Form Center

2. 445 Lafayette Avenue, Suite 102

   Hawthorne, NJ 07506

   Phone: 973-427-1167

3. Lori Fernandez, RMC, CMC, Borough Clerk
   Email Lori Fernandez
5. *IMPORTANT NOTICE: Requests are fulfilled in (7) business days or (14) business days. See Item #2 below for details.

   The last part of this form contains important information related to your rights concerning government records. Please read it carefully.

7. Requestor Information
9. First Name
10. Middle Initial
11. Last Name
13. Email Address
15. Mailing Address
17. City
18. State
19. Zip Code
21. Telephone
22. Fax
23. Preferred Delivery

    1. Email (No Fee)
    2. On-Site Inspection (No Fee)
    3. Pick Up (Charges per Page)
    4. U.S. Mail (Charge Copies + Postage)
25. Under penalty of NJSA 2C:28-3, I certify that I*

    1. Have

    1. Have Not

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

27. Under penalty of NJSA 2C:28-3, I certify that I *

    1. Will

    1. Will Not

    2. use the requested government records for a commercial purpose.

29. Under penalty of NJSA 2C:28-3, I certify that I *

    1. Am

    1. Am Not

    3. seeking records in connection with a legal proceeding.

31. Electronic Signature
32. Date
    Date
34. Fees for Printed Copies

    Letter size pages - $0.05 per page

    Legal size pages - $0.07 per page

    Other materials (CD, DVD, etc.) - actual cost of material

35. Maximum Authorization Cost
36. Select Payment Method

    1. Cash
    2. Check
    3. Money Order
38. Extras

    Special service charge may apply dependent upon scope of request.

40. RECORDS REQUEST INFORMATION

    Please be as specific as possible in describing the records being requested.   
    Include Property Address AND Block & Lot#.   Not providing this information may cause delay in receiving the records.

    NOTE:  If you confirmed above that the records sought are in connection with a legal proceeding, identification of that proceeding is also required below.

42. >
44. Deposits

    The custodian may require a deposit against costs for reproducing documents whenever the custodian anticipates that the documents requested will cost in excess of $5 to reproduce. N.J.S.A. 47:1A-5(f).

    Where a special service charge is warranted under OPRA, that amount will be communicated to you as required under the statute. You have the opportunity to review and object to the charge prior to it being incurred. If, however, you approve of the fact and amount of the special service charge, you may be required to pay a deposit or pay in full prior to reproduction of the documents.

46. Request for Records Under the Common Law*

    If, in addition to requesting records under OPRA, you are also requesting the government records under the common law, please check the box.  A public record under the common law is one required by law to be kept, or necessary to be kept in the discharge of a duty imposed by law, or directed by law to serve as a memorial and evidence of something written, said, or done, or a written memorial made by a public officer authorized to perform that function, or a writing filed in a public office. The elements essential to constitute a public record are that it be a written memorial, that it be made by a public officer, and that the officer be authorized by law to make it.

    1. Yes

    1. No

48. If the information requested is a "public record" under common law and the requestor has a legally recognized interest in the subject matter contained in the material, then the material must be disclosed if the individual's right of access outweighs the State's interest in preventing disclosure.

50. Please set forth your interest in the subject matter contained in the requested material: (NOT for listing requested records)*

    Note that any challenge to a denial of a request for records under the common law cannot be made to the Government Records Council, as the Government Records Council only has jurisdiction to adjudicate challenges to denials of OPRA requests. A challenge to the denial of access under the common law can be made by filing an action in Superior Court.

52. COMPLETE RULES AND REGULATIONS OF THE NEW JERSEY OPEN PUBLIC RECORDS ACT MAY BE FOUND https://www.nj.gov/opra/.

    
    

54. Government Records Council
    Government Records Council Webiste
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field