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2. Return Form To:
   Toms River Town Clerk
   P.O. Box 728
   Toms River, NJ 08753
4. Request Type

   I am requesting registration of the following address upon Toms River Township's "Do Not Knock" Registry. I am the (check appropriate):

   1. Occupant of the Premises
   2. Owner
6. I understand that my address shall be placed upon a list to be kept by the Township Clerk which will be updated twice per year. I understand that registration upon the "Do Not Knock Registry" restricts all forms of door-to-door canvassing and solicitation of those residents that have applied, obtained and posted the "Do Not Knock" sticker.
8. Information to Be Included on the "Do Not Knock" Registry
10. Street Number*
11. Street Name*
12. Building / Apartment Number*
14. City*
15. State*
16. Zip Code*
18. Phone Number
20. Owner Name (If Different Than Resident)
21. Phone Number
23. Owner Street*
26. Electronic Signature Agreement

    By checking the "I agree" box below, I am signing this application electronically. In doing so, I certify under penalty of perjury and false swearing that: (1) I am the person identified in the application; (2) I am signing this application knowingly and voluntarily; (3) my answers are correct and complete to the best of my knowledge; (4) I have read and understood the information presented; and (5) that my electronic signature has the same legal effect and can be enforced in the same way as my written signature.

    1. I agree.
28. Electronic Signature
29. Date
    Date
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field