New Jersey Judiciary form CN 10517. This walkthrough fills the
21 text fields; 16 checkbox(es) on the form are
left for you to mark after download.
The “Civil Case Information Statement (Civil CIS)” is a four-page New Jersey Judiciary form issued by the Civil Practice Division. The footer reads “Revised Form Promulgated by 01/07/2026 Notice to the Bar, CN 10517 (Appendix XII-B1).” Directly under the title the form states that it is for “Use for initial Law Division Civil Part pleadings (not motions) under Rule 4:5-1,” and it states that a “Pleading will be rejected for filing, under Rule 1:5-6(c), if information above the black bar is not completed, or attorney’s signature is not affixed.”
The first field block on page 1 is a box labeled “For Use by Clerk’s Office Only,” covering payment type (check, charge, or cash), charge or check number, amount, overpayment, and batch number. The filer-completed portion collects “Attorney/Pro Se Name,” telephone number and extension, firm name, office address, “County of Venue,” “Docket Number (when available),” “Document Type,” a “Jury Demand” Yes/No box, “Name of Party (e.g., John Doe, Plaintiff),” the case caption, and a “Case Type Number (See page 3 for listing).” It then asks whether sexual abuse claims are alleged, whether the case involves claims related to COVID-19, whether it is a professional malpractice case, next to which the form prints “If ‘Yes,’ see N.J.S.A. 2A:53A-27 and applicable case law regarding your obligation to file an affidavit of merit,” whether related cases are pending, with a space to list docket numbers, whether additional parties are anticipated “(arising out of same transaction or occurrence),” and the name of the defendant’s primary insurance company “(if known),” with “None” and “Unknown” checkboxes. The page closes with the line “The Information Provided on This Form Cannot be Introduced into Evidence.”
Page 2 is headed “Case Characteristics for Purposes of Determining if Case is Appropriate for Mediation” and asks about a current, past, or recurrent relationship between the parties (Employer/Employee, Friend/Neighbor, Familial, Business, or Other), fee-shifting under the governing statute, special case characteristics, disability accommodations, and interpreter needs. It carries a certification that “confidential personal identifiers have been redacted … in accordance with Rule 1:38-7(b)” above an “Attorney/Self-Represented Litigant Signature” line.
Pages 3 and 4 list the numbered case types grouped by discovery track - Track I (150 days), Track II (300 days), Track III (450 days), Track IV (active case management by individual judge, 450 days), and Multicounty Litigation - plus checkboxes for Putative Class Action, Consumer Fraud, Title 59, and Medical Debt Claim.
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How this works & your privacy
⬇ Blank form in English (PDF) — The English form as published, blank, for printing and filling by hand.
⬇ Este formulario en español (PDF) — la versión oficial en español publicada por el Poder Judicial de Nueva Jersey.
This form in Spanish, as published by the New Jersey Judiciary.