Type Full Name :

Sign With Hand

A copy of this information shall also be filed with the Building Department of the Borough of Atlantic Highlands.

City, State, ZIP

1) By Cash, Check or Credit Card On-Site at Borough Hall

100 First Avenue, Atlantic Highlands, NJ 07716
Phone #: (732) 291-1222 | Fax: (732) 291-9725
www.ahnj.com

Email *

Landlord Registration
Statement

Is Fuel Oil used? If "Yes," provide the name and address of the supplier. *

Complete Name

Payment

Oil

2) By Check in the mail. Please make sure to note the application reference number on the check. Instructions can be found in the email confirmation of this application.

Complete Name

Owner of Record

Complete Name

Is the Emergency Contact person the same as Property Owner listed above? If "No" please fill out the section below. *

*Note that payment must be received in full before a business registration certificate can be issued.

Block

Begin typing address and select from the populated dropdown *

Mailing Address

3) By Credit Card Online. Instructions can be found in the email confirmation of this application.

Utilities

Water

Fuel Oil Service

Full Address, City, State, ZIP

Applicant Signature

Maintenance Provider

Phone # *

Zone

Complete Name

Phone #

Electric

Lot

Property Type *

Full Address, City, State, ZIP

Is the Maintenance Provider the same as the Property Owner above? If "No" please fill out below. *

Fee Due

Full Address, City, State, ZIP

Phone #

# Units Leased

Full Address, City, State, ZIP

Payment Type *

Pursuant to the terms of N.J.S.A. 46:8-27, et seq., the following information is being supplied to the tenant.

Is the Managing Agent the same as the Property Owner above? If "No" please fill out the section below. *

Gas

One & Two Family Residence

Managing Agent

Property Information

Payment can be made:

Complete Name

# Units Owned

Borough of
Atlantic Highlands

Emergency Contact

Address