OPRA Request Form
Information provided on this form may be subject to disclosure under the Open Public Records Act
| Personal Information |
| Name: |
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| Company: |
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| Street Address: |
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| City, ST, Zip: |
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| Home Phone: |
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| Business Phone: |
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| Email Address: |
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Choose one: Under penalty of N.J.S.A. 2C:28-3, I certify that [ I have] [ I have not]
been convicted of any indictable offense under the laws of New Jersey, and any state, or the United States. |
| Record Request Information |
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To expedite your request, be as specific as possible in describing the records requested. Also, please include the type of access requested (copying or inspection), and if data, the medium requested.
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| Payment Information |
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The following fees apply:
- Letter size pages - $0.05 per page
- Legal size pages - $0.07 per page
- Other materials (CD, DVD,Tape, etc) - Actual Cost
- Delivery/postage fees additional depending on delivery type.
- Special service charge dependent upon request.
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| Maximum Authorization Cost: $ |
| Delivery Method: |
Email USPS Onsite Inspection Pick-Up |
| Payment Method: |
Cash Check Money Order
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| Electronic Signature: Typing your full name in the box below constitutes a signature on this document. |
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By entering my electronic signature above, I agree to that I have read the important information related to my rights concerning government records.