Type Full Name :
Sign With Hand
City, State, ZIP
Owner of Record
Is this a New or Renewal application?
Please upload a Lead-Safe Certification, if one exists. If not, all properties built prior to 1978 must provide one before July 22, 2024.
Mailing Address
Lot
Heating Information
Is Fuel Oil used?
Provide information for someone who may be reached at any time in the event of an emergency affecting the premises, any unit or dwelling space therein, including such emergencies as the failure of any essential service or system, and who has the authority to make emergency decisions concerning the premises, any unit or dwelling space, and any immediate repair and expenditures in connection thereof.
Phone #
Mortgage Holder Information
Who is making this application?
Does the Property Owner
provide the Fuel Oil used?
Number of units being rented
Tenant Information
Per NJ P.L., c182, all residential properties built before 1978 are required to be tested for lead-based paint hazards. All rental units must be inspected for lead-based paint no later than July 22, 2024, regardless of change in tenancy. Dwelling owners and landlords are permitted to hire a certified lead evaluation contractor for this purpose. South Orange Village is currently in the process of qualifying several contractors who can perform these services, as well as contracting with a certified contractor so that we can offer you this service through our Building Department. All costs to perform these tests and obtain the necessary lead-safe certification will be at the expense of the owner/landlord. Should you already have a lead-safe certification, please upload it when completing this year's rental registration form. Any questions regarding this new requirement should be directed to our building official, Mr. Anthony Grenci, at 973.378.7715, ext. 7703.
I certify that the information contained in this statement are true and accurate and that I am authorized to submit and sign the Annual Registration Statement on behalf of the owner(s) of the property and premises.

I further certify that I understand that pursuant Ordinance #2009-18 of the Township of South Orange Village, that I am required to file an amended Annual Registration Statement with the Township of South Orange Village within seven (7) days of any changes to the information contained herein.

By signing below, I hereby declare and certify under penalty of law that the information provided in this Annual Rental Registration Statement is true and correct in all of its particulars as of the date indicated.

Provide the names and addresses of every holder of the recorded mortgage on the premises
Address 2
Emergency Contact Person
Single Family
Multi Family (2-50 units)
Multi Family (51+ units)

Late Fee (Filing 9/2-10/31)
Additional Late Fee for each calendar month beginning on 11/1
Full Address, City, State, ZIP
Provide the tenant and lease information for every unit being rented
Rental Registration
Applicant Signature
Attachments
Enter the address of the rental property and select from the populated dropdown
Lead-Safe Certification exists?
If the answer to any of the above is Yes, provide the name, address and contact information for the Fuel Oil provider.
Phone #
What year was the property built? *
Email
Applicant Information
Fee Schedule
Address
Property Type
Address
Phone #
Phone #
First Name
Fuel Oil Company
$125.00
$175.00
$250

$100
$50/month
76 South Orange Avenue Suite 302
South Orange, NJ 07079
(973) 378-7715
www.southorange.org
City, State, ZIP
Email
Block
Email
Complete Name
Complete Name
Amount Due
Certification
Last Name