AFFIDAVIT OF COMPLIANCE

Applicant name:

Address:

Phone number:

_________________________, of full age, does hereby certify as follows:

1.         I am the Applicant and/or its duly appointed representative on the development application that has been granted approval by the Medford Township Planning or Zoning Board (“Board”) in accordance with the Municipal Land Use Law, N.J.S.A. 40:55D-1 et seq.

2.         I have reviewed the Board’s Resolution of Approval, including the conditions imposed therein and I hereby certify that each condition of the Resolution has been satisfied.

3.         I attach hereto to this affidavit copies of any outside agency approvals from outside governmental agencies having jurisdiction over my development application.

4.         I understand that issuance of any building and/or construction permits, pursuant to the Board’s Resolution of Approval, are also being issued by the Township in reliance upon this Affidavit. 

I certify that if any of the foregoing statements made be me are willfully false, I am subject to punishment. I am also aware that if any of the foregoing statements made by me are false, the Township of Medford, through its duly appointed representative, may direct the issuance of a stop work order.

                                                                        _____________________________

Date:

Sworn and subscribed to before me

this          day of                 , 2006

__________________________