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Get NJ CN 10486 2020-2024

PrintForm Clear form New Jersey Judiciary Confidential Litigant Information Sheet R. 5 4-2 g To assure accuracy of court records - To be filled out by Plaintiff or Defendant or Attorney Collection of the following information is pursuant to N.J.S.A. 2A 17-56. 60 and R* 5 7-4. Please complete the entire form leaving no blank spaces. If something does not apply to you enter N/A. This form is confidential and will not be shared with the other party. Docket Number CS Number Do you have an active Domestic Violence Order with the other party in this case Yes No Plaintiff Defendant Name last first middle initial Social Security Number Date of Birth Place of Birth Address Street City State Plaintiff Telephone Number Zip Employer Telephone Number Defendant Telephone Number Employer Name or other income source Employer Address Street Professional Occupational Recreational Licenses include types and license numbers Driver s License Number Sex State of Issuance Race/Ethnicity Auto License Plate Height Make Eyes Hair Year Model Attorney Name Attorney Address Street Children Information Health Coverage for Children - available through parent filling out this form Health Care Provider Policy Number Group Number I certify that the foregoing statements made by me are true to the best of my knowledge. I am aware that if any of the foregoing statements made by me are wilfully false I am subject to punishment. 2A 17-56. 60 and R* 5 7-4. Please complete the entire form leaving no blank spaces. If something does not apply to you enter N/A. This form is confidential and will not be shared with the other party. Docket Number CS Number Do you have an active Domestic Violence Order with the other party in this case Yes No Plaintiff Defendant Name last first middle initial Social Security Number Date of Birth Place of Birth Address Street City State Plaintiff Telephone Number Zip Employer Telephone Number Defendant Telephone Number Employer Name or other income source Employer Address Street Professional Occupational Recreational Licenses include types and license numbers Driver s License Number Sex State of Issuance Race/Ethnicity Auto License Plate Height Make Eyes Hair Year Model Attorney Name Attorney Address Street Children Information Health Coverage for Children - available through parent filling out this form Health Care Provider Policy Number Group Number I certify that the foregoing statements made by me are true to the best of my knowledge. This form is confidential and will not be shared with the other party. Docket Number CS Number Do you have an active Domestic Violence Order with the other party in this case Yes No Plaintiff Defendant Name last first middle initial Social Security Number Date of Birth Place of Birth Address Street City State Plaintiff Telephone Number Zip Employer Telephone Number Defendant Telephone Number Employer Name or other income source Employer Address Street Professional Occupational Recreational Licenses include types and license numbers Driver s License Number Sex State of Issuance Race/Ethnicity Auto License Plate Height Make Eyes Hair Year Model Attorney Name Attorney Address Street Children Information Health Coverage for Children - available through parent filling out this form Health Care Provider Policy Number Group Number I certify that the foregoing statements made by me are true to the best of my knowledge. I am aware that if any of the foregoing statements made by me are wilfully false I am subject to punishment.

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