Landlord Registration Application

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Executive Summary

This document is a Landlord Information Statement form for the Township of Mantua, Gloucester County, New Jersey, as required by Public Law 1974, Chapter 50. It collects information about the property owner, managing agent, emergency contact, and mortgage holders. The form must be completed and submitted to the Township, and it explicitly states that altered forms will not be accepted.

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Document Text

--- Document: Landlord Registration Application Document ---
Townshin.N.J.
TOWNSHIP OF MANTUA
Gloucester County, New Jersey
401 Main Street Mantua, NJ 08051
(856) 468-1500 Fax (856) 464-1022
www.mantuatownship.com
LANDLORD INFORMATION STATEMENT
(Public Law 1974, Chapter 50)
YEAR: 20
FOR PREMISES LOCATED AT:
1. Name and Address of Owner(s) of Record:
2. Record owner(s) of rental business (if any):
3. If Record Owner(s) is a corporation, name corporate officers:
Record Owner is not a corporation.
4. If the address of Record Owner is not located in the County in which the premises are located
(Gloucester County), the name and address of a person who resides in, or has an office in, the
county in which the premises are located and is authorized to accept notices from a tenant and to
issue receipts therefor and to accept service of process on behalf of the Record Owner:
The address of record owner in the county in which dwelling is located:
5. Name and address of managing agent of the premises, if any:
There is no managing agent.
6. Superintendent, janitor, custodian or other individual employed to provide regular maintenance
service, if any:
There is no superintendent, janitor, custodian or other individual employed to provide regular
maintenance service.
7. Name, address, and telephone number of an individual representative of the Record Owner or
Managing Agent who may be reached or contacted at any time in the event of an emergency
affecting the premises or any unit of dwelling space herein, including such emergencies as the
failure of any essential service or system, and who has the authority to make emergency decisions
concerning the building and any repair thereto or expenditure in connection therewith:
8. Name and address of every holder of a recorded mortgage on the premises:
Registrant Signature
FOR OFFICIAL USE ONLY:
Date
Date Received:
Time Received:
Received By:
This document is being provided online in Word format for ease in use to the user. It cannot be altered in any way.
THIS FORM WILL NOT BE ACCEPTED IF IT IS ALTERED IN ANY WAY.