Type Full Name :
Sign With Hand
City, State, ZIP
Owner of Record
Is this a New or Renewal application?
Mailing Address
Heating Information
Is Fuel Oil used?
Provide information for someone who may be reached at any time in the event of an emergency affecting the premises, any unit or dwelling space therein, including such emergencies as the failure of any essential service or system, and who has the authority to make emergency decisions concerning the premises, any unit or dwelling space, and any immediate repair and expenditures in connection thereof.
Phone #
Mortgage Holder Information
Who is making this application?
Does the Property Owner
provide the Fuel Oil used?
Number of units being rented
Tenant Information
I certify that the information contained in this statement are true and accurate and that I am authorized to submit and sign the Annual Registration Statement on behalf of the owner(s) of the property and premises.

I further certify that I understand that pursuant Ordinance #2009-18 of the Township of South Orange Village, that I am required to file an amended Annual Registration Statement with the Township of South Orange Village within seven (7) days of any changes to the information contained herein.

By signing below, I hereby declare and certify under penalty of law that the information provided in this Annual Rental Registration Statement is true and correct in all of its particulars as of the date indicated.

Provide the names and addresses of every holder of the recorded mortgage on the premises
Address 2
Emergency Contact Person
Single Family
Multi Family (2-50 units)
Multi Family (51+ units)

Late Fee (Filing 9/2-10/31)
Additional Late Fee for each calendar month beginning on 11/1
Full Address, City, State, ZIP
Provide the tenant and lease information for every unit being rented
Rental Registration
Applicant Signature
Enter the address of the rental property and select from the populated dropdown
If the answer to any of the above is Yes, provide the name, address and contact information for the Fuel Oil provider.
Phone #
Applicant Information
Fee Schedule
Property Type
Phone #
Phone #
First Name
Fuel Oil Company

76 South Orange Avenue Suite 302
South Orange, NJ 07079
(973) 378-7715
City, State, ZIP
Complete Name
Complete Name
Amount Due
Last Name