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Please Note: Another request must be made if the request is for more than one (1) block number.

The fee per request is $10.00 [N.J.S.A. 40:55D-12(2)c.]. If requests are for more than one (1) list, additional fees will be applied. The completed certified list will be forwarded to the above named applicant within the statutory deadline of seven (7) working days from date request is received.

Phone # *

First Name *

Enter any contiguous lots or lots that share a border (if applicable) that you are requesting.

Within 200 feet of (Select address) *

Block

State *

Lot

City *

Applicant Information

Applicant Signature

A request can be made for contiguous lots, or lots that share a border. For each lot that is not contiguous or shared, a separate request must be made.

Fee

Fax #

Request Location

Preferred Delivery Method *

Address *

Email *

Address

I certify that the information provided is correct and true to the best of my knowledge.

ZIP *

Certification

Last Name *