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Howell Township, NJ

1. 

2. Requestor Information - Please Print

3. First Name

4. Middle Initial

5. Last Name

6. E-mail Address

7. Address1

8. City

9. State

10. Zip

11. Telephone

12. Fax

13. Preferred Delivery

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

14. If you are requesting records containing personal information, please select one: Under penalty of N.J.S.A. 2C:28-3, I certify that I

    1. Have
    2. Have Not

    been convicted of any indictable offense under the laws of New Jersey, any other state, or the United States.

15. Signature

    You agree that by typing your name, you are electronically signing this document.

16. Date and Time
    Date and Time

    Date and Time

17. Payment Information

18. Maximum Authorization Cost

19. Select Payment Method

    1. Cash
    2. Check
    3. Money Order
20. 

21. Record Request Information

22. Please be as specific as possible in describing the records being requested. Also, please note that your preferred method of delivery will only be accommodated if the custodian has the technological means and the integrity of the records will not be jeopardized by such method of delivery.

23. 

24. 

25. .

    1. Yes, I am also requesting the documents under common law.

26. 

27. Please set forth your interest in the subject matter contained in the requested material:

28. 

29. 

30. 

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

34. Submit Submit and Print

* indicates a required field