Council Records Request Form

State of New Jersey
Council on Local Mandates
Important Notice
The second page of this form contains important information related to your rights concerning government records. Please read it carefully.
Requester Information – Please Print
First Name
Payment Information
I agree to pay for fees related to this
request no greater than
Last Name
Select Payment Method
Money Order
Mailing Address
Business Hours Telephone: Area Code
Preferred Delivery:
Area Code
Pick Up
US Mail
Pages 1-10
Pages 11-20
Pages 21 @$0.25
Delivery: Delivery / postage fees
additional depending upon
delivery type.
On Site Inspect
Check 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.
Extraordinary service fees
dependent upon request.
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.
Request Access to:
Receive a Copy
Estimated Record Cost
Tracking Information
Special Cost
Total Cost Estimated
Final Cost
Tracking #
Rec’d Date
Ready Date
Balance Due
Balance Paid
Total Pages
Records Provided
Estimated time for delivery
Custodian Signature
7-02 Record Request Form(v2)
Requesting Access to Government Records Under the New Jersey Open Public Records Act (N.J.S.A. 47:1A-1 et seq.)
In order to request access to government records under OPRA, you must complete all the required portions of this request
form, sign and date it, and deliver it in person during regular business hours, or by mail or fax, to the Records Custodian at the
address/fax number listed below. Your request is not considered filed until the Custodian has received a completed request
form. If you submit the request form to any other State officer or employee, that person does not have the authority to accept
your request form and you will be directed to the Custodian.
2. Only requests submitted on this form and delivered to the Records Custodian of the Council will be considered official
requests under the Open Public Records Act. Deadlines, restrictions and remedies will not apply to requests unless received
by the Custodian on this form.
3. The fees for duplication of a government record in printed form are listed on the front of this form. You will also be required
to pay any special charges, special service charges or other additional charges authorized by State law or regulation. If
estimated costs exceed the maximum amount you stated you were willing to pay, we will contact you for authorization before
proceeding. Payment shall be made by cash, check or money order payable to the State of New Jersey.
4. If it is necessary for the records custodian to contact you concerning your request, identifying information, such as your name,
address and telephone number or an e-mail address is required. Where contact is not necessary, anonymous requests are
permitted; except that anonymous requests for personal information are not honored.
5. Anonymous requests, when permitted, require a deposit of 50% of estimated fees if the total cost is expected to exceed $15.
You agree to pay the balance due upon delivery of the records.
6. The Custodian must deny access to a person who has been convicted of an indictable offense in New Jersey, any other state, or
the United States, who is seeking government records containing personal information that may pertain to the person’s victim
or the victim’s family.
7. The Custodian must notify you that your request for access is granted or denied within seven business days after the Custodian
receives the request, provided that the record is currently available and not in storage. If the record requested is not currently
available or is in storage, the Custodian will advise you within seven business days when the record can be made available and
the estimated cost. You may agree with the Custodian to extend the time for making records available, or for granting or
denying your request.
8. You may be denied access to a government record if your request would substantially disrupt Council operations and the
Custodian is unable to reach a reasonable solution with you.
9. If the Council is unable to comply with your request for access to a government record, the Custodian will indicate the
reason(s) for denial on the request form and send you a signed and dated copy.
10. Except as otherwise provided by law or by agreement with the requester, if the Custodian fails to respond to you within seven
business days of receiving a request form, the failure to respond will be considered a denial of your request.
11. If your request for access to a government record has been denied or unfilled within the time permitted by law, you have a
right to challenge the decision to deny access. At your option, you may either institute a proceeding in the Superior Court of
New Jersey or file a complaint in writing with the Government Records Council (GRC). You may contact the GRC by tollfree telephone at 866-850-0511, by mail at PO Box 819, Trenton, NJ, 08625, by e-mail at [email protected], or at their web
site at The GRC can also answer other questions about the law.
12. Information provided on this form may be subject to disclosure under the Open Public Records Act.
State of New Jersey
Council on Local Mandates
Records Custodian
By Mail:
PO Box 627
Trenton, NJ 08625-0627
In person requests (from 9 am to 4 pm) at Council Office:
135 West Hanover Street
Trenton, NJ
By fax:
Fax number -- 609-984-9737
For more information, contact the Records Custodian at 609 984-9738.
7-02 Record Request Form(v2)