Free 10500 Appellate Civil Case Information Statement - New Jersey

Civil Case Information Statement Form
1. 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. 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". Answer whether there was a prior appeal in this court involving this same case or controversy.

2.

3.

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7. 8. 9. 10.

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13.

Revised Effective: 09/01/2008, CN:10500-English (Civil Case Information Statement)

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14.

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. 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.

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16. 17. 18. 19.

Revised Effective: 09/01/2008, CN:10500-English (Civil Case Information Statement)

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Print Form
New Jersey Judiciary

Clear Form

Superior Court - Appellate Division
CIVIL CASE INFORMATION STATEMENT
Please type or clearly print all information. TITLE IN FULL

(1)

TRIAL COURT OR AGENCY DOCKET NUMBER

(2)



Attach additional sheets as necessary for any information below. EMAIL ADDRESS: DEFENDANT OTHER (SPECIFY) CLIENT

(3)

APPELLANT'S ATTORNEY PLAINTIFF NAME

STREET ADDRESS

CITY

STATE

ZIP

TELEPHONE NUMBER

(4)

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.

(5)

GIVE DATE AND SUMMARY OF JUDGMENT, ORDER, OR DECISION BEING APPEALED AND ATTACH A COPY:

(6)

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.)

YES YES

NO NO

(7)
(8)

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

(9)

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.):

Revised effective 9/01/2008

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(10)

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:

(11)

(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 THE ANSWER TO EITHER 1 OR 2 ABOVE IS YES, STATE: Case Name:

YES YES YES

NO NO NO

(12) (13) (14)

Appellate Division Docket Number:

Civil appeals are screened for submission to the Civil Appeals Settlement Program (CASP) to determine their potential for settlement or, in the alternative, a simplification of the issues and any other matters that may aid in the disposition or handling of the appeal. Please consider these when responding to the following question. A negative response will not necessarily rule out the scheduling of a preargument conference.

(15)

State whether you think this case may benefit from a CASP conference. Explain your answer:

YES

NO

(16)
Name of Appellant or Respondent

(17)
Name of Counsel of Record (or your name if not represented by counsel)

(18)
Date

(19)
Signature of Counsel of Record (or your signature if not represented by counsel)
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