Type Full Name :
Sign With Hand
Property Information
In the event of an emergency at the property, who can we contact?
How is this property heated? *
Attach a simple floor plan sketch of the rental premises. Also attach documents required to prove fee exemption status. (if applicable)
Full Address
Is Applicant Owner of Record or Agent? *
Last Name *
If Fuel Oil is used, please include name address and phone number of oil provider.
Phone
Annual Registration - $50.00 Per Rental Unit - Due Upon Registration Submission
  1. Inspection Fees
    • Initial Inspection - Free
    • First Re-Inspection - Free
    • Second Re-Inspection - $25.00 Per Unit
    • Additional Re-Inspection - $50.00 Per Unit
    If any fees are not paid within thirty (30) days of its due date, an additional late surcharge of $30.00 will be assessed for each month past due.
  2. PLEASE INCLUDE A FLOOR PLAN SKETCH OF THE RENTAL PREMISES (See "Required Documents" section below).
  3. Each rental unit will be inspected at least once a year.
  4. Any change in ownership will require, within twenty (20) days of the change, a new registration form, fee and inspection of the premises. Any change in tenancy will require a new registration form within twenty (20) days of change at no fee.
  5. Every owner and/or landlord must provide a copy of the registration certificate to each tenant or it must be posted in a conspicuous place within the rental unit.
  6. There is no fee if the property owner is receiving a Senior Citizen or Disabled Person Property Tax Deduction under the laws of the State of New Jersey. Also, there is no fee if the property owner is registered as a 501(c)3 Corps. and considered tax exempt by the Internal Revenue Service. Documentation must be submitted to validate this exemption - see "Required Documents" section below.
Phone *
Mailing Address *
Required Documents
Applicant Information
Name of Oil Provider
Complete Name *
Qualifier
Property Type *
{[CNAME]}
Emergency Contact Information
Specify unit number, full legal name, age and gender of all tenants (including children) living in the premises.
Tenant Information
Address 2
{[PNAME]}
First Name *
If the property is owned by a rental business, partnership, LLC, Corporation or other business relationship, provide the names, addresses, phone numbers, and percentage of ownership of each general partner
City, State,ZIP
Amount Due
Lot
Additional Phone
Begin typing address and select from the populated dropdown
Any person violating or failing to comply with any other provision of this chapter shall, upon conviction thereof, be punishable by a fine of no less than $100.00 and nor more than $1,250.00, by imprisonment of not to exceed ninety (90) days or by community service of not more than ninety (90) days or any combination of fine, imprisonment and community service as determined in the discretion of the Municipal Court Judge. The continuation of such violation for each successive day shall constitute a separate offense and the person or persons allowing or permitting the continuation of the violation may be punished as provided above for each separate offense.

I submit the information on this application in reference to N.J.S.A. 46:8-28 regarding the above referenced property. I certify the information to be true and accurate.

Certification
Heating Information
Additional Phone
Applicant Signature *
Registration Type *
Phone *
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[PPHONE]}
{[AWEBSITE]}
Full Address, City, State, ZIP
Fee Schedule
Block
City, State, ZIP *
Property Address *
Email *