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OPRA Request
Requestor Information - Please Print
First Name
Middle Initial
Last Name
E-mail Address
Address1
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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
Have
Have Not
been convicted of any indictable offense under the laws of New Jersey, any other state, or the United States.
Signature
You agree that by typing your name, you are electronically signing this document.
Date and Time
Date and Time
Date and Time
Payment Information
Maximum Authorization Cost
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Record Request Information
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.
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Yes, I am also requesting the documents under common law.
Please set forth your interest in the subject matter contained in the requested material:
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