for a breach of contract, your case number would be 599.
After you have completed the CIS, keep it with the other papers you are planning to file.
Note: These materials have been prepared by the New Jersey Administrative
Office of the Courts for use by self-represented litigants. The guides, instructions,
and forms will be periodically updated as necessary to reflect current New Jersey
statutes and court rules. The most recent version of the forms will be available at
the
county
courthouse
or
on
the
Judiciary’s
Internet
site
(www.judiciary.state.nj.us). However, you are ultimately responsible for the
content of your court papers.
Revised 09/2006, CN 10517-English
How to Ask the Court to Change Your Name (Adult), CN 10551-English
page 17 of 23
CIVIL – LAW – 7/26/2006
CASE INFORMATION STATEMENT – FORM F
INSTRUCTIONS FOR PARTIES NOT REPRESENTED BY AN
ATTORNEY FOR COMPLETING THE CIVIL CASE
INFORMATION STATEMENT (CIS)
BOX# INSTRUCTION
1.
Print your name.
2.
List a telephone number, including area code, where you can be reached during
the day.
3.
Insert the name of the county where the complaint or answer is being filed.
4,
Leave the box blank.
5.
If you know the docket number of your case, insert it in the docket number box.
If the CIS is being filed with a complaint, the court will assign the docket
number before it returns the filed complaint.
6.
Enter an address where you wish to receive mail concerning this matter.
7.
Document type means the type of paper you are filing. If you are filing the
complaint, print complaint; if you are filing an answer, print answer. For a name
change, you are filing a verified complaint.
8.
Check the box marked “yes” if you have requested that the matter be heard by a
jury. Otherwise, check “no.”
9.
Enter your name and indicate whether you are the plaintiff or defendant.
10.
The caption is the name of the case - the name of the plaintiff(s) v. the name of
the defendant(s). For a name change, the caption should be “In the Matter of the
Application of (your name) to Change the Name of (your name) to (new name).
11.
The Case Type Number identifies the type of case. On the back of the CIS form
is a list of case types. The case type number for a name change is 151.
12.
Check the box marked “no.”
13.
If you believe that you have any other cases involving the same adversary or
arising from the same set of circumstances, check the box marked “yes.”
Otherwise, check “no.”
14.
If you checked “yes” to the previous question, enter the docket number(s) of any
related cases.
15.
If you believe you will be adding more parties to the case, check “yes.”
Otherwise, check “no.”
16.
If you are the plaintiff and know the name of the defendant’s primary insurance
company enter it in the box. Otherwise check “unknown.” If you are the
defendant and you have insurance that might cover or partially cover the
damages complained of, enter the name of your insurance company.
17.
If you and your adversary knew each other before the event giving rise to the
law suit occurred, check “yes.” Otherwise, check “no.”
18.
If the answer was “yes”, check the box next to the word(s) that best describe the
relationship between the parties.
If you believe that the statute governing your case provides for payment of fees
Revised 09/2006, CN 10517-English
How to Ask the Court to Change Your Name (Adult), CN 10551-English
page 18 of 23
CIVIL – LAW – 7/26/2006
CASE INFORMATION STATEMENT – FORM F
19.
20.
21.
22,.
by the losing party, (for example, the Law Against Discrimination), check “yes.”
Otherwise, check “no.”
If you believe that your case has some unusual circumstance which would
require special attention, indicate the problem in the space provided. For
example, if there is a witness who is ill or who may be unavailable, you should
let the court staff know.
If you are requesting any accommodation for a disability, check “yes” and
indicate what is needed. Otherwise, check “no.”
If you are requesting an interpreter, check “yes” and indicate the language for
which it is needed. Otherwise, check “no.”
The person whose name appears in Box 1 must sign the CIS in the space marked
“Attorney Signature.”
Revised 09/2006, CN 10517-English
How to Ask the Court to Change Your Name (Adult), CN 10551-English
page 19 of 23
CIVIL CASE INFORMATION STATEMENT
(CIS)
PAYMENT TYPE: CK
Use for initial Law Division
Civil Part pleadings (not motions) under Rule 4:5-1
Pleading will be rejected for filing, under Rule 1:5-6(c),
if information above the black bar is not completed or
if attorney’s signature is not affixed.
1. ATTORNEY/PRO SE NAME
2. TELEPHONE NUMBER
(
4. FIRM NAME (If applicable)
FOR USE BY CLERK’S OFFICE ONLY
)
CA
CHG/CK NO.
AMOUNT:
OVERPAYMENT:
BATCH NUMBER:
3. COUNTY OF VENUE
5. DOCKET NUMBER (When available)
6. OFFICE ADDRESS
7. DOCUMENT TYPE
8. JURY DEMAND
9. NAME OF PARTY (e.g., John Doe, Plaintiff)
11. CASE TYPE NUMBER
(See reverse side for listing)
YES
NO
10. CAPTION
12. IS THIS A PROFESSIONAL MALPRACTICE CASE?
YES
NO
IF YOU HAVE CHECKED “YES,” SEE N.J.S.A. 2A:53A-27 AND APPLICABLE CASE LAW REGARDING
YOUR OBLIGATION TO FILE AN AFFIDAVIT OF MERIT.
14. IF YES, LIST DOCKET NUMBERS
13. RELATED CASES PENDING?
YES
NO
15. DO YOU ANTICIPATE
ADDING ANY PARTIES (arising
out of same transaction or
occurrence)?
CG
YES
NO
16. NAME OF DEFENDANT’S PRIMARY INSURANCE COMPANY, IF KNOWN
NONE
UNKNOWN
THE INFORMATION PROVIDED ON THIS FORM CANNOT BE INTRODUCED INTO EVIDENCE.
CASE CHARACTERISTICS FOR PURPOSES OF DETERMINING IF CASE IS APPROPRIATE FOR MEDIATION
17. A. DO PARTIES HAVE A CURRENT,
PAST OR RECURRENT
RELATIONSHIP?
YES
NO
IF YES, IS THAT
RELATIONSHIP
EMPLOYER-EMPLOYEE
FAMILIAL
FRIEND/NEIGHBOR
BUSINESS
OTHER (explain)
18. B. DOES THE STATUTE GOVERNING THIS
YES
NO
CASE PROVIDE FOR PAYMENT OF FEES
BY THE LOSING PARTY?
19. USE THIS SPACE TO ALERT THE COURT TO ANY SPECIAL CASE CHARACTERISTICS THAT MAY WARRANT INDIVIDUAL MANAGEMENT OR ACCELERATED
DISPOSITION:
20. DO YOU OR YOUR CLIENT NEED
ANYDISABILITY ACCOMMODATIONS?
21. WILL AN INTERPRETER BE NEEDED?
YES
YES
NO
NO
IF YES, PLEASE IDENTIFY THE
REQUESTED ACCOMMODATION:
IF YES, FOR WHAT LANGUAGE:
22. ATTORNEY SIGNATURE
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How to Ask the Court to Change Your Name (Adult), CN 10551-English
page 20 of 23
SIDE 2
CIVIL CASE INFORMATION STATEMENT
(CIS)
Use for initial pleadings (not motions) under Rule 4:5-1
CASE TYPES (Choose one and enter number of case type in appropriate space on the reverse side.)
Track I — 150 days' discovery
151
175
302
399
502
505
506
510
511
512
801
802
999
NAME CHANGE
FORFEITURE
TENANCY
REAL PROPERTY (other than Tenancy, Contract, Condemnation, Complex Commercial or Construction)
BOOK ACCOUNT (debt collection matters only)
OTHER INSURANCE CLAIM (INCLUDING DECLARATORY JUDGMENT ACTIONS)
PIP COVERAGE
UM or UIM CLAIM
ACTION ON NEGOTIABLE INSTRUMENT
LEMON LAW
SUMMARY ACTION
OPEN PUBLIC RECORDS ACT (SUMMARY ACTION)
OTHER (Briefly describe nature of action)
Track II — 300 days' discovery
305
509
599
603
605
610
699
CONSTRUCTION
EMPLOYMENT (other than CEPA or LAD)
CONTRACT/COMMERCIAL TRANSACTION
AUTO NEGLIGENCE – PERSONAL INJURY
PERSONAL INJURY
AUTO NEGLIGENCE – PROPERTY DAMAGE
TORT – OTHER
Track III — 450 days' discovery
005
301
602
604
606
607
608
609
616
617
618
CIVIL RIGHTS
CONDEMNATION
ASSAULT AND BATTERY
MEDICAL MALPRACTICE
PRODUCT LIABILITY
PROFESSIONAL MALPRACTICE
TOXIC TORT
DEFAMATION
WHISTLEBLOWER / CONSCIENTIOUS EMPLOYEE PROTECTION ACT (CEPA) CASES
INVERSE CONDEMNATION
LAW AGAINST DISCRIMINATION (LAD) CASES
Track IV — Active Case Management by Individual Judge / 450 days' discovery
156
303
508
513
514
701
ENVIRONMENTAL/ENVIRONMENTAL COVERAGE LITIGATION
MT. LAUREL
COMPLEX COMMERCIAL
COMPLEX CONSTRUCTION
INSURANCE FRAUD
ACTIONS IN LIEU OF PREROGATIVE WRITS
Mass Tort (Track IV)
240
241
248
264
266
268
REDUX/PHEN-FEN (formerly "DIET DRUG")
TOBACCO
CIBA GEIGY
PPA
HORMONE REPLACEMENT THERAPY (HRT)
MANUFACTURED GAS PLANT (MGP)
271
272
274
601
619
ACCUTANE
BEXTRA/CELEBREX
RISPERDAL/SEROQUEL/ZYPREXA
ASBESTOS
VIOXX
If you believe this case requires a track other than that provided above, please indicate the reason on Side 1,
in the space under "Case Characteristics."
Please check off each applicable category:
Verbal Threshold
Putative Class Action
Revised 09/2006, CN 10517-English
How to Ask the Court to Change Your Name (Adult), CN 10551-English
Title 59
page 21 of 23
CIVIL-LAW
Name Change – Adult
8/24/2006
Directory of Civil Division Managers’ Offices
Below is a list of addresses and phone numbers for Civil Division Managers in every courthouse.
You must send your papers to the county where you are filing your case. Use this list of
addresses to find the appropriate Superior Court to file your papers.
Civil Division Manager
Atlantic County Civil Courts Building
1201 Bacharach Blvd.
Atlantic City NJ 08401
(609) 345-6700
Civil Division Manager
Bergen County Justice Center
10 Main Street, Room 415
Hackensack, NJ 07601-7015
(201) 527-2601
Civil Division Manager
Burlington County Courts Facility
49 Rancocas Road
Mt. Holly NJ 08060
(609) 518-2815
Civil Division Manager
Camden County
Hall of Justice
101 South Fifth Street, Suite 150
Camden, NJ 08103
(856) 379-2234
Civil Division Manager
Cape May County Superior Court
4 Moore Road, DN 203
Cape May Court House NJ 08210
(609) 463-6515
Civil Division Manager
Cumberland County Courthouse
Broad and Fayette Streets
Bridgeton NJ 08302
(856) 453-4331
Civil Division Manager
Essex County Superior Court
470 Martin Luther King, Jr. Blvd.
Room 208 HCH
Newark NJ 07102
(973) 693-6521
Civil Division Manager
Gloucester County Courthouse
Broad and Delaware Streets
Woodbury NJ 08096
(856) 853-3375
Civil Division Manager
Hudson County Superior Court
583 Newark Avenue
Jersey City NJ 07306
(201) 795-6398
Civil Division Manager
Hunterdon Justice Center
Hunterdon Civil Division
65 Park Ave., 2nd Floor
Flemington NJ 08822
(908) 237-5832
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CIVIL-LAW
Name Change – Adult
8/24/2006
Civil Division Manager
Mercer County Civil Courts Building
175 South Broad Street
Trenton NJ 08650-0068
(609) 571-4452
Civil Division Manager
Middlesex County Courthouse
One John F. Kennedy Square
P.O. Box 2633
New Brunswick, NJ 08903
(732) 981-3055
Civil Division Manager
Monmouth County Courthouse
71 Monument Park
Freehold NJ 07728
(732) 677-4298
Civil Division Manager
Morris County Courthouse
P.O. Box 910
Morristown NJ 07963-0910
(973) 656-4110
Civil Division Manager
Ocean County Justice Complex
120 Hooper Avenue
Toms River NJ 08754
(732) 929-2042
Civil Division Manager
Passaic County Courthouse
77 Hamilton Street
Paterson NJ 07525
(973) 247-8176
Civil Division Manager
Salem County Courthouse
92 Market Street
Salem NJ 08079
(856) 935-7510
Civil Division Manager
Somerset County
40 North Bridge Street
P.O. Box 3000
Somerville NJ 08876
(908) 231-7054
Civil Division Manager
Union County Courthouse
Two Broad Street
Elizabeth, NJ 07207
(908) 659-3844
Civil Division Manager
Warren County Courthouse
413 Second Street
P.O. Box 900
Belvidere NJ 07823
(908) 475-6143
Civil Division Manager
Sussex County Judicial Center
7 High Street
Newton, NJ 07860
(973) 579-0675
PAGE 2