Name:         ___________________________________________________________________________


Address:     ___________________________________________________________________________




Telephone:  ______________________________________Fax #:________________________________



Information Requested:


[_______]  Copy of Minutes [specify board or entity, date, topic or other identifying information]






[_______]  Copy of Ordinance of Resolution [specify date, number or other identifying information]






[_______]    Police Accident Report                                                         Fee:___________________


                  Identifying Accident: __________________________________________________________


[_______]   Other [specify]








[_______]  License Information [specify]




Information on a Specific Property           Address ____________________________________________


                                                            Block _______________________ Lot ___________________



[_______]   Municipal Lien Search                                                             Fee        $10.00                 

                  Municipal Lien Searches are provided by the designated search officer and will be within 15 days after the request is received and the fee paid, as provided in N.J.S.A. 54:5-11, et seq.



[_______]    List of Property Owners within 200’                                        Fee ____________________

                  As provided in N.J.S.A. 40:55D-12, the fee is the greater of $.25 per name or $10.00



A request for a copy of Public Records should be submitted on this form which has been adopted by the Municipal Clerk as the Custodian of Records.  Some records will be immediately available during normal business hours.  Some records will require time to compile and to make the copies requested, but will generally be available during normal business hours and within seven (7) business days.  If any document or copy which has been requested is not a public record or cannot be provided with the seven (7) business days, you will be provided with a response with that information within the seven (7) business days.  Some records requested have specific fees or other response times established by statute.  There is no fee involved in simply inspecting a document during normal business hours.  This request may be filed electronically.  In general:


                     Immediate access is ordinarily available for budgets, bills, vouchers, contracts, including collective negotiations agreements and individual employment contracts, and public employee salary and overtime information.  Minutes of public meetings will be generally available immediately after the minutes have been approved.

                     Records which are in storage or archived or which will require a search of records will be made available as soon as possible and the requester will be advised with the seven (7) business days when the records can be made available.

                     Except as otherwise provided by law or regulation, the fee assessed for the duplication of a printed record shall be: first page to tenth page, $0.75 per page; eleventh page to twentieth page, $0.50 per page; all pages over twenty, $0.25 per page; for a police accident report there is an additional fee when the request is not made in person of $5.00 for the first 3 pages and $1.00 for each additional page, as provided by N.J.S.A. 39:4-131.

                     Where a request is for a copy in a format other than a photocopy, reasonable efforts will be made to provide the information in the format requested.  The cost will be based on the costs of producing the format requested.

                     Where a legal determination must be made as to whether a record is a “government record” a provided by law, the request will be reviewed by the Municipal Attorney.

The term “government record” generally includes those records determined to be public in accordance with N.J.S.A. 47:1A-1.  The term does not include employee personnel files, police investigation records, public assistance files or other matters in which there is a right to privacy or confidentiality or which is specifically exempted by law.



The requester hereby acknowledges receipt of a copy of this form with the date on which the information is expected to be available and the estimated cost.  The requester hereby certifies that he or she has not been convicted of any indictable offense under the laws of this State, and other state or the United States and is not seeking government records containing personal information pertaining to the victim of a crime or the victim’s family as provided by N.J.S.A. 47:1A-a et seq.



This form when signed by the municipal official shall constitute a receipt for any deposit received.



The information requested will be ready on                 ______________________________________


Estimate Number of Pages                                       ______________________________________


Estimated Cost                                                        ______________________________________


Deposit                                                                   ______________________________________


[may be required where the anticipated cost of reproduction exceeds $5.00]



________________________________________           ______________________________________

                             Requester                                                            Municipal Official



________________________________________           ______________________________________

                                 Date                                                                           Date