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Landlord Registration
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{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
Property
Contacts
Certification
Single Family Home
Detached Unit
Apartment
Duplex
Condo
Two Family
Mobile Home
Twin
Other
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
Move in Date
Is Dwelling Vacant?
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Oil
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Block
Specify which of the following utilities are provided at this property by the Property Owner.
Water
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Building Name(s)
Lock Box #
Utilities
Electric
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Lot
Property Type
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# of Bedrooms
Lockbox Location
Total # of Buildings on Property
*
If Other
Sewer
*
Gas
*
Property Details
# of Dwelling Units
*
Address
*
Corporation
Individual
Partnership
Other
Owner
Realtor
Other
Electric
Gas
Fuel Oil
Address
Type
*
City, State, ZIP
Email
*
Heating Dealer Address
Email
Name
Heating Dealer Name
Property Owner
Name
Type
*
Mailing Address
Realtor Details
Phone #
Required if Property Type Owner = Individual
Disclaimer: Tenant information is not mandatory
Tenant Details
Heating Details
Heating Dealer Phone #
Maintenance Provider
Phone #
*
Business Name
Corporate Officer Details
Name
*
Phone #
Phone #
*
City, State, ZIP
Full Address, City, State, ZIP
Emergency Contact Person Is
*
Name
Emergency Contact
Email
Heating Grade
Submit
Type Full Name :
Sign With Hand
Clear
Done
Attachments
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).
Applicant Signature
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Female
Male
Age
Unit
Last Name
First Name
Gender
Building
Tenant Details
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Phone #
Corporate Officer Details
City State ZIP
Address
Name
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