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N.J. DCA Landlord/Tenant Information Series — Attorney's Packet, Law & Regulations

Citation
N.J. DCA Landlord/Tenant Information Series — Attorney's Packet, Law & Regulations
Jurisdiction
New Jersey (state)
Source
Official source

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Street Address: ______________________________________________________________

Apartment number: __________________________________________________________

City: _____________________________________ State: ___________________________

Zip Code: __________________ County: _______________________________________

Home phone: ____________________ Work phone: ____________________________

Name of Building or Project (if any): ___________________________________________

Is this your principal place of residence: ______________________________________

If this is you principal residence on what date did you begin occupying it as your
principal place of residence: ___________________________________________________

Are you disabled: ____________________________________

If you are disabled, please provide proof of disability.
 T-4
Part B (Financial Information)

List each household member currently residing in the rental unit and provide
the following information with respect to each household member including the
applicant:
Relation to
Name Age Applicant Income

Provide proof of income for each household member

Total Household Income for the last full calendar year: ________________________

Amount of current monthly rent: ______________________________________________

Additional charges paid by the tenant, please check all that apply:

__________ Heat

__________ Gas

__________ Electric

__________ Water

__________ Other, Please explain ______________________________________________

_______________________________________________________________________________

_______________________________________________________________________________