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. 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

28. Payment Information

30. Maximum Authorization Cost

31. Select Payment Method

    1. Cash
    2. Check

    1. Money Order

33. 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

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

    Delivery / postage fees additional depending upon delivery type.

36. Extras
    Extraordinary service fees dependent upon request.

    Extraordinary service fees dependent upon request.

40. Record Request Information*

    To expedite the request, be as specific as possible in describing the records being requested. Also, please include the type of access requested (copying or inspection), and if data, the medium requested.

42. Estimated Document Cost

43. Estimated Delivery Cost

45. Estimated Extras Cost

46. Total Estimated Cost

48. Deposit Amount

49. Estimated Balance

51. Deposit Date
    Deposit Date

53. Disposition Notes

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

55. In Progress - Open

56. Denied - Closed

58. Filled - Closed

59. Partial - Closed

61. Tracking #

62. Received Date
    Received Date

64. Ready Date
    Ready Date

65. Total Pages

67. Final Total Cost

68. Deposit

70. Balance Due

71. Balance Paid

73. Records Provided

75. Custodian Signature

76. Date
    Date

Leave This Blank:


78. 1. Receive email copy
79. Email address

    This field is not part of the form submission.

80. Submit Submit and Print

* indicates a required field