TOWNSHIP OF BARNEGAT
COUNTY OF OCEAN

Municipal Offices: (609)698-0080
Fax: (609)698-7980
Website: www.barnegat.net

TRUTH IN RENTING—LANDLORD TENANT STATEMENT

STATEMENT REQUIRED BY P.L. 1974—CHAPTER 50

A. RENTAL PROPERTY:

Tenant Name:_______________________________________

Property Address: ___________________________________

Block: __________  Lot: ___________  Phone #: ____________             

B: PROPERTY OWNER OF RECORD:

Name: ______________________________________________

Address: ____________________________________________
(No Post Office Boxes)

Phone: Day: __________________   Evening: ________________

C: PERSON AUTHORIZED TO ACCEPT SERVICE OF PROPERTY: (PERSON TO RECEIVE LEGAL NOTICES)

(MUST BE OCEAN COUNTY RESIDENT)

 Name: _________________________________________

Address: _______________________________________

Phone #: _______________
(No Post Office Boxes)

D: PERSON RESPONSIBLE FOR REGULAR MAINTENANCE:

Name: ______________________________________________

Address: ____________________________________________
(No Post Office Boxes)

E. MANAGING AGENT—IN CASE OF EMERGENCY:

Name: _________________________________________

 Address: _______________________________________

(No Post Office Boxes)

F: MORTGAGE COMPANY NAME & ADDRESS:(If NO mortgage-write None)

Name: _________________________________________

Address: _______________________________________

Signature of Owner: ____________________________________________________

Date: ____________________

I, Sharon L. Auer, Acting Municipal Clerk of the Township of Barnegat, County of Ocean, state of New Jersey, acknowledge receipt of this LANDLORD TENANT STATEMENT this ______ day of _________________, 20___.                                                                                           ________________________________________
Sharon L. Auer, CMR
Acting Municipal Clerk