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2. ** APPLICATION FOR NO KNOCK REGISTRY **
4. I am requesting registration of the following address in the Borough of Hawthorne for the "No Knock Registry".
6. I am the (check appropriate), of the property address below:*

   1. Owner

   1. Occupant
8. Address
   Please include floor or apt. number
10. I understand that my address shall be placed upon a list to be kept by the Police Records Division. Addresses will remain on the registry until notification to the Borough that the occupant wishes to be removed. The list will be provided to any licensee who is issued a license to conduct door-to-door sales pursuant to Ordinance 2238-19, Section 361-8 of the Borough of Hawthorne, New Jersey. I understand that registering with the “No Knock” Registry DOES NOT prohibit door-to-door solicitation for civic, religious, charitable, or political purposes, or on behalf of an educational, recreational, cultural, scientific or similar non-profit organization.
12. Additional Resident information for HPD Files only (will not be distributed to solicitors):
14. First Name
15. Last Name
17. Phone Number
18. Email Address
20. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
22. Electronic Signature
23. Date
    Date
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit Submit and Print

* indicates a required field