Mortgages Holder (Company Holder)
Property Owner Type *
Block
Please add the names and addresses of all record owners of the building or the rental business (including all general partners in the case of a partnership) *
Does the owner reside in the home? *
Zone
Lot
Property Type *
Owners Of Building
Is there a recorded mortgage on the property? *
Address *
Property Details
The names and addresses of all holders of recorded mortgages on the property are required. *
Address *
Type *
Phone # *
Heating Dealer Address
Email *
Name *
Does the Landlord furnish heat (Fuel Oil Only)?
Address *
Heating Dealer Name
Name *
Is the Authorized Agent same as the Emergency Contact? *
If the address of any record owner is not located in the county in which the dwelling is located, the name and address of a person who resides in the county and is authorized to accept notices from a tenant, to issue receipts for those notices and to accept service of process on behalf of the out-of-county record owner(s) is as follows:
If the record owner is a corporation, the names and addresses of the registered agent and of the corporate officers are as follows:
Managing Agent Details
Phone # *
City, State, ZIP *
Heating Details
Dealer Phone #
Maintenance Provider
Address *
Registered Agent & Corporate Officers Details
Business Name *
First Name *
Name *
Phone # *
City, State, ZIP *
Phone # *
* Must Live in Bergen County
Emergency Contact
City, State, ZIP *
Email *
Full Address, City, State, ZIP *
Emergency Contact Person Is *
If fuel oil is used to heat the building and the landlord furnishes the heat, the name and address of the fuel oil dealer servicing the building and the grade of fuel oil used are as follows:
Authorized Agent/Owner
Is there a Managing Agent? *
The name and address (including dwelling unit, apartment or room number) of the superintendent, janitor, custodian or other person employed to provide regular maintenance service is as follows:
Email *
The name, address and telephone number of an individual representative of the record owner or managing agent who may be reached or contacted at any time in the event of an emergency affecting the dwelling or any dwelling unit, including such emergencies as the failure of any essential service or system, and who has authority to make emergency decisions concerning the building, including the making of repairs and expenditures, is as follows:
Is the a Maintenance Provider? *
Heating Grade
Certification
N.J.A.C. 5:29-1.1
5:29-1.1 Applicability
(a) Pursuant to N.J.S.A. 46:8-28 and 46:8-29, the form prescribed by this subchapter is required to be given by landlords to tenants in single unit dwellings and in two
– unit dwellings that are not owner-occupied and to be filed in the office of the clerk of the municipality in which any such single unit dwelling or two-unit dwelling is situated.
(b) Tenants in multiple dwellings are required to be given a copy of the certificate of registration filed with the Bureau of Housing Inspection in accordance with N.J.S.A. 55:13A-12, N.J.S.A. 46:8-28 and N.J.A.C. 5:10-1.11. (Contact the Bureau of Housing Inspection, P.O. Box 810, Trenton, New Jersey 08625
(609) 633-6240 for registration applications for buildings with three or more dwelling units).
The # of Registered Agent & Corporate Officers Details can not be 0 when Property Owner Type is Corporation.
Please Note
The # of Mortgages Holder (Company Holder) can not be 0 when there is Mortgage on the property.
