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State of New Jersey Department of Environmental Protection
State of New Jersey Department of Environmental Protection
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State of New Jersey
Division of Law Environmental Enforcement
A-901 Unit - Phone (609) 376-3270

Electronic copies of Registration Forms

These forms were revised September 2018
Acrobat Reader is required to view and print these files:
You may download a freeware version of Adobe Acrobat here:. 

You may order NJ Division of Law Environmental Enforcement Finger print cards online here:
IMPORTANT MESSAGE: Finger print cards should only be requested for individuals who work or reside outside
the state of New Jersey. Those who work or reside in the state of New Jersey do not need to request finger print cards.

Order finger print cards online here
   

Form Name

MS Word PDF
Notice of Surrender
N/A

Adobe pdf icon

NEW APPLICATION
INSTRUCTIONS AND EXPLANATION (READ FIRST) - IMPORTANT INFORMATION REGARDING THE A-901 APPLICATION
N/A

Adobe pdf icon

BUSINESS CONCERN DISCLOSURE STATEMENT

Microsoft Word icon

Adobe pdf icon
PERSONAL HISTORY DISCLOSURE STATEMENT

Microsoft Word icon

Adobe pdf icon 

SECOND LEVEL (PARENT COMPANY) BUSINESS CONCERN DISCLOSURE

Microsoft Word icon

Adobe pdf icon

RENEWAL
2019 ANNUAL UPDATE - Due November 1, 2018
N/A

Adobe pdf icon
2019 ANNUAL UPDATE SECOND LEVEL (PARENT COMPANY) -  Due November 1, 2018
N/A
Adobe pdf icon
LESSORS
BUSINESS CONCERN DISCLOSURE STATEMENT - For Lessors

Microsoft Word icon

Adobe pdf icon

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Last Updated: January 12, 2018