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4. The landlord registration requirement applies to all rental premises or units used for dwelling purposes except owner-occupied premises with not more than two (2) rental units within (30) days of transfer of ownership, or creation of new apartments, owner must file appropriate registration statements with: The Municipal Clerk of the municipality, or with such other municipal official as is designated by the Municipal Clerk, in which the residential property is situated for one or two family non-owner occupied rental dwelling as per [N.J.S.A. 46:8-26 et seq.]
6. Property Address*
   Street address, town, zip code
8. Block*
9. Lot*
10. Qualifer or Suite Number
12. Name of Record Owner*
13. Address of Record Owner*
    Street address, town, zip code
15. Name of Managing Agent*
    This may also be the owner's information
16. Managing Agent Address*
    Street address, town, zip code
18. Name of Superintendent*
    If not applicable please denote N/A
19. Superintendent Address*
    If not applicable please denote N/A
21. Emergency Contact Name*
    First and last name
22. Emergency Contact Phone Number*
23. Emergency Contact Email*
25. Name of Mortgagee*
    First and last name or company name. If not applicable please denote N/A.
26. Mortgagee Address*
    Street address, town, zip code. If not applicable please denote N/A.
28. Name of Tenant*
    First and last name
29. Start of Lease Date*
    mm/dd/yyyy
30. End of Lease Date*
    mm/dd/yyyy
32. Signature*
33. Date*
35. All rented properties are required to have a fire inspection. Please contact the Fire Prevention Office to schedule an inspection. Wall Fire Bureau 1612 Hwy 71, Wall NJ 07719 732-449-8444 ext. 2254 www.wallfirebureau.com
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37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field