10512 – Certification by Landlord – Appendix XI-T – New Jersey

The 10512 – Certification by Landlord – Appendix XI-T form is used by landlords to certify the details surrounding an eviction case filed in the Superior Court of New Jersey, Law Division, Special Civil Part, Landlord-Tenant Division.

This guide will help you complete the Certification by Landlord form accurately and thoroughly.

Filing Attorney Information or Landlord

• Name: Enter your full name (landlord or attorney).
• NJ Attorney ID Number: If you are an attorney, enter your NJ Attorney ID number.
• Address: Provide your complete mailing address.
• Telephone Number: Enter a valid phone number where you can be reached.

Superior Court of New Jersey, Law Division, Special Civil Part, County

• County: Specify the county where the court is located.
• Docket Number: Enter the docket number assigned to your case (LT-XXXXX).

Plaintiff and Defendant Information

• Plaintiff: Enter the landlord’s name.
• Defendant: Enter the tenant’s name.

Part A: When the Eviction is Based on Unpaid Rent

1. Rent Due: Enter the total amount of rent due, broken down into:

• Basic Rent: The amount of unpaid basic rent.
• Late Charges: Any late fees charged.
• Legal Fees: Legal fees related to the eviction action.
• Filing Fees and Costs: Costs associated with filing the eviction action.
• Other: Any additional charges permitted by the lease agreement and applicable laws (specify what these are).

2. Inclusion in Lease Agreement: Confirm that all items listed are included in the lease agreement as rent.

3. Compliance with Laws: Confirm that all items are permitted by federal, state, and local laws to be charged as rent for eviction purposes.

Part B: When the Eviction is Based on Other Grounds

Provide a detailed description of the grounds for eviction if it is based on reasons other than unpaid rent.

Part C: In All Cases

1. Attach Notices: Attach copies of all notices served to the tenant.

2. Method of Service: Select the method(s) used to serve the notices (ordinary mail, certified mail, personal service) and provide the date of service.

3. Truthfulness of Facts: Confirm that all facts stated in the notices are true.

4. Property Ownership: If proceeding without an attorney, certify that you own the property in your name or in the name of a general partnership of which you are a partner.

5. Registration Compliance: Confirm compliance with the registration requirements of N.J.S.A. 46:8-27 et seq.

6. Ownership Transfer: Confirm that the tenant did not transfer ownership to you and that you have not given the tenant an option to buy the property.

7. Military Service: Confirm that the tenant is not in military service and that the premises are not used for dwelling purposes by a spouse, child, or dependent of a person in military service.

Certification Statement

• Date: Enter the date you are signing the form.
• Landlord Signature: Sign the form.
• Print Name: Print your name clearly.

Final Steps

• Review: Double-check all information for accuracy and completeness.
• Submit: Submit the form to the Superior Court of New Jersey, Law Division, Special Civil Part, Landlord-Tenant Division, in the appropriate county.

Notice: Do not enter personal identifiers such as Social Security numbers, driver’s license numbers, vehicle plate numbers, insurance policy numbers, active financial account numbers, or active credit card numbers, as this is a public document.