Free 10501 Appellate Criminal Case Information Statement - New Jersey

Criminal Case Information Statement Form
1. Enter the caption or title of the case as it appears on the papers from the trial court from which you are appealing. Enter the number assigned the case by the trial court from which you are appealing. 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 name, address, including any email address, and telephone number of the county prosecutor's office which represented the State of New Jersey in the trial court and/or where appropriate, the name, address and telephone number of the Office of the Attorney General. See Court Rule 2:5-1 as to adult criminal and juvenile matters. The "CLIENT" is the State of New Jersey. Briefly summarize the terms of the judgment or order which is the subject of this appeal, including its date, and attach a copy. Answer whether there are any issues below involving you 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. Check the appropriate box. Answer whether you are presently confined or on bail. Set forth any SBI number and your date of birth. Answer whether the issue(s) involve only whether the trial court imposed a proper sentence. Answer whether there are any co-defendants and, if so, set forth their names and whether they were tried with you or shared any pretrial motion. (If the co-defendants are juveniles who were not waived up to the Law Division, use only their initials.) Briefly summarize the facts and the procedural history of the case. List the issues which you plan to raise in your appeal.

2. 3.

4.

5.

6.

7. 8.

9. 10.

11. 12.

13.

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 a co-defendant 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".
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14.

15.

Revised Effective: 09/01/2008, CN: 10501-English (Criminal Case Information Statement)

16. 17.

Answer whether there was a prior appeal in this court involving this same case or controversy List the case name, type and Appellate Division docket number for any appeal indicated in 14, 15 or 16 above. 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.

18. 19. 20. 21.

Revised Effective: 09/01/2008, CN: 10501-English (Criminal Case Information Statement)

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Print Form
New Jersey Judiciary

Clear Form

Superior Court - Appellate Division
CRIMINAL CASE INFORMATION STATEMENT
(For use in Criminal, Quasi-Criminal and Juvenile Actions)
Please type or clearly print all information. TITLE IN FULL (1) TRIAL COURT DOCKET NUMBER

(2)

(3)

APPELLANT'S ATTORNEY PLAINTIFF NAME

EMAIL ADDRESS: DEFENDANT OTHER (SPECIFY) CLIENT

MAILING ADDRESS

CITY

STATE

ZIP

TELEPHONE NUMBER

(4)

RESPONDENT'S ATTORNEY NAME

EMAIL ADDRESS: CLIENT

MAILING ADDRESS

CITY

STATE

ZIP

TELEPHONE NUMBER

(5)

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

(6) (7)
(8)

Are there any issues below in this action involving defendant which have not been disposed of? (If so, leave to appeal must be sought. R. 2:2-4, 2:5-6) Is the validity of a statute, regulation, executive order, franchise or constitutional provision of this State being questioned? (R. 2:5-1(h)) Is defendant presently confined? If not, is defendant on bail?

YES YES

NO NO

YES YES

NO NO

Provide any State Bureau of Identification (SBI) number and date of birth: ___________________________ / __________________

(9)

Will the issue(s) in this appeal involve only whether the trial court imposed a proper sentence? If so, briefs shall not be filed without leave of court. (R. 2:9-11)

YES

NO

(10) Are there co-defendants?
If so, state their names and whether they were tried with the defendant or shared any pretrial motion.

YES

NO

(11)

GIVE A BRIEF STATEMENT OF THE FACTS AND PROCEDURAL HISTORY:

(12) 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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(13)

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? ___________________ (Attach a copy.) 3. Will the trial judge be filing a statement or an opinion pursuant to R. 2:5-1(b)? YES YES NO NO

YES

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 CASE NOW PENDING OR ABOUT TO BE BROUGHT BEFORE THIS COURT WHICH:

(14)
(15)

(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 and Type (direct, 1st PCR, other, etc.):

YES YES YES

NO NO NO

(16) (17)

Appellate Division Docket Number:

(18)
Name of Appellant or Respondent

(19)
Name of Counsel of Record (or your name if not represented by counsel)

(20)
Date

(21)
Signature of Counsel of Record (or your signature if not represented by counsel)

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