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OPRA Request Form

 Information provided on this form may be subject to disclosure under the Open Public Records Act

 Personal Information
 Name:  
 Company:  
 Street Address:  
 City, ST, Zip:  
 Home Phone:  
 Business Phone:  
 Email Address:  
 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

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.

 
 Payment Information
 The following fees apply:
  • Pages 1-10   -   .75 per page
  • Pages 11-20 -   .50 per page
  • Pages 21+    -   .25 per page

 Special Fees:  Delivery/postage fees additional depending on delivery method. Extraordinary service fees may apply dependent upon request.
 Maximum Authorization Cost:  $     
 Delivery Method:   Email  USPS   Onsite Inspection     Pick-Up
 Payment Method:

  Cash   Check   Money Order

 Electronic Signature: Typing your full name in the box below constitutes a signature on this document.

 

By entering my electronic signature above, I agree to that I have read the important information related to my rights concerning government records.