Type Full Name :
Sign With Hand
Attachments
Email
Agent Name
Address
State
State
Block
Property Identified As
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
Property Owner Details
Phone #
I, the undersigned, hereby affirm that I am duly authorized to act on behalf of all ownership interests in the above-referenced property. I hereby attest/swear that the information contained herein is accurate and complete to the best of my knowledge. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment under the violations section of the Code of the {[CNAME]}.
ZIP
Type Fee
Vacant Property and Property in Foreclosure $500
If Property is ALSO Abandoned $1500 Additional
Property Type
Name
Email
{[PNAME]}
Property Details
Company Name
ZIP
Certification
Fees
Assessment
Applicant Signature
Address
Financial Institution/Bank Details
City
ZIP
State
Lot
Registration Fee
City
Address
Property Abandoned?
Email
Company Name
Phone #
Email
City
Representative
Mailing Address
Name
ZIP
Agent/Representative Details
It must be a NJ address
Unit #
Pursuant to {[CNAME]} Code, every owner of a vacant building is required to acquire or maintain liability insurance in the amount of not less than $300,000 for buildings designed primarily for one- to four-unit residential use and not less than $1,000,000 for any other building. You are required to attach evidence of insurance such as a Certificate of Liability Insurance or Insurance Declaration Page within 30 days.
Did you attach the liability insurance?
State
Phone #
Registration Type
City
Phone #
Maintenance Company Details
Contact Agent
Date of Vacancy/Foreclosed
Address