Effective 11/01/2001, CN 10513 (Appendix XI-U)
NOTICE: This is a public document, which means the document as submitted will be available to the public upon request.
Therefore, do not enter personal identifiers on it, such as Social Security number, driver’s license number, vehicle plate
number, insurance policy number, active financial account number, or active credit card number.
Filing Attorney Information or Pro Se Litigant:
Superior Court of New Jersey
Law Division, Special Civil Part
Certification by Landlord’s
1. I am the attorney for the landlord in this matter and make this certification pursuant to
Rule 6:6-3(b) or Rule 6:6-4.
2. The landlord has asserted that the tenant has failed to pay rent now due and owing in this matter.
3. I have reviewed the applicable federal, state, and local law and the written lease between the parties,
and in my opinion the charges and fees sought, other than the base rent, are permitted to be included
in the rent for purposes of this action.
I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing
statements made by me are willfully false, I am subject to punishment.