FORM P

Application No._______________
Filed______________________   Considered by Planning Board________________________
                              (Date)                                                                                                   (Date)

(Do Not Write Above This Line)

APPLICATION FOR APPROVAL OF PRELIMINARY SUBDIVISION PLAN

PLANNING BOARD

BOROUGH OF MADISON

Application is hereby made for approval of a Preliminary Plan of a proposed subdivision of land
hereinafter more particularly described.

1. Applicant's Name_____________________________ Telephone No. ________________
   Address_________________________________________________________________
                                                           (Present Owner or Duly Authorized Agent)

2. Attorney's Name______________________________Telephone No._________________
   Address_________________________________________________________________

3. Engineer's Name______________________________Telephone No._________________
   Address_________________________________________________________________

4. Present Owner of Land_________________________Address______________________

5. Status of Applicant:         Individual  [   ]         Partnership  [   ]         Corporation  [   ]

6. If Partnership, Names and Addresses:
   _______________________________________________________________________
   _______________________________________________________________________

7. If Corparation, Name and Address of Registered Agent in New Jersey:
   _______________________________________________________________________
   _______________________________________________________________________

8. Tax Map:             Block__________________ Lot Numbers________________________

9. If applicant is other than owner, what interest has applicant in said land, and when same will
   be acquired______________________________________________________________
   _______________________________________________________________________

10. Number of Lots shown on Preliminary Plan_______ Lineal feet of new streets__________

11. Proposed character of subdivision and preliminary sketch of house if available__________
    _______________________________________________________________________

12. Is applicant will and able, in the event of approval of a Final Map, to undertake and complete
    installation of improvements, in accordance with requirements and specifications of the
    Borough of Madison, and to furnish a bonding of surety bond to guarantee performance
    thereon for such improvements required?       Yes  [    ]        No   [   ]

                                                                            ______________________________________
                                                                            (Applicant's Signature)

                                                                            ______________________________________
                                                                            (Address)

Dated:_____________________________