Fillable Certicate of Authorization Instruction Sheet (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Certicate of Authorization Instruction Sheet (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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New Jersey Is An Equal Opportunity Employer • Printed on Recycled Paper and Recyclable
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
New Jersey State Board of Architects
124 Halsey Street, 3rd Floor, P.O. Box 45001
Newark, New Jersey 07101
(973) 504-6385
Certicate of Authorization
Instruction Sheet
The form must be typewritten or printed clearly, and separate sheets may be used for additional information. Please provide a
telephone number.
A nonrefundable application ling fee of $100.00, made payable to the New Jersey State Board of Architects, must be
submitted with the application.
A notary seal is required in the two areas provided on page two of the form. You also must provide the signatures of
the licensee who is “in responsible charge” and a corporate ofcer where indicated.
The “Details of Ownership” information must be submitted with all initial applications.
Domestic corporations (New Jersey corporations) must submit a certied copy of the Certicate of Formation or
incorporation, issued by the Division of Revenue in the New Jersey Department of the Treasury. To obtain the certicate,
call (609) 292-9292 or (609) 292-1730 or log onto www.nj.gov/njbgs.
Foreign corporations (out-of-state corporations) must present a certied copy of the Certicate of Formation or incorporation
issued by the home state. In addition, provide a certied copy of a Certicate of Authority to do business in New Jersey
which is issued by the Division of Revenue in the New Jersey Department of the Treasury. To obtain the certicate, complete
an Application for Public Records Filing for New Business Entities. For a copy of the application, call (609) 292-1730 or log
onto www.nj.gov/njbgs.
A copy of the most current annual report led with the Division of Revenue must be submitted with every application.
Any corporation or L.L.C. that offers or renders landscape architectural services but which does not have an ofcer or
employee who is licensed as a landscape architect by the New Jersey State Board of Architects and who serves as the
responsible licensee-in-charge, shall have a written contract with a landscape architect who is currently licensed by
the State Board prior to offering or rendering any such service in addition to being required to obtain a Certicate of
Authorization pursuant to N.J.S.A. 45:3A-16 and N.J.A.C. 13:27-8.11.
Any changes (corporate address, address of record, licensee in-responsible-charge, corporate ofcers, etc.) must be reported,
in writing, within 30 days of the change.
Return the Certicate of Authorization application along with the above-noted documentation to the following address:
New Jersey State Board of Architects
P.O. Box 45001
Newark, NJ 07101
Once your Certicate of Authorization application has been approved, you will be issued a certicate number, which
must be indicated in your title block.
Note: Applications submitted without the required documentation, or any application that has not been signed, dated
or notarized, will be returned.
New Jersey Ofce of the Attorney General
Division of Consumer Affairs
New Jersey State Board of Architects
124 Halsey Street, 3rd Floor, P.O. Box 45001
Newark, New Jersey 07101
Application for a Certicate of Authorization
to Provide or Offer to Provide Landscape Architectural Services
Instructions
1. Please print clearly. Provide a telephone number including the correct area code. 4. Business addresses listed on this application must be numbered.
2. If any space is inadequate, use a separate sheet of paper. 5. Attach to this application the Certicate of Formation or Incorporation led
in New Jersey or in the original state of incorporation.
3. Enclose a check made payable to the New Jersey State Board of Architects. 6. Biennial renewals of the Certicate of Authorization are required.
Applicant (Name of corporation) State of incorporation Date of this application
Address of principal ofce in state of incorporation (1) Telephone No. (include area code)
Address of principal ofce in New Jersey, if different from above (2) Telephone No. (include area code)
Addresses of other ofces where professional services will be offered or provided in New Jersey.
Each ofce must be sequentially numbered beginning with 3; as 3, 4, 5, etc.
Address Telephone No. (include area code) N.J. Landscape Architect license number Signature
Professional Service Corporations (N.J.S.A. 14A:17-1
et seq.) are not required to obtain a Certicate of
Authorization.
If a “foreign” corporation (outside of N.J.), you will need a Certicate
of Authority from the New Jersey Department of the Treasury’s
Division of Revenue.
Yes No
I am aware that the Certicate of Authorization may be revoked if
any agent, employee, director or ofcer of the corporation violates
or causes to be violated any provisions of those laws or regulations
governing the practice of landscape architecture in New Jersey.
The persons in responsible charge listed below must include the numerical identier of their work location following their
name in the column below. If a licensee is in responsible charge of more than one ofce, use a separate line for each ofce
and attach an explanation. If a licensee is also in responsible charge of landscape architectural services for other business
entities or as a sole proprietor, he/she shall place an “X” in the column next to his/her signature and attach a written description
of the details of all such associations. List all personnel in responsible charge who act on behalf of the corporation as a
landscape architect. The rst licensee listed will be considered the designated Board contact. This individual will be sent
all of the mail from the Board ofce and will be the person listed on the renewed certicate.
Name N.J. license number Address of record X Signature
Use additional sheets of paper if necessary.
Any changes in the above information must be reported to the Board in writing, within 30 days after such changes become effective. Original signatures are needed
for additions/deletions to the list of those who are in responsible charge. Under oath, I declare that the foregoing statements, to the best of my knowledge and belief,
are true and made in good faith.
Signature of designated responsible-in-charge licensee__________________________________________________________ Title________________________________________
Print name__________________________________________________________ Date________________________________________
Signature of authorized ofcer__________________________________________________________ Title________________________________________
Print name__________________________________________________________ Date________________________________________
Name of corporation________________________________________________________________________________________________________
Before me personally appeared the signer of the above, who acknowledges himself/herself to be the authorized above-named ofcer of the above-named corporation and he/she being
authorized to do so, executed this application for the purposes stated by signing the name of the corporation by himself/herself as the authorized ofcer, in witness thereof:
Sworn and subscribed to before me this __________
day of _________________________ , ___________
Month Year
_______________________________________
Name of Notary Public (please print)
_______________________________________
Signature of Notary Public
I am aware that the Certicate of Authorization may be
revoked if any agent, employee, director or ofcer of the
corporation violates or causes to be violated any provisions
of those laws or regulations governing the practice of
landscape architecture in the State of New Jersey.
Afx seal here
For oFFice Use only
Approved Fee
Date issued L.A. Certicate of Authorization number
Signed Date
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Certicate of Authorization Instruction Sheet (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Completed 14 August 2020

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