Type Full Name :
Sign With Hand
Address
City
Attach the below document and any other related documents (If Applicable):
  • Lease Agreement.
  • Lead-Safe Certificate.
Attachments
Lead Hazard Inspections & Tenant Registration
Begin typing address and select from the populated drop-down
Policy #
Expiration Date
# of Bedrooms
Property Insurance Information
Lead Safe Certificate Expiration Date
Note: Form must be completed by legal owner or authorized agent of the legal owner of this property.
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
Phone: {[APHONE]}
Fax: 908-474-1836
{[AWEBSITE]}
Registration Type (Please Choose One)
City of Linden Board of Health Ordinance 2023-02 requires that owners of all residential rental dwelling units as defined by BOH Ordinance 2023-02 must register their tenant information with the Board of Health. Residential rental dwelling units include, but are not limited to, apartment buildings, multiple-family dwellings, and single-family homes. This rental property tenant registration is not transferable to new tenants. A new tenant registration form must be submitted to the Board of health within 5 (five) business days of each change of tenant turnover or other change in tenancy of the rental dwelling unit.

TENANT TURNOVER – The time at which all existing occupants vacate a dwelling unit and all new tenants move into the same dwelling unit, or the time at which new tenants move into a vacant dwelling unit.

The registration fee is $10.00 per each tenant registration form filed.

Failure to comply with BOH Ordinance 2023-02 will result in legal action, which can include Notices of Violation, summons to Municipal Court, fines, and other penalties.
Amount Due
State
Name
Parcel ID #
Signature
I hereby declare and affirm that I am the legal owner or authorized agent of the legal owner of this property, and that all information on this form is complete and accurate to the best of my knowledge.

I, the legal owner or authorized agent of the legal owner of this property, understand that failure to comply with state, county, and local ordinances regarding residential rental dwelling units will result in legal action, which can include but is not limited to Notices of Violation, summons to Municipal Court, property liens, and other penalties.
Lease End Date
Certification
Email
Lead Safe Certificate (Please Choose One)
Block
Owner Information
Phone # (Must be accessible 24/7)
ZIP
Include all tenant names included in the tenant lease/rental agreement
Description Fees
Tenant Registration Filing Fee $10.00
NJ DCA State Fee $20.00
Initial/Reinspection Inspection Fee $250.00
Each Additional Bedroom $25.00
Floor/Apt/Unit #
Ordinance
State
City
Company Name
Lease Start Date
ZIP
Total # of Tenants
Property Information
Address
Fee Schedule
Tenant Information
Lot