Government Records Request Form (OPRA)

2. Important Notice
   Government Records Request Notice (OPRA) PDF

   The attached document contains important information related to your rights concerning government records. Please read it carefully.

4. Requestor Information

6. First Name*

7. Middle Initial

8. Last Name*

10. Company

12. Mailing Address*

14. City*

15. State*

16. Zip*

18. Email*

20. Business Hours Telephone*

    Please include area code and extension.

22. Preferred Delivery*

    1. On Site Inspect
    2. Pick Up
    3. US Mail
    4. Email

24. Record Request Information*

    To expedite the request, be as specific as possible in describing the records being requested.

26. Type of Access Requested*

    1. Copying
    2. Requesting

27. If Data, Medium Requested*

    1. Email
    2. Mail
    3. No Data

31. Payment Information

33. Maximum Authorization Cost

34. Select Payment Method

    1. Cash
    2. Check

    1. Money Order

36. Fees
    Paper Size 8 ½ X 11: $0.05 per page<br> Paper Size 8 ½ X 14: $0.07 per page

    Paper Size 8 ½ X 11: $0.05 per page
    Paper Size 8 ½ X 14: $0.07 per page

37. Delivery
    Delivery / postage fees additional depending upon delivery type.

    Delivery / postage fees additional depending upon delivery type.

39. Extras
    Extraordinary service fees dependent upon request.

    Extraordinary service fees dependent upon request.

41. Under penalty of N.J.S.A. 2C:28-3, I certify that I _______ been convicted of any indictable offense under the laws of New Jersey, any other state, or the United States.*

    1. Have

    1. Have Not

45. Estimated Document Cost

46. Estimated Delivery Cost

48. Estimated Extras Cost

49. Total Estimated Cost

51. Deposit Amount

52. Estimated Balance

54. Deposit Date
    Deposit Date

56. Disposition Notes

    Custodian: If any part of request cannot be delivered in 7 business days, detail reasons here.

58. In Progress - Open

59. Denied - Closed

61. Filled - Closed

62. Partial - Closed

64. Tracking #

65. Received Date
    Received Date

67. Ready Date
    Ready Date

68. Total Pages

70. Final Total Cost

71. Deposit

73. Balance Due

74. Balance Paid

76. Records Provided

78. Custodian Signature

79. Date
    Date

Leave This Blank:


81. 1. Receive an email copy of this form.
82. Email address

    This field is not part of the form submission.

83. Submit Submit and Print

* indicates a required field