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This document is the official Planning/Zoning Board Application Packet for the Borough of Somerdale, New Jersey. It outlines the procedures and requirements for individuals or businesses seeking land use approvals such as subdivisions, site plans, site plan waivers, or variances. Applicants are strongly advised to seek legal counsel or land use professional advice during the process, and corporations or LLCs are required to be represented by legal counsel at board meetings.

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--- Document: Planning Board Application Document ---
Borough of
SOMERDALE
The Crossroads of South Jersey
105 Kennedy Boulevard
Somerdale, New Jersey 08083
(856) 783-6320
www.Somerdale-NJ.com
PLANNING/ZONING BOARD
APPLICATION
PACKET
IT IS HIGHLY RECOMMENDED YOU HAVE AN ATTORNEY
OR LAND USE PROFESSIONAL ADVISE YOU
DURING ANY LAND USE PROCESS
Borough of
SOMERDALE
The Crossroads of South Jersey.
ESCROW APPLICATION
Date of Application:
Name of Project:
Address of Project:
City
Name of Applicant:
Address of Applicant:
City
Telephone Number:
Application Fee: $
State
Zip
State
Fax Number:
,
Zip
Cash / Check / Money Order (Circle)
Cash / Check / Money Order (Circle)
Initial Deposit: $
Check#
Check Received By:
(Initial)
TAX ID #
W-9 Received By:
(Initial)
FOR OFFICE USE ONLY
Date Activated.
Sub-Account Number:
Project Description
Memo/Other Info:
Date Closed:
Date Sent:
Developer Name:
BLOCK:
LOT
Date of Check:
Check Number:
(Attach Copy of Check)
(Attach Copy of Resolution)
105 Kennedy Blvd, Somerdale, NJ 08083
Revised 0110112013
Borough of
SOMERDALE
The Crossroads of South Jersey.
To Whom It May Concern:
Attached please find a copy of a W -9 Form. Any person or business making an application to the Planning/Zoning
Board, must complete this form.
Thank you,
Subrat puno
Debra A. Reino
Recording Secretary
Planning/Zoning Boards
105 Kennedy Blvd. Somerdale, NJ 08083
Form
W-9
(Rev. December 2014)
Department of the Treasury
Internal Revenue Service
Print or type
See Specific Instructions on page 2.
Request for Taxpayer
Identification Number and Certification
1 Name (as shown on your income tax return). Name is required on this line, do not leave this line blank.
2 Business name/disregarded entity name, if different from above
Check appropriate box for federal tax classification; check only one of the following seven boxes:
Individual/sole proprietor or
single-member LLC
C Corporation
S Corporation
Partnership
Trust/estate
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership)
Note. For a single-member LLC that is disregarded, do not check LLC, check the appropriate box in the line above for
the tax classification of the single-member owner.
Other (see instructions) ►
5 Address (number, street, and apt or suite no)
6 City, state, and ZIP code
7 List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Give Form to the
requester. Do not
send to the IRS.
4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
Exempt payee code (if any)
Exemption from FATCA reporting
code (if any)
(Applies to accounts maintained outside the US)
Requester's name and address (optional)
Borough of Somerdale
105 Kennedy Boulevard
Somerdale, NJ 08083-1018
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN on page 3.
Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for
guidelines on whose number to enter.
Social security number
or
Employer identification number
Part II
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below), and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage
interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
instructions on page 3.
Sign Signature of
Here U.S. person
General Instructions
Section references are to the Internal Revenue Code unless otherwise noted.
Future developments. Information about developments affecting Form W-9 (such
as legislation enacted after we release it) is at www.irs.gov/fw9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an information
return with the IRS must obtain your correct taxpayer identification number (TIN)
which may be your social security number (SSN), individual taxpayer identification
number (ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN), to report on an information return the amount paid to
you, or other amount reportable on an information return. Examples of information
returns include, but are not limited to, the following:
• Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
• Form 1099-B (stock or mutual fund sales and certain other transactions by
brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
Date
• Form 1098 (home mortgage interest). 1098-E (student loan interest), 1098-T
(tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S person (including a resident alien), to
provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might be subject
to backup withholding. See What is backup withholding? on page 2.
By signing the filled-out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a number
to be issued).
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U S. exempt payee If
applicable, you are also certifying that as a U.S. person, your allocable share of
any partnership income from a U.S. trade or business is not subject to the
withholding tax on foreign partners' share of effectively connected income, and
4. Certify that FATCA code(s) entered on this form (if any) indicating that you are
exempt from the FATCA reporting, is correct See What is FATCA reporting? on
page 2 for further information.
Cat. No 10231X
Form W-9 (Rev. 12-2014)
Form W-9 (Rev. 12-2014)
Note. If you are a U.S. person and a requester gives you a form other than Form
W-9 to request your TIN, you must use the requester's form if it is substantially
similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are considered a U.S
person if you are:
• An individual who is a U.S. citizen or U.S. resident alien;
• A partnership, corporation, company, or association created or organized in the
United States or under the laws of the United States,
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or business in
the United States are generally required to pay a withholding tax under section
1446 on any foreign partners' share of effectively connected taxable income from
such business. Further, in certain cases where a Form W-9 has not been received,
the rules under section 1446 require a partnership to presume that a partner is a
foreign person, and pay the section 1446 withholding tax. Therefore, if you are a
U.S. person that is a partner in a partnership conducting a trade or business in the
United States, provide Form W-9 to the partnership to establish your U.S. status
and avoid section 1446 withholding on your share of partnership income.
In the cases below, the following person must give Form W-9 to the partnership
for purposes of establishing its US status and avoiding withholding on its
allocable share of net income from the partnership conducting a trade or business
in the United States:
• In the case of a disregarded entity with a U S. owner, the U.S. owner of the
disregarded entity and not the entity,
• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally.
the U.S. grantor or other U.S. owner of the grantor trust and not the trust, and
• In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a
grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person or the U.S. branch of a foreign bank
that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use
the appropriate Form W-8 or Form 8233 (see Publication 515, Withholding of Tax
on Nonresident Aliens and Foreign Entities).
Nonresident alien who becomes a resident alien. Generally, only a nonresident
alien individual may use the terms of a tax treaty to reduce or eliminate US. tax on
certain types of income However, most tax treaties contain a provision known as
a "saving clause." Exceptions specified in the saving clause may permit an
exemption from tax to continue for certain types of income even after the payee
has otherwise become a US resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception contained in the
saving clause of a tax treaty to claim an exemption from U.S. tax on certain types
of income, you must attach a statement to Form W-9 that specifies the following
five items:
1. The treaty country Generally, this must be the same treaty under which you
claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income
3. The article number (or location) in the tax treaty that contains the saving
clause and its exceptions.
4 The type and amount of income that qualifies for the exemption from tax
5. Sufficient facts to justify the exemption from tax under the terms of the treaty
article
Example. Article 20 of the U.S.-China income tax treaty allows an exemption
from tax for scholarship income received by a Chinese student temporarily present
in the United States. Under U.S. law, this student will become a resident alien for
tax purposes if his or her stay in the United States exceeds 5 calendar years.
However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30,
1984) allows the provisions of Article 20 to continue to apply even after the
Chinese student becomes a resident alien of the United States. A Chinese student
who qualifies for this exception (under paragraph 2 of the first protocol) and is
relying on this exception to claim an exemption from tax on his or her scholarship
or fellowship income would attach to Form W-9 a statement that includes the
information described above to support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the
appropriate completed Form W-8 or Form 8233.
Backup Withholding
What is backup withholding? Persons making certain payments to you must
under certain conditions withhold and pay to the IRS 28% of such payments. This
is called "backup withholding" Payments that may be subject to backup
withholding include interest, tax-exempt interest, dividends, broker and barter
exchange transactions, rents, royalties, nonemployee pay, payments made in
settlement of payment card and third party network transactions, and certain
payments from fishing boat operators. Real estate transactions are not subject to
backup withholding.
You will not be subject to backup withholding on payments you receive if you
give the requester your correct TIN, make the proper certifications, and report all
your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the Part II instructions on page
3 for details).
3. The IRS tells the requester that you furnished an incorrect TIN,
Page 2
4. The IRS tells you that you are subject to backup withholding because you did
not report all your interest and dividends on your tax return (for reportable interest
and dividends only), or
5. You do not certify to the requester that you are not subject to backup
withholding under 4 above (for reportable interest and dividend accounts opened
after 1983 only).
Certain payees and payments are exempt from backup withholding. See Exempt
payee code on page 3 and the separate Instructions for the Requester of Form
W-9 for more information.
Also see Special rules for partnerships above.
What is FATCA reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign
financial institution to report all United States account holders that are specified
United States persons. Certain payees are exempt from FATCA reporting. See
Exemption from FATCA reporting code on page 3 and the Instructions for the
Requester of Form W-9 for more information.
Updating Your Information
You must provide updated information to any person to whom you claimed to be
an exempt payee if you are no longer an exempt payee and anticipate receiving
reportable payments in the future from this person. For example, you may need to
provide updated information if you are a C corporation that elects to be an S
corporation, or if you no longer are tax exempt. In addition, you must furnish a new
Form W-9 if the name or TIN changes for the account; for example, if the grantor
of a grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are
subject to a penalty of $50 for each such failure unless your failure is due to
reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you make a
false statement with no reasonable basis that results in no backup withholding.
you are subject to a $500 penalty
Criminal penalty for falsifying information. Willfully falsifying certifications or
affirmations may subject you to criminal penalties including fines and/or
imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in violation of federal law.
the requester may be subject to civil and criminal penalties.
Specific Instructions
Line 1
You must enter one of the following on this line, do not leave this line blank The
name should match the name on your tax return.
If this Form W-9 is for a joint account, list first, and then circle, the name of the
person or entity whose number you entered in Part I of Form W-9
a. Individual. Generally, enter the name shown on your tax return. If you have
changed your last name without informing the Social Security Administration (SSA)
of the name change, enter your first name, the last name as shown on your social
security card, and your new last name.
Note. ITIN applicant: Enter your individual name as it was entered on your Form
W-7 application, line 1a. This should also be the same as the name you entered on
the Form 1040/1040A/1040EZ you filed with your application
b. Sole proprietor or single-member LLC. Enter your individual name as
shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade,
or "doing business as" (DBA) name on line 2.
c. Partnership, LLC that is not a single-member LLC, C Corporation, or S
Corporation. Enter the entity's name as shown on the entity's tax return on line 1
and any business, trade, or DBA name on line 2
d. Other entities. Enter your name as shown on required U S. federal tax
documents on line 1. This name should match the name shown on the charter or
other legal document creating the entity. You may enter any business, trade, or
DBA name on line 2.
e. Disregarded entity. For U.S. federal tax purposes, an entity that is
disregarded as an entity separate from its owner is treated as a "disregarded
entity." See Regulations section 301.7701-2(c)(2)(iii). Enter the owner's name on
line 1. The name of the entity entered on line 1 should never be a disregarded
entity. The name on line 1 should be the name shown on the income tax return on
which the income should be reported. For example, if a foreign LLC that is treated
as a disregarded entity for U.S. federal tax purposes has a single owner that is a
U.S. person, the U.S. owner's name is required to be provided on line 1. If the
direct owner of the entity is also a disregarded entity, enter the first owner that is
not disregarded for federal tax purposes. Enter the disregarded entity's name on
line 2, "Business name/disregarded entity name." If the owner of the disregarded
entity is a foreign person, the owner must complete an appropriate Form W-8
instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN.
Form W-9 (Rev. 12-2014)
Line 2
If you have a business name, trade name, DBA name, or disregarded entity name,
you may enter it on line 2.
Line 3
Check the appropriate box in line 3 for the U.S. federal tax classification of the
person whose name is entered on line 1. Check only one box in line 3.
Limited Liability Company (LLC). If the name on line 1 is an LLC treated as a
partnership for U.S. federal tax purposes, check the "Limited Liability Company"
box and enter "P" in the space provided. If the LLC has filed Form 8832 or 2553 to
be taxed as a corporation, check the "Limited Liability Company" box and in the
space provided enter "C" for C corporation or "S" for S corporation. If it is a
single-member LLC that is a disregarded entity, do not check the "Limited Liability
Company" box; instead check the first box in line 3 "Individual/sole proprietor or
single-member LLC."
Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting, enter in the
appropriate space in line 4 any code(s) that may apply to you
Exempt payee code.
• Generally, individuals (including sole proprietors) are not exempt from backup
withholding.
• Except as provided below, corporations are exempt from backup withholding
for certain payments, including interest and dividends.
• Corporations are not exempt from backup withholding for payments made in
settlement of payment card or third party network transactions
• Corporations are not exempt from backup withholding with respect to attorneys
fees or gross proceeds paid to attorneys, and corporations that provide medical or
health care services are not exempt with respect to payments reportable on Form
1099-MISC
The following codes identify payees that are exempt from backup withholding
Enter the appropriate code in the space in line 4
1-An organization exempt from tax under section 501(a), any IRA, or a
custodial account under section 403(b)(7) if the account satisfies the requirements
of section 401 (f) (2)
2-The United States or any of its agencies or instrumentalities
3-A state, the District of Columbia, a U.S. commonwealth or possession, or
any of their political subdivisions or instrumentalities
4-A foreign government or any of its political subdivisions, agencies, or
Instrumentalities
5-A corporation
6-A dealer in securities or commodities required to register in the United
States, the District of Columbia, or a U S. commonwealth or possession
7-A futures commiss on merchant registered with the Commodity Futures
Trading Commission
8-A real estate investment trust
9-An entity registered at all times during the tax year under the Investment
Company Act of 1940
10-A common trust fund operated by a bank under section 584(a)
11-A financial institution
12-A middleman known in the investment community as a nominee or
custodian
13-A trust exempt from tax under section 664 or described in section 4947
The following chart shows types of payments that may be exempt from backup
withholding. The chart applies to the exempt payees listed above, 1 through 13
IF the payment is for
Interest and dividend payments
Broker transactions
Barter exchange transactions and
patronage dividends
Payments over $600 required to be
reported and direct sales over $5,000
Payments made in settlement of
payment card or third party network
transactions
THEN the payment is exempt for.
All exempt payees except
for 7
Exempt payees 1 through 4 and 6
through 11 and all C corporations. S
corporations must not enter an exempt
payee code because they are exempt
only for sales of noncovered securities
acquired prior to 2012
Exempt payees 1 through 4
Generally, exempt payees
1 through 5
Exempt payees 1 through 4
See Form 1099-MISC, Miscellaneous Income, and its instructions
Page 3
However, the following payments made to a corporation and reportable on Form
1099-MISC are not exempt from backup withholding medical and health care
payments, attorneys' fees, gross proceeds paid to an attorney reportable under
section 6045(f), and payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify payees
that are exempt from reporting under FATCA. These codes apply to persons
submitting this form for accounts maintained outside of the United States by
certain foreign financial institutions. Therefore, if you are only submitting this form
for an account you hold in the United States, you may leave this field blank.
Consult with the person requesting this form if you are uncertain if the financial
institution is subject to these requirements. A requester may indicate that a code is
not required by providing you with a Form W-9 with "Not Applicable" (or any
similar indication) written or printed on the line for a FATCA exemption code.
A-An organization exempt from tax under section 501(a) or any individual
retirement plan as defined in section 7701(a) (37)
B-The United States or any of its agencies or instrumentalities
C-A state, the District of Columbia, a U.S. commonwealth or possession, or
any of their political subdivisions or instrumentalities
D-A corporation the stock of which is regularly traded on one or more
established securities markets, as described in Regulations section
1.1472-1(c)(1)(0)
E-A corporation that is a member of the same expanded affiliated group as a
corporation described in Regulations section 1.1472-1(c)(1)(i)
F-A dealer in securities, commodities, or derivative financial instruments
(including notional principal contracts, futures, forwards, and options) that is
registered as such under the laws of the United States or any state
G-A real estate investment trust
H-A regulated investment company as defined in section 851 or an entity
reg stered at all times during the tax year under the Investment Company Act of
1940
I-A common trust fund as defined in section 584(a)
J-A bank as defined in section 581
K-A broker
L-A trust exempt from tax under section 664 or described in section 4947(a)(1)
M-A tax exempt trust under a section 403(b) plan or section 457(g) plan
Note. You may wish to consult with the financial institution requesting this form to
determine whether the FATCA code and/or exempt payee code should be
completed
Line 5
Enter your address (number, street, and apartment or suite number). This is where
the requester of this Form W-9 will mal your information returns
Line 6
Enter your city, state, and ZIP code
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and you do not
have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer
identification number (ITIN). Enter it in the social security number box. If you do not
have an ITIN, see How to get a TIN below.
If you are a sole proprietor and you have an EIN, you may enter either your SSN
or EIN. However, the IRS prefers that you use your SSN
If you are a single-member LLC that is disregarded as an entity separate from its
owner (see Limited Liability Company (LLC) on this page), enter the owner's SSN
(or EIN, if the owner has one). Do not enter the disregarded entity's EIN. If the LLC
is classified as a corporation or partnership, enter the entity's EIN
Note. See the chart on page 4 for further clarification of name and TIN
combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately. To apply
for an SSN, get Form SS-5, Application for a Social Security Card, from your local
SSA office or get this form online at www.ssa.gov. You may also get this form by
calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer
Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer
Identification Number, to apply for an EIN. You can apply for an EIN online by
accessing the IRS website at www.irs gov/businesses and clicking on Employer
Identification Number (EIN) under Starting a Business. You can get Forms W-7 and
SS-4 from the IRS by visiting IRS gov or by calling 1-800-TAX-FORM
(1-800-829-3676).
If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN
and write "Applied For" in the space for the TIN, sign and date the form, and give it
to the requester. For interest and dividend payments, and certain payments made
with respect to readily tradable instruments, generally you will have 60 days to get
a TIN and give it to the requester before you are subject to backup withholding on
payments. The 60-day rule does not apply to other types of payments. You will be
subject to backup withholding on all such payments until you provide your TIN to
the requester.
Note. Entering "Applied For" means that you have already applied for a TIN or that
you intend to apply for one soon.
Caution: A disregarded U S. entity that has a foreign owner must use the
appropriate Form W-8
Form W-9 (Rev. 12-2014)
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or resident alien,
sign Form W-9. You may be requested to sign by the withholding agent even if
items 1, 4, or 5 below indicate otherwise.
For a joint account, only the person whose TIN is shown in Part I should sign
(when required). In the case of a disregarded entity, the person identified on line 1
must sign. Exempt payees, see Exempt payee code earlier.
Signature requirements. Complete the certification as indicated in items 1
through 5 below.
1. Interest, dividend, and barter exchange accounts opened before 1984
and broker accounts considered active during 1983. You must give your
correct TIN, but you do not have to sign the certification.
2. Interest, dividend, broker, and barter exchange accounts opened after
1983 and broker accounts considered inactive during 1983. You must sign the
certification or backup withholding will apply. If you are subject to backup
withholding and you are merely providing your correct TIN to the requester, you
must cross out item 2 in the certification before signing the form.
3. Real estate transactions. You must sign the certification. You may cross out
item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not have to sign
the certification unless you have been notified that you have previously given an
incorrect TIN. "Other payments" include payments made in the course of the
requester's trade or business for rents, royalties, goods (other than bills for
merchandise), medical and health care services (including payments to
corporations), payments to a nonemployee for services, payments made in
settlement of payment card and third party network transactions, payments to
certain fishing boat crew members and fishermen, and gross proceeds paid to
attorneys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of secured
property, cancellation of debt, qualified tuition program payments (under
section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your correct TIN, but you
do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account:
1 Individual
2. Two or more individuals (joint
account)
3. Custodian account of a minor
(Uniform Gift to Minors Act)
4. a. The usual revocable savings
trust (grantor is also trustee)
b. So-called trust account that
is not a legal or valid trust under
state law
5. Sole proprietorship or disregarded
entity owned by an individual
6 Grantor trust filing under Optional
Form 1099 Filing Method 1 (see
Regulations section 1.671-4(b)(2)(1)
(A))
For this type of account:
7. Disregarded entity not owned by an
individual
8. A valid trust, estate, or pension trust
9 Corporation or LLC electing
corporate status on Form 8832 or
Form 2553
10 Association, club, religious,
charitable, educational, or other tax-
exempt organization
11 Partnership or multi-member LLC
12. A broker or registered nominee
13. Account with the Department of
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
14. Grantor trust filing under the Form
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulations section 1.671-4(b)(2)(1)
(B))
Give name and SSN of:
The individual
The actual owner of the account or,
if combined funds, the first
individual on the account'
The minor'
The grantor-trustee
The actual owner'
The owner'
The grantor
Give name and EIN of:
The owner
Legal entity'
The corporation
The organization
The partnership
The broker or nominee
The public entity
The trust
List first and circle the name of the person whose number you furnish if only one person or a
joint account has an SSN, that person's number must be furnished
Circle the minor's name and furnish the minor's SSN
Page 4
You must show your individual name and you may also enter your business or DBA name on
the Business name/disregarded entity" name line. You may use either your SSN or EIN (if you
have one), but the IRS encourages you to use your SSN.
List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TiN of the
personal representative or trustee unless the legal entity itself is not designated in the account
title.) Also see Special rules for partnerships on page 2.
*Note. Grantor also must provide a Form W-9 to trustee of trust.
Note. If no name is circled when more than one name is listed, the number will be
considered to be that of the first name listed.
Secure Your Tax Records from Identity Theft
Identity theft occurs when someone uses your personal information such as your
name, SSN, or other identifying information, without your permission, to commit
fraud or other crimes. An identity thief may use your SSN to get a job or may file a
tax return using your SSN to receive a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a notice from
the IRS, respond right away to the name and phone number printed on the IRS
notice or letter.
If your tax records are not currently affected by identity theft but you think you
are at risk due to a lost or stolen purse or wallet, questionable credit card activity
or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit
Form 14039.
For more information, see Publication 4535, Identity Theft Prevention and Victim
Assistance.
Victims of identity theft who are experiencing economic harm or a system
problem, or are seeking help in resolving tax problems that have not been resolved
through normal channels, may be eligible for Taxpayer Advocate Service (TAS)
assistance. You can reach TAS by calling the TAS toll-free case intake line at
1-877-777-4778 or TTY/TDD 1-800-829-4059.
Protect yourself from suspicious emails or phishing schemes. Phishing is the
creation and use of email and websites designed to mimic legitimate business
emails and websites. The most common act is sending an email to a user falsely
claiming to be an established legitimate enterprise in an attempt to scam the user
into surrendering private information that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does
not request personal detailed information through email or ask taxpayers for the
PIN numbers, passwords, or similar secret access information for their credit card,
bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS, forward this
message to phishing@irs.gov. You may also report misuse of the IRS name, logo.
or other IRS property to the Treasury Inspector General for Tax Administration
(TIGTA) at 1-800-366-4484. You can forward suspicious emails to the Federal
Trade Commission at: spam@uce.gov or contact them at www.ftc.gov/idtheft or
1-877-IDTHEFT (1-877-438-4338).
Visit IRS.gov to learn more about identity theft and how to reduce your risk.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct
TIN to persons (including federal agencies) who are required to file information
returns with the IRS to report interest, dividends, or certain other income paid to
you; mortgage interest you paid; the acquisition or abandonment of secured
property; the cancellation of debt; or contributions you made to an IRA, Archer
MSA, or HSA. The person collecting this form uses the information on the form to
file information returns with the IRS, reporting the above information. Routine uses
of this information include giving it to the Department of Justice for civil and
criminal litigation and to cities, states, the District of Columbia, and U.S.
commonwealths and possessions for use in administering their laws. The
information also may be disclosed to other countries under a treaty, to federal and
state agencies to enforce civil and criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism. You must provide your TIN whether or
not you are required to file a tax return. Under section 3406, payers must generally
withhold a percentage of taxable interest, dividend, and certain other payments to
a payee who does not give a TIN to the payer. Certain penalties may also apply for
providing false or fraudulent information.
Borough of
SOMERDALE
The Crossroads of South Jersey.
Municipal Clerk's Office
105 Kennedy Boulevard
Somerdale, New Jersey 08083
856.783.6320 phone
856.784.9377 fax
DATE:
REQUESTOR:
REQUESTOR'S ADDRESS:
PHONE:
EMAIL:
FAX:
ADDRESS OF LOCATION 200 FT SEARCH FOR:
BLOCK
LOT
PLEASE CHECK PREFERRED METHOD OF DELIVERY:
FEE: $10.00 PER SEARCH.
E-MAIL
FAX
MAIL
PICK UP
PLEASE MAKE CHECK PAYABLE TO THE BOROUGH OF SOMERDALE
105 Kennedy Blvd. Somerdale, NJ 08083
Borough of
SOMERDALE
The Crossroads of South Jersey
INSTRUCTIONS
'T IS HIGHLY RECOMMENDED YOU HAVE AN ENGINEER OR SOLICITOR ADVISE YOU DURING THIS
PROCESS. IF YOU ARE AN “LLC” OR “CORPORATION”, YOU MUST BE REPRESENTED BY LEGAL
COUNCIL AT YOUR PLANNING/ZONING BOARD MEETING.
1. After obtaining the application packet from the Borough. completely fill out each form.
2. Form 992-2 is a site plan review checklist designed to assist the applicant as to what is included the plan.
3. File 12 copies of the completed application and 5 copies of plans with the Borough Clerk.
4.
File I copy of the application and plan with the Planning Board Solicitor:
David F. Carlamere, Esquire
Carlamere and Rowan
1546 Blackwood- Clementon Road
PO Box 1397
Blackwood, New Jersey 08012
5. File I copy of the application and plan with the Planning Board Engineer:
Charles Riebel, Jr.
Borough of Somerdale
105 Kennedy Boulevard
Somerdale. New Jersey 08083
6. File I copy of the application and plan with the Somerdale Police Department and I copy of the application and plan with
the Somerdale Fire Marshal.
7. It is only necessary to file with the Camden County Planning Board if your site is located on a County road. Please check
with the Zoning Officer, Borough Clerk or Planning Board Secretary to determine this and obtain the proper forms.
8. Form 493-1 is a "Fill in the Blank" form to be used to advertise your intentions and have your notice published 10
days prior to the regular meeting of the Planning -Board. If you are applying for a variance, you must notify all
property owners within 200 feet of your site, also at least 10 days before the scheduled meeting, by certified/ return
receipt mail or personal service. (A certified list of property owners can be obtained from the Clerk's office). It is your
responsibility to place and pay for the advertisement. It is suggested you use The Courier Post or Record Breeze for
publication (the Record Breeze must receive the ad by Monday for it to appear on Thursday). YOU MUST BRING THE
PUBLICATION AFFIDAVIT AT LEAST 2 DAYS BEFORE THE MEETING AS PROOF OF ADVERTISEMENT,
OR YOUR CASE WILL NOT BE HEARD.
9. After the Board makes a ruling, a copy of the Resolution will be sent to you and/or your attorney if applicable. A $25.00
advertising fee is collected by the Borough to publish the results of your application in the newspaper.
10. If you have any questions, you should contact your attorney for advice or the Borough Clerk at
856-783-6320, ext. 3300 who will provide you with information only, not advice.
BLUEPRINT PLANS MUST BE SUBMITTED PROPERLY FOLDED
105 Kennedy Blvd. Somerdale, NJ 08083
Borough of
SOMERDALE
The Crossroads of South Jersey.
ADVERTISEMENT TO BE PLACED
IN LOCAL NEWSPAPER
(SUCH AS THE RECORD BREEZE)
ADVERTISEMENT MUST APPEAR AT LEAST 10 DAYS
BEFORE THE SCHEDULED MEETING
TAKE NOTICE that the undersigned has applied to the Somerdale Planning/Zoning Board for a
subdivision,
variance,
regarding application concerning:
Address:
Block:
Lot:
site plan,
site plan waiver as follows:
20
at 7:00 p.m. at the Borough Hall,
A public hearing regarding this application will be held on
105 Kennedy Boulevard, Somerdale New Jersey, at which time you may appear either in person or by attorney and
present any objections you may have to this application.
The application is available for examination at the Borough Hall Planning/ Zoning Office during normal business
hours.
Applicant Name:
Applicant Address:
Form 493-1
105 Kennedy Blvd. Somerdale, NJ 08083
Borough of
SOMERDALE
The Crossroads of South Jersey.
BOROUGH OF SOMERDALE
PLANNING BOARD
105 ΚΕΝΝEDY BOULEV ARD
SOMERDALE, NEW JERSEY 08083
TAX AND ASSESSMENT PAYMENT REPORT
Section I (to be completed by the applicant)
Name of Applicant
Address
has made application to the Planning Board for Block Lot
located at
Whose record owner is
Owner's address
I request the Tax Collector to determine whether there are any delinquent taxes and/ or assessments due.
Date
****
Applicant's Signature
Section II (to be completed by the Tax Collector)
I find that:
All taxes due have been paid.
All assessments due have been paid.
The following are delinquent and past due.
Tax Collector
105 Kennedy Blvd. Somerdale, NJ 08083
*********:
Borough of
SOMERDALE
The Crossroads of South Jersey.
SITE PLAN CHECKLIST
The following checklist is designed to assist applicants in preparing their site plan for board review. Applicants should check off
each item to ensure that it is included on the plan. ITEMS OMITTED MAY DELAY CONSIDERATION BY THE BOARD
UTILITY PLANS, LANDSCAPING PLAN, ARCHITECTURAL ELEVATIONS, ETC., MAY BE SHOWN ON
SEPARATE SHEETS.
Name and title of applicant, owner and person preparing map.
Place for signature of chairman and secretary of planning/zoning board.
Place for signature of Borough Engineer.
Tax map lot and block numbers.
Date, scale and "north" sign.
Key map of the site with reference to surrounding areas and to existing street locations.
Zone district in which property in questions falls, zone district of adjoining properties and all property within a 200
radius of the property in question.
Names of owners of all contiguous land and adjacent property.
Dimensions of lot, setbacks, front yard, side yards and real yard; size, kind and location of fences.
Location dimensions and details of all signs and exterior lighting including type of standards, location, radius of
lighting and intensity in footcandles.
Method of solid waste disposal and storage.
Existing and proposed spot elevations based upon the U.S. Coastal Geodetic datum at all building corners, all floor
levels, center lines of abutting roads, top and bottoin curbs, property corners, gutters and other pertinent locations.
Existing and proposed contours of site at 2 foot intervals for areas less than 5 percent grade and 10 foot intervals
above 5 percent grade.
Location of all existing trees or tree masses, indicating general sizes and species of trees.
Landscaping and buffering plan showing what will remain and what will be planted, indicating names of plans and
trees and dimensions, approximate time of planting and method of planting (base rooted, ball and burlap).
Any other pertinent information as may be required by the board.
105 Kennedy Blvd. Somerdale, NJ 08083
Form 992-2
Borough of
SOMERDALE
The Crossroads of South Jersey.
APPLICATION
SUBDIVISION, SITE PLAN, SITE PLAN WAIVER, CONCEPT DESIGN
PLEASE FILE 12 COPIES OF THIS COMPLETED DOCUMENT 14 DAYS BEFORE THE REGULAR
MEETING OF THE PLANNING BOARD.
Phone #
Applicant's Name
Address
Applying For
Subdivision
Site Plan
Site Plan Waiver
Concept Design, located at
Somerdale, New Jersey Block Lot
Plate
Location of Nearest Intersection
Does this constitute
new application
revision or resubmission of a prior application?
ATTACH A COPY OF ANY DEED RESTRICTIONS, COVENANTS OR EASEMENTS EFFECTING THIS
PROPERTY
Owner's Name (if different than applicant)
Address
Phone#
Are you being represented by an attorney, real estate broker, or a land use professional? If so, please state:
Name
Address
Interest of Applicant if other than the Owner
Phone#
1,
STATEMENT OF LANDOWNER WHERE APPLICANT IS NOT THE OWNER:
owner of Lot(s) in Block(s}
for a
in the Borough of Somerdale,
Camden County, New Jersey, hereby acknowledge that the application of
subdivision/ site plan approval/site plan wavier/concept design of said Lot(s) is made with my complete understanding and
permission and in accordance with an agreement for purchase or option agreement entered into between myself and the applicant
herein stated.
Signature of Landowner
105 Kennedy Blvd. Somerdale, NJ 08083
Borough
SOMERDALE
The Crossroads of South Jersey
FOR SUBDIVISION APPLICATIONS ONLY
Planning Application, Pg. 2
Number of proposed lots
Area of entire tract
Lot Sizes
Number of proposed parking spaces per lot
Or applicant
Why is subdivision being requested?
Proposed density per acre
Portion being subdivided
Building Area (ground floor)
Number of dwelling units per acre
Building Area (total sq. ft.)
Area in acres of any additional adjoining lot(s) owned by Owner
to sell lots
construct houses for sale
other (please explain)
Name (of person preparing plan)
Address
Phone#
ALL OTHER APPLICATIONS
PROPOSED DEVELOPMENT
Title of Proposal
Site Plan Dated
Present Use
Property part of subdivision approved on
Board of Adjustment action required
Total tract
Building Coverage
(acres to nearest tenth)
% of lot area
Prepared by
Proposed Use
yes
no; variance(s) granted on
Paved Coverage
Maximum # of stories
FOR RESIDENTIAL PROPOSALS
Total # of dwelling units
# of efficiency units
% of total
# of 1 bedroom units
% of total
# of 2 bedroom units
% of total
% of lot area
: and not more than feet
FOR NON RESIDENTIAL PROPOSALS
Total # of square feet in gross floor area
Gross floor area in warehouse facilities
Gross floor area in other facilities
Gross floor area in mfr. research
# of 3 bedroom units
% of total
ACTUAL NUMBER OF OFF STREET PARKING SPACES PROPOSED
Parking space dimensions and access aisles conform to ordinance
Now served by existing street improved to municipal specifications
New street being constructed
Existing street being widened
Public water now available
Public water to be extended
Sufficient capacity in public water system to serve the proposed use
Public sanitary sewage treatment available to proposed use
Public sanitary sewage treatment to be extended to the proposed use
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
105 Kennedy Blvd. Somerdale, NJ 08083
Planning Application
Page 3
SIGNATURE*
Name
Address
Phone #
APPLICANT
١١١١١١
Borough of
SOMERDALE
The Crossroads of South Jersey.
LANDOWNER
PLAN PREPARER
*NOTE The signature indicates an understanding of all the codes and regulations applicable to this application and of matters
contained on this application
105 Kennedy Blvd. Somerdale, NJ 08083
Signature of Applicant
Date
Borough o
SOMERDALE
The Crossroads of South Jersey
APPLICATION FOR VARIANCE
TO THE BOARD OF ADJUSTMENT:
An application is hereby made for a (hardship) (use) variance from the terms of Article(s) and
Section(s)
of the Zoning Ordinance so as to permit
DESCRIPTION OF PROPOSED STRUCTURE OR USE
PREMISES AFFECTED known as Block
Street address:
Lot
Applicant:
Owner:
Lessee:
Address
Address
Address
Last previous occupancy
Size of Lot
At street level
Size of Building(s) (Present and/or Proposed):
ft. Front
ft. Deep
Percentage of lot occupied by building(s) % Height of Building(s)
Set back: Front property line
feet. From side (if corner lot)
Zoning requirements frontage, side yards _, set-back
"Prevailing set-back" of adjoining buildings within one block
Has there been any previous appeal involving these premises? Yes
If yes, state character of appeal and date of disposition
Proposed Use:
105 Kennedy Blvd. Somerdale, NJ 08083 (856-783-6320)
Somerdale, New Jersey
stories
ft.
feet
rear yard
feet
No
Borough of
SOMERDALE
The Crossroads of South Jersey
AFFIDAVIT OF PROOF OF SERVICE
BOARD OF ADJUSTMENT
PROOF OF SERVICE OF NOTICES REQUIRED BY STATUTE MUST BE FILED AND
VARIFIED WITH BOARD SECRETARY AT LEAST 2 DAYS PRIOR TO MEETING OR
CASE WILL NOT BE HEARD.
STATE OF NEW JERSEY COUNTY OF
and says, that he/she resides at
}ss.
of full- age being duly sworn according to law, deposes
in the municipality
of Somerdale, County of Camden, and the State of New Jersey being an appeal or application
under the Zoning Ordinance, and relates to premise
that on
20
:
he/she gave written notice of the hearing on this application to each
and all of the persons upon whom service must be had, in the required form and according to
the attached lists, and in the manner indicated thereon.
Signature
Sworn to and Subscribed before me
this
day of
20
NOTE: Attach list of all persons served.
105 Kennedy Blvd. Somerdale, NJ 08083 (856-783-6320)
Borough of
SOMERDALE
The Crossroads of South Jersey
NOTICE OF HEARING ΤΟ CLERK OF ADJACENT MUNICIPALITY
WITHIN 200' OF PROPOSED PROJECT
DATE:
To: Municipal Clerk
of
New Jersey
PLEASE TAKE NOTICE:
That
the undersigned, has applied to the Board of Adjustment of
Somerdale for relief from
at
Block
Lot
which
property fronts upon a county road, or adjoins county owned property. or is within two hundred
(200) feet of a municipal boundary. A hearing on this matter will be held on
20
at the Municipal Building in Somerdale. Applicant is seeking a hardship
use
variance, and subdivision
site plan
conditional use
approval. This notice is given pursuant to N.J.S.A. 40:55D-12d.
Signature
Note: This notice must be personally served or sent by certified mail at least 10 days before
the day of the hearing, and proof of service given to the Secretary of the Board of Adjustment
at least 2 days before the hearing.
105 Kennedy Blvd. Somerdale, NJ 08083 (856-783-6320)
BOROUGH OF SOMERDALE
LAND USE AND DEVELOPMENT FEES
SUBDIVISION
MINOR
MAJOR
PRELIMINARY
APPROVAL
MAJOR
FINAL
APPROVAL
250.00
125.00 per lot
75.00 per lot
Application Fee
Professional Services
Escrow
1,275.00
325.00 per lot
225.00 per lot
1,500.00 minimum
SITE PLAN
WAIVER
MINOR
PRELIMINARY/FINAL
APPROVAL
Application Fee
Professional Services
250.00
250.00
Escrow
700.00
1,275.00
MAJOR
MAJOR
PRELIMINARY
FINAL
Application Fee
Professional Services
250.00
250.00
Escrow
2,175.00
1,525.00
OTHER FEES
Zoning Permit
25.00
Appeal to Zoning Board
250.00
Zoning Interpretation
250.00
Variances
250.00
Legal Escrow
500.00
Conditional Use
250.00
Concept Design
250.00
Sign Permit
25.00
Sign Permit (temporary or banner)
15.00
Legal Fee (residential)
50.00
Permit Fee Repair/Replace Sidewalks,
Driveways (concrete or asphalt), and
Aprons
25.00
Publication Fee (if necessary)
25.00
APPLICATION FEES ARE NOT REFUNDABLE
PUBLISHING A LEGAL AD IN THE COURIER POST WILL NEED TO BE PRE-PAID BEFORE THEY WILL PUBLISH YOUR NOTICE.
PLEASE CALL THE COURIER POST 486-2567 FOR INFORMATION.
PROPERTY SEARCH - 200 FT -$10.00