New Jersey Administrative Code
Title 13 - LAW AND PUBLIC SAFETY
Chapter 43 - STATE BOARD OF COURT REPORTING
Appendix A
WRITTEN NOTIFICATION AND DISCLOSURE FORM
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______________________________________
(Name of Temporary Registered Reporter)
______________________________________
(Temporary Registered Reporter Number)
___________________________________________________
(Name and Telephone Number of Agency, if applicable)
___________________________________________________
Date of Deposition or Proceeding
Pursuant to the mandates of 45:15B-9 b(2) and 13:43-2.2(d), please be advised that I am a Temporary Registered Reporter in the State of New Jersey. A Temporary Registered Reporter is not certified by the State Board of Court Reporting ("Board") but is registered with the Board to practice as a court reporter on a temporary basis.
A Temporary Registered Reporter is required to disclose to all parties at a proceeding that he/she is not a certified court reporter in this State and is further required to obtain a written acknowledgment that this information has been disclosed to the parties. Therefore, please sign and date this form below in order to acknowledge and attest to the fact that this proceeding is being recorded by a Temporary Registered Reporter rather than a Board certified court reporter.
| Plaintiff/Petitioner/Attorney | Defendant/Respondent/Attorney |
| _____________Print Name | ________________Print Name |
| ______________Signature | ________________Signature |
| Plaintiff/Petitioner/Attorney | Defendant/Respondent/Attorney |
| _____________Print Name | ________________Print Name |
| ______________Signature | _________________Signature |
| Plaintiff/Petitioner/Attorney | Defendant/Respondent/Attorney |
| _____________Print Name | ________________Print Name |
| ______________Signature | _________________Signature |
| Plaintiff/Petitioner/Attorney | Defendant/Respondent/Attorney |
| _____________Print Name | ________________Print Name |
| ______________Signature | _________________Signature |
REFUSAL TO CONSENT
I, ________________________, a Temporary Registered Reporter, Registration Number _______________, hereby certify that, as required by 45:15B-9 b(2) and 13:43-2.2(d), I disclosed to the participants of the proceeding identified above that I am not certified by the State Board of Court Reporting but that I am registered with the Board to practice as a court reporter on a temporary basis. The parties thereafter chose to postpone the proceeding until a certified court reporter is available. The foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment.
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Name and Registration Number of Temporary Registered Reporter
