Property Information
# of Bedrooms
Unit Location (1st Floor, etc.)
Designation (If Any)
Property Type
I submit the following information in reference to N.J.S.A 46:8-28 regarding the above referenced property. I certify the information to be true and accurate.
Address 2
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
Lot
# of Bathrooms
Begin typing address and select from the populated dropdown
{[PNAME]}
Block
Property Address
  • Contacts
  • Attachments & Certification
Does Landlord Provide Heat?
Name
Heating Type
Address
Phone #
Email
Name
Address
Address
City, State, ZIP
Phone #
Address
Additional Phone #
Is this property vacant?
Mailing Address
Partner Information
Applicant Information
Emergency Contact
Name
Is this property tenant occupied ?
Property Superintendent/Custodian Information
Is there a recorded mortgage on property?
Name
If the property is owned by a rental business, partnership, LLC, Corporation or other business relationship, provide the names of all general partners.
Phone #
Please provide the name, address and phone 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.
Email
Mortgage or Lien Holder Information
Agent or Representative Information
Heating Information
Email
City, State, ZIP
Name
Phone #
Phone #
Phone #
City, State, ZIP
City, State, ZIP
Emergency Contact Is?
Company Name
City, State, ZIP
Email
Address
Email
City, State, ZIP
Is this an owner occupied property?
Type Full Name :
Sign With Hand
Please attach any necessary documents.
Attachments
Applicant Signature
Certification
I certify that the information mentioned above is true to my knowledge.