Residential Commercial Mixed Use

Initial Registration First Renewal Any Subsequent Renewal De-Registration

Vacant Abandoned Under Construction Occupied

Yes No

Yes No

On Off

On Off

On Off

Yes No

Yes No

Yes No

Initial Registration

Sign affixed to building and visible to public, indicating the name, address and telephone number of the responsible party, any authorized agent designated by the responsible party for the purpose of receiving service of process, and the person responsible for the maintenance of the property if different from the property or authorized agent? *

Attachments

Email *

De-Registration

Water

Agent Name *

Address

First Renewal

Status

Block *

Property Identified As

Amendment to Registration

City, State, ZIP *

Property Owner Information

Phone #

City, State, ZIP

Any change in the information contained on this form must be submitted to the Manville Borough Clerk within 30 days of the change. Failure to submit the changes is a violation and the Responsible Party may be subject to fines pursuant to Section 7 of Ordinance #2016-1173.

Please provide payment payable to Borough of Manville.

I certify that the foregoing statements made by me are true.

Property Type *

Number of Stories

Proof of Liability Insurance pursuant to Section 232-12(3) *

Name

$0.00 - Property is no longer Vacant & Abandonded

Email *

$5000.00 - January 15th each year

Property Details

$3000.00 - In-Compliance Next January 15th

Phone Number

Company Name *

Account Number

Certification

Fee Schedule

Assessment

Applicant Signature *

Address *

Number of Garages

Financial Institution/Bank Information

City, State, ZIP *

Gas

Lot *

Registration Fee

Address *

Enclosed and secured from unauthorized entry? *

Email *

City, State, ZIP *

Company Name

Phone # *

Email

Company Name

Copy of Notice detailing your agent/contact# that is to be posted on the vacant and abandoned property pursuant to Section 332-12(2) *

Representative *

Mailing Address *

Name *

Agent/Representative

Property Address

Address *

The fee and registration shall be remain valid for one year from the date of issuance and shall be renewed on an annual basis if the property remains vacant and abandoned.

Unit #

Fees, if applicable, pursuant to Section 232-11D *

Any Subsequent Renewal

Utilities

$0.00

Phone # *

Registration Type *

$1500.00 - Prorated depending on which month

Phone # *

Maintenance Company

Contact Agent

Electric

Date of Vacancy *

Square Footage