Appendix V - Family Part Case Information Statement Form
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Appendix V
Family Part Case Information Statement
This form and attachments are confidential pursuant to Rules 1:38-3(d)(1) and 5:5-2(f)
Attorney(s):
Office Address:
Tel. No./Fax No.
Attorney(s) for:
SUPERIOR COURT OF NEW JERSEY
CHANCERY DIVISION, FAMILY PART
Plaintiff,
COUNTY
vs.
DOCKET NO.
Defendant.
CASE INFORMATION STATEMENT
OF
NOTICE:
This statement must be fully completed, filed and served, with all required attachments, in accordance
with Court Rule 5:5-2 based upon the information available. In those cases where the Case
Information Statement is required, it shall be filed within 20 days after the filing of the Answer or
Appearance. Failure to file a Case Information Statement may result in the dismissal of a party’s
pleadings.
INSTRUCTIONS:
The Case Information Statement is a document which is filed with the court setting forth the financial
details of your case. The required information includes your income, your spouse's/partner's income, a
budget of your joint life style expenses, a budget of your current life style expenses including the
expenses of your children, if applicable, an itemization of the amounts which you may be paying in
support for your spouse/partner or children if you are contributing to their support, a summary of the
value of all assets referenced on page 8 – It is extremely important that the Case Information
Statement be as accurate as possible because you are required to certify that the contents of the
form are true. It helps establish your lifestyle which is an important component of alimony/spousal
support and child support.
The monthly expenses must be reviewed and should be based on actual expenditures such as those shown
from checkbook registers, bank statements or credit card statements from the past 24 months. The asset
values should be taken, if possible, from actual appraisals or account statements. If the values are
estimates, it should be clearly noted that they are estimates.
According to the Court Rules, you must update the Case Information Statement as your circumstances
change. For example, if you move out of your residence and acquire your own apartment, you should file
an Amended Case Information Statement showing your new rental and other living expenses.
It is also very important that you attach copies of relevant documents as required by the Case Information
Statement, including your most recent tax returns with W-2 forms, 1099s and your three (3) most
recent paystubs.
If a request has been made for college or post-secondary school contribution, you must also attach all
relevant information pertaining to that request, including but not limited to documentation of all costs and
reimbursements or assistance for which contribution is sought, such as invoices or receipts for tuition,
board and books; proof of enrollment; and proof of all financial aid, scholarships, grants and student loans
obtained.
Revised to be effective September 1, 2017. CN: 10482 (Court Rules Appendix V)
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