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Within 200 feet of (Select address)
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
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The fee per request is $10.00 [N.J.S.A. 40:55D-12(2)c.]. The completed certified list will be forwarded to the above named applicant within the statutory deadline of seven (7) working days from date request is received.
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{[PNAME]}
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I certify that the information provided is correct and true to the best of my knowledge.
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