11252 – Verified Complaint for Nonpayment of Rent – Appendix XI-X

This form, 11252 – Verified Complaint for Nonpayment of Rent (Appendix XI-X), is used in the Superior Court of New Jersey, Law Division, Special Civil Part. It is a standardized document that landlords or their attorneys use to initiate legal action against tenants who have failed to pay rent.  The form concludes with sections for the landlord’s or attorney’s signature and date, verification of personal knowledge of the complaint, and any necessary accommodations for disabilities or language interpreters. Personal identifiers such as Social Security numbers or active financial account numbers should not be included in the document, as it is a public record.

Filling out this form involves several steps. Here’s a guide to help you complete each section accurately:

Section 1: Plaintiff or Filing Attorney Information

• Name: Enter the full name of the landlord or the attorney filing the complaint.
• NJ Attorney ID Number: If an attorney is filing, enter their New Jersey Attorney ID number.
• Address: Provide the complete mailing address of the plaintiff or the filing attorney.
• Email: Enter a valid email address for correspondence.
• Telephone Number: Provide a contact phone number.

Section 2: Court Information

• Superior Court of New Jersey, Law Division, Special Civil Part: Enter the county where the case is being filed.
• Docket Number: Leave this blank if unknown; the court will assign it.

Section 3: Parties Involved

• Name of Plaintiff(s)/Landlord(s): Write the full name(s) of the landlord(s).
• Name of Defendant(s)/Tenant(s): Write the full name(s) of the tenant(s).
• Address of Rental Premises: Provide the full address of the rental property.
• Tenant’s Phone Number: Enter the tenant’s contact phone number.
• Tenant’s Email: Enter the tenant’s email address.

Section 4: Ownership and Agreement Details

• Owner of Record: Enter the name of the property owner.
• Plaintiff Status: Check the appropriate box to indicate whether the plaintiff is the owner, agent, assignee, grantee, or prime tenant of the owner.
• Ownership Acquisition: Check whether the landlord acquired ownership from the tenant(s).
• Option to Purchase: Check if the landlord has given the tenant(s) an option to purchase the property.
• Possession Details: Enter the date the tenant(s) began residing in the premises and check whether the agreement is written or oral.
• Subsidized Tenancy: Check this box if the tenancy is subsidized by federal or state programs or if it’s public housing.
• Lease Registration: Check if the landlord has registered the leasehold and notified the tenant as required by law.

Section 5: Rent Payment Information

• Monthly Rent: Enter the amount the tenant(s) must pay for the premises and the due date each month.
• Unpaid Rent and Charges: List the unpaid base rent, late charges, attorney fees, and other charges for each relevant period.
• Next Rent Due Date: Enter the date the next rent payment is due.

Section 6: Additional Claims (If Applicable)

• Additional Reasons for Possession: If the complaint includes reasons other than non-payment of rent, attach all relevant notices and state the reasons.
• Tenant Holdover: Check if the tenant(s) continue to possess the property without the landlord’s consent.

Section 7: Landlord Verification

• Certification: Check the box that describes the landlord’s status (landlord, general partner, or authorized officer).
• Personal Knowledge: Certify that the information in the complaint is true and based on personal knowledge.
• Other Actions: State if the matter is the subject of any other court action or arbitration, listing any exceptions.
• Confidential Information: Certify that personal identifiers have been redacted from all documents.
• Truthfulness: Acknowledge that false statements are subject to punishment.

Section 8: Additional Information

• Interpreter Needed: Indicate if an interpreter is needed and specify the language.
• Disability Accommodation: Indicate if any accommodations for disabilities are required.

Signature

• Signature: The landlord, partner, or authorized officer must sign and date the form.
• Printed Name: Print the name of the person signing the form.

Ensure all information is accurate and complete before submitting the form to the court. If you have any doubts or need legal advice, consult with an attorney.