Document Text
--- Document: Landlord Registration Form Document ---
LANDLORD IDENTITY REGISTRATION
STATEMENT
In compliance with P.L. 1974 c. 50 & P.L. 2022 c. 92 of the
laws of the State of New Jersey and all amendments thereto
Instructions:
Complete this form for each structure and mail it with the fee and insurance certificate to:
Robbinsville Township Clerk’s Office
2298 Route 33
Robbinsville, NJ 08691
Fee: $60 fee made payable to Robbinsville Township (please note that Credit Card payments will incur a 3%
surcharge).
Proof of Insurance: Pursuant to P.L. 2022, c.92, owners of rental units in the Township of Robbinsville shall provide
a certificate of liability insurance for negligent acts and omissions as set forth below. Such insurance may be provided
as part of policies such as those for commercial general liability, personal liability or an umbrella insurance policy.
o
For landlords of one or more rental units: $500,000 for combined property damage and bodily injury to or
death of one or more persons in any one accident of occurrence.
o
For owner-occupied two-, three-, or four-family homes: $300,000 for combined property damage and bodily
injury to or death of one or more persons in any one accident of occurrence.
This form is due at the time of the creation of the first tenancy in any newly constructed or reconstructed building.
Registrations expire June 30th of each year. Renewals are due by July 1st of each year.
Owners of non-owner occupied one- and two-unit dwellings must supply their tenants with a copy of this form and
amendments made to it.
Owners of multiple dwelling units (like apartment complexes) must also comply with filing forms with the Bureau of
Housing Inspection in the Department of Community Affairs as defined in N.J.S.A. 55:13A-3.
Please Check one:
Owner of a non-owner occupied one- or two-unit dwelling (Fill out #’s 1 through 9 below)
Owner of an owner-occupied two-, three-, or four-family home (Fill out #’s 1 and 2 below)
(1) Property Address:
_____________________________________________________________________________
_____________________________________________________________________________
(2) The names and mailing addresses of all record owners of the building or the rental business
(including all general partners in the case of a partnership) are as follows:
______________________________________________________________________________
______________________________________________________________________________
(3) If the record owner is a corporation, the names and addresses of the registered agent and of
the corporate officers are as follows:
______________________________________________________________________________
______________________________________________________________________________
Check here if record owner is not a corporation.
(4) If the address of any record owner is not located in the county in which the dwelling is
located, the name and address of a person who resides in the county and is authorized to accept
notices from a tenant, to issue receipts for those notices and to accept service of process on
behalf of the out-of-county record owner(s) is as follows:
______________________________________________________________________________
The addresses of all record owners in the county in which the dwelling is located:
________________________________________________________________________
________________________________________________________________________
(5) The name and address of the managing agent is as follows:
______________________________________________________________________________
______________________________________________________________________________
There is no managing agent.
(6) The name and address (including dwelling unit, apartment or room number) of the
superintendent, janitor, custodian or other person employed to provide regular maintenance
service is as follows:
______________________________________________________________________________
______________________________________________________________________________
There is no superintendent, janitor, custodian or other person employed to provide regular
maintenance service.
(7) The 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 dwelling or any dwelling unit, including such emergencies as the failure of any
essential service or system, and who has authority to make emergency decisions concerning the
building, including the making of repairs and expenditures, is as follows:
______________________________________________________________________________
______________________________________________________________________________
(8) The names and addresses of all holders of recorded mortgages on the property are as
follows:
______________________________________________________________________________
______________________________________________________________________________
There is no recorded mortgage on the property.
(9) If fuel oil is used to heat the building and the landlord furnishes the heat, the name and
address of the fuel oil dealer servicing the building and the grade of fuel oil used are as follows:
______________________________________________________________________________
______________________________________________________________________________
The building is not heated by fuel oil
The building is heated by fuel oil, but the landlord does not furnish heat.
(10) Email Address to send renewal notices to: _______________________________________
________________
______________________________________________________
Date
Landlord or Authorized Representative