Type Full Name :
Sign With Hand
If the request is for more than one (1) block number then another request must be made.
The fee per request is $10.00 [N.J.S.A. 40:55D-12(2)c.]
(555) 555-5555
Telephone #*
First Name*
List any contiguous lots or lots that share a border (if applicable) that you are requesting. Click Add New Record to add a Lot # and Update to save.
Request for Certified List
Block
State*
Lot
Fee Schedule
Requestor Information
City*
* Indicates required field
Applicant Signature
A request can be made for contiguous lots, or lots that share a border. For each lot that is not contiguous or shared, a separate request must be made.
Certification
Fax #
Preferred Delivery Method
Address*
Email*
www.yourtown.us
Your Town, USA 00000
Address
Zip*
Your Town
123 Main Ave
Request Location
Last Name*
Fee Due