Certification By Landlord Form - Superior Court Of New Jersey
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CERTIFICATION BY LANDLORD
YOU MUST COMPLETE THIS PART:
NAME OF LANDLORD OR ATTORNEY: ________________________________
ADDRESS & PHONE#: ______________________________________________
_______________________________________________________
SUPERIOR COURT OF NEW JERSEY
LAW DIVISION
SPECIAL CIVIL PART
Plaintiff,
_____________ COUNTY
LANDLORD-TENANT DIVISION
vs.
Docket No. LT-__________
Civil Action
Defendant.
CERTIFICATION BY LANDLORD
T
L
S
C
P
A
P
B
B
(I
B
A
). C
O
A
P
HE
ANDLORD
HOULD
OMPLETE
ART
OR
ART
OR
OTH
F
OTH
PPLY
ROSS
UT
NY
ARAGRAPHS IN
T
P
T
D
N
A
I
T
C
. P
C A
T
A
C
A
M
B
C
.
HOSE
ARTS
HAT
O
OT
PPLY
N
HIS
ASE
ART
PPLIES
O
LL
ASES
ND
UST
E
OMPLETED
A. WHEN THE EVICTION IS BASED ON UNPAID RENT
1. The tenant has failed to pay rent now due and owing in the amount of $_______________ . That amount consists of
basic rent of $_______________, late charges of $_______________, legal fees relating to this action for eviction
of $_______________, filing fees and costs of $_______________, and other (specify) ______________________.
2. All of the items listed above are included in the lease agreement as rent.
3. All of those items are permitted by applicable federal, state and local laws (including rent control or rent leveling, if
applicable) to be charged as rent for purposes of this action.
B. WHEN THE EVICTION IS BASED ON OTHER GROUNDS
Eviction is sought because
C. IN ALL CASES:
1. I have attached a copy of all notices that have been served on the tenant.
2. These notices were served on the tenant (check one or more) _____ by ordinary mail, _____ by certified mail,
_____
personally, on _____________________________________________________________________.
3. All of the facts stated in the notices are true.
4. If I proceeded without an attorney, I certify that I own the property in my own name or in the name of a general partnership
of which I am a partner.
5. I have complied with the registration requirements of N.J.S.A. 46:8-27 et seq.
6. The tenant did not transfer ownership to me and I have not given the tenant an option to buy the property.
7. The tenant is not in the military service of the United State nor any of its allies, nor is the premises used for dwelling
purposes of the spouse, a child or other dependent of a person in the military service of the United States.
I, THE LANDLORD, CERTIFY THAT THE FOREGOING STATEMENTS MADE BY ME ARE TRUE. I AM
AWARE THAT IF ANY OF THE FOREGOING STATEMENTS MADE BY ME ARE WILFULLY FALSE, I AM
SUBJECT TO PUNISHMENT.
DATE: _______________
___________________________________________________________
(PRINT NAME BELOW)
LANDLORD
Effective 9/1/2008 , CN 10512-English (Appendix XI-T)
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