First Name *
Last Name*

Address Information *

Phone Number *

Please Select One *

Please select a status Individual Owner(s) Corporation Partnership Unincorporated business

If Corporation, the Name and Address of the Registered Agent & Corporate Officers: *

First Name
Last Name

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Address Information *

Block *
Lot *
Rental Certificate of Occupancy Number *

Has the property been inspected yet? *

Please select a status Yes No

Please Select One *

Please select a status Single Family Duplex Condo
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Is this applicable? *

Please select a status Yes No
Name(s) *

Address Information *

Phone Number *
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Is this applicable? *

Please select a status Yes No
Mortgage Company *

Address Information *

Phone Number *
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If the property owner does not reside in Ocean County, the name and address of a person who resides in Ocean County who is authorized to accept notices from a tenant & issue receipts therefore & to accept service of process on behalf of the record owner.

Does the property owner live in Ocean County? *

Please select a status Yes No
Name *
Phone Number *

Address Information *

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Is this applicable? *

Please select a status Yes No
Name *
Phone Number *

Address Information *

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Superintendent, Janitor, Custodian or Other employed by the record owner or managing agent to provide regular maintenance services, if any.

Is this applicable? *

Please select a status Yes No
Name *
Phone Number *

Address Information *

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Individual representing the record owner who has the authority to make emergency decisions concerning the building and any repair thereto and who has access to a current list of building tenants.

Is this applicable? *

Please select a status Yes No
Name *
Phone Number *

Address Information *

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If fuel oil is used to heat the building and the Landlord furnishes the heat in the building.

Is this applicable? *

Please select a status Yes No
Name *
Phone Number *

Address Information *

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I hereby declare under the penalties of the Law that the foregoing Statement is correct in all particulars.

Full Name *
Email *
Number of Certified Occupants *
Certificate of Occupancy *
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* indicates a required field.