Registration Tenant Change

Single Family Detached Single Family Attached Duplex Multiple Dwelling Garden Apartments High Rise Apartments Garage Apartment Studio Detached Cottage Community Residence Condominium Unit Rooming Unit Rooming House Other

Yes Non-Applicable

No Yes

1 2 3+

No Yes

No Yes

No Yes

No Yes

No Yes

# of Stories

Move in Date

Is Dwelling Vacant? *

Oil *

Block

# of units (if 3+)? *

Specify which of the following utilities are provided at this property by the Property Owner.

Water *

Building Name(s)

Zone

Lock Box #

Utilities

Electric *

Lot

Property Type *

Apt/Unit #

# of Legal/Approved Bedrooms

Is There a Mortgage on the Property? *

Lockbox Location

Total # of Buildings on Property *

If Other

Application Type *

Sewer *

Gas *

Property Details

# of Dwelling Units *

Address *

Corporation LLC Individual Partnership Other

Propane Natural Gas Fuel Oil Electric Underground Tank Aboveground Tank Other

Address

Type *

Policy # *

City, State, ZIP

Email *

Heating Dealer Address

Email

Supervisor Information

Name

Company Name *

Heating Dealer Name

Property Owner

Name

Type *

Name

Company Address *

Mailing Address

Company Phone # *

Realtor Details

Phone #

Company City, State, Zip *

Phone #

Disclaimer: If a Tenant is a minor, you must specify their age. You must enter at least one tenant to be allowed to submit.

Tenant Details

Heating Details

Heating Dealer Phone #

Maintenance Provider

Phone # *

Business Name

Phone #

City, State, ZIP

% of Ownership *

Full Address, City, State, ZIP

Insurance Company Information

% Owned by Additional Owners

Total % Owned (must equal 100%)

Please specify additional owners and percentage owned, if applicable.

Name

Expiration Date *

Heating Grade

Name *

Phone # *

Name *

- At least one Emergency Contact MUST be a Monmouth County Resident.

Email *

Email *

Emergency Contact Role Is *

Name *

Phone # *

Emergency Contact Role Is *

Emergency Contact Role Is *

Phone # *

Emergency Contacts

Email

Bank Address *

Mortgage Holder Information

First Name *

Bank City, State, Zip *

Bank Name *

City, State, Zip *

Mortgage Bank Information

Bank Phone # *

Address *

Last Name *

I Agree

100% Ownersip Entered Less than 100% Ownership Entered

Number of Tenants can not be 0 Acceptable Number of Tenants Entered

Attachments

Fee Schedule

If Acceptable Number of Tenants Entered is not displayed below, you will not be able to submit.

Certification

N.J.A.C. 5:29-1.1
5:29-1.1 Applicability
(a) Pursuant to N.J.S.A. 46:8-28 and 46:8-29, the form prescribed by this subchapter is required to be given by landlords to tenants in single unit dwellings and in two – unit dwellings that are not owner-occupied and to be filed in the office of the clerk of the municipality in which any such single unit dwelling or two-unit dwelling is situated.
(b) Tenants in multiple dwellings are required to be given a copy of the certificate of registration filed with the Bureau of Housing Inspection in accordance with N.J.S.A. 55:13A-12, N.J.S.A. 46:8-28 and N.J.A.C. 5:10-1.11. (Contact the Bureau of Housing Inspection, P.O. Box 810, Trenton, New Jersey 08625 (609) 633-6240 for registration applications for buildings with three or more dwelling units).

Please attach your  Lead-Safe Certificate as Law requires all landlords of every single family, 2-family, and multi-family rental to provide a current Lead Safe Certificate for each rental turnover for all properties built prior to 1978.

First Time Registration: $50.00
Tenant Change: $20.00

Check, Money Order or Cash payments only. Please do not mail Cash.

Fee Due

If 100% Ownership Entered is not displayed below, you will not be able to submit.

Do you acknowledge and agree to the above certification? *

Applicant Signature *

Please attach floor plan for each dwelling unit and any other necessary documenation.