41 SCHOOLHOUSE ROAD
JACOBSTOWN, NJ 08562
[PURSUANT TO N.J.S.A. 46:8-26 ET SEQ. - THE LANDLORD REGISTRATION REQUIRMENT APPLIES TO ALL RENTAL PREMISES OR UNITS USED FOR DWELLING PURPOSES EXCEPT OWNER-OCCUPIED PREMISES WITH NOT MORE THAN TWO RENTAL UNITS]
Pursuant to the New Jersey Landlord Act, N.J.S.A. 46:8-27 et seq., I hereby file the following registration statement with your office for the property located at__________________________________ in the ____________________of __________________________and County of___________________________:
Name and address of owner of property:
____________________________________________________________________________________________________________________________________
Name and address of owner of rental agent:
____________________________________________________________________________________________________________________________________
If record owner of property is a corporation:
Name and address of registered agent of the corporation:
________________________________________________________________________________________________________________________
b. Name and address of officers of the corporation:
____________________________________________________________
____________________________________________________________
Name of person located in the County in which the property is located who is authorized by the owner of the property to accept and sign a receipt for notices from tenants and to accept service of process:
____________________________________________________________________________________________________________________________________
Name and address of managing agent (if any):
____________________________________________________________________________________________________________________________________
Name and address (including apartment number) of maintenance employee:
____________________________________________________________________________________________________________________________________
Name, address and telephone number of emergency representative of the owner or managing agent to be available 24 hours per day:
____________________________________________________________________________________________________________________________________
Name and address of all holders or recorded mortgages:
____________________________________________________________________________________________________________________________________
If fuel oil is used to heat the building and the landlord furnishes the heat in the building, the name and address of the fuel oil dealer servicing the building and the grade of fuel oil used:
____________________________________________________________________________________________________________________________________
Name and address where tenants may obtain crime insurance applications through the Federal Crime Insurance Program, Title VI of the Housing and Urban Development Act of 1970:
____________________________________________________________________________________________________________________________________
At time of filing a Certificate of Registration or an amended Certificate of Registration the landlord shall provide each occupant or tenant in the premises with a copy within seven (7) days of filing.
Upon filing of a Certificate of Registration with the Municipal Clerk, the Municipal Clerk shall index and file said Certificate and make it available for public inspection.
__________________________________________________________________
Signature of Owner Date
__________________________________________________________________
Signature of Municipal Clerk Date