Form Center

2. 445 Lafayette Avenue, Suite 102

   Hawthorne, NJ 07506

   Phone: 973-427-1167

4. Lori Fernandez, RMC, CMC, Borough Clerk
   Email Lori Fernandez
6. *PLEASE NOTE: Requests are fulfilled in (7) business days as per NJSA 47:1A-5 unless an extension has been agreed to.

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

8. Requestor Information
10. First Name
11. Middle Initial
12. Last Name
14. Email Address
16. Mailing Address
18. City
19. State
20. Zip Code
22. Telephone
23. Fax
25. If you are requesting records containing personal information.

    1. Have
    2. Have Not

    Under penalty of NJSA 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.
27. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
29. Electronic Signature
30. Date
    Date
32. Preferred Delivery

    1. Email
    2. On-Site Inspect
    3. Pick Up
    4. U.S. Mail
34. Payment Information

    No Fee for Emailed Documents

36. Maximum Authorization Cost
37. Select Payment Method

    1. Cash
    2. Check
    3. Money Order
38. Fees
    Letter size pages - $0.05 per page
    Legal size pages - $0.07 per page
    Other materials (CD, DVD, etc.) - actual cost of material
40. Delivery
    Delivery / postage fees additional depending upon delivery type.
41. Extras
    Special service charge dependent upon request.
43. **RECORDS REQUEST INFORMATION - List the records you are seeking, include property address, BLOCK AND LOT #. Not completing this box with this information may delay receipt of the records. Thank you.**

    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.

53. Deposits
    The custodian may require a deposit against costs for reproducing documents sought through an anonymous request whenever the custodian anticipates that the documents requested will cost in excess of $5 to reproduce.
    
    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.
64. 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, I am also requesting the documents under common law.
66. 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.
68. 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.

70. 1. All government records are subject to public access under the Open Public Records Act (“OPRA”), unless specifically exempt.

    2. A request for access to a government record under OPRA must be in writing, hand-delivered, mailed, transmitted electronically, or otherwise conveyed to the appropriate custodian. N.J.S.A. 47:1A-5.g. The seven business day response time does not commence until the records custodian receives the request form. If you submit the request form to any other officer or employee of the Borough of Hawthorne, that officer or employee must either forward the request to the appropriate custodian, or direct you to the appropriate custodian. N.J.S.A. 47:1A-5.h.

    3. Requestors may submit requests anonymously. If you elect not to provide a name, address, or telephone number, or other means of contact, the custodian is not required to respond until you reappear before the custodian seeking a response to the original request.

    4. The fees for duplication of a government record in printed form are listed on the front of this form. We will notify you of any special service charges or other additional charges authorized by State law or regulation before processing your request. Payment shall be made by cash, check or money order payable to the Borough of Hawthorne.

    5. You may be charged a 50% or other deposit when a request for copies exceeds $25. The Borough of Hawthorne custodian will contact you and advise you of any deposit requirements. You agree to pay the balance due upon delivery of the records. Anonymous requests in excess of $5 require a deposit of 100% of estimated fees.

    6. Under OPRA, a 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, and who is seeking government records containing personal information pertaining to the person’s victim or the victim’s family. This includes anonymous requests for said information.

    7. By law, the Borough of Hawthorne must notify you that it grants or denies a request for access to government records within seven business days after the agency custodian of records receives the request. If the record requested is not currently available or is in storage, the custodian will advise you within seven business days after receipt of the request when the record can be made available and the estimated cost for reproduction.

    8. You may be denied access to a government record if your request would substantially disrupt agency operations and the custodian is unable to reach a reasonable solution with you.

    9. If the Borough of Hawthorne is unable to comply with your request for access to a government record, the custodian will indicate the reasons for denial on the request form or other written correspondence and send you a signed and dated copy.

    10. Except as otherwise provided by law or by agreement with the requester, if the agency custodian of records fails to respond to you within seven business days of receiving a request, the failure to respond is a deemed denial of your request.

    11. If your request for access to a government record has been denied or unfilled within the seven business days required by law, you have a right to challenge the decision by the Borough of Hawthorne to deny access. At your option, you may either institute a proceeding in the Superior Court of New Jersey or file a complaint with the Government Records Council (“GRC”) by completing the Denial of Access Complaint Form. You may contact the GRC by toll-free telephone at 866-850-0511, by mail:

    P.O. Box 819

    Trenton, NJ, 08625

    You can also contact them on their website. The Council can also answer other questions about the law. All questions regarding complaints filed in Superior Court should be directed to the Court Clerk in your County.

    12. Information provided on this form may be subject to disclosure under the Open Public Records Act.

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


74. 1. Receive an email copy of this form.
75. Email address

    This field is not part of the form submission.

76. Submit

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