Type Full Name :
Sign With Hand
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.
Business Name (If applicable)
Special service charge dependent upon request.
By law, the Name of Agency must notify you that it grants or denies a report for access to government records within seven (7) 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 (7) business days after receipt of the request when the record can be made available and the estimated cost for reproduction. You may agree with the custodian to extend the time for making records available, or granting or denying your request.
1. The custodian has the technological means
Note that your preferred method of delivery will only be accommodated if:
First Name
In order to request access to government records under OPRA, you must complete all the required portions of and date this request form and deliver it in person during regular business hours or by mail, fax or electronically to the agency custodian of records. Your request is not considered filed until the agency custodian of records receives the request form. If you submit the request form to any other officer or employee of the Name of Agency, that officer or employee may not have the authority to accept your request form on behalf of the Name of Agency and your request will be directed to the agency custodian of records. The seven (7) business day response time will not commence until the agency custodian of records receives the request form. N.J.S.A. 47:1A-5.h.
Fax #
Do you wish to submit this request anonymously?
If it is necessary for the records custodian to contact you concerning your request, providing identifying information, such as your name, address, telephone number, fax number or e-mail address is required. Where contact is not necessary, anonymous requests are permitted; except the anonymous requests for personal information are not honored.
Standard mailing costs are $0.25 for each envelope plus postage.
(555) 555-5555
Your Town, USA 00000
@ $0.07 per page
Open Public Records Act Request Form
Letter Size Pages (8.5'' x 11'')
been convicted of any indictable offense under the laws of New Jersey, any other
state, or the United States.
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 governmental records containing personal information pertaining to the person's victim or the victim's family.
If you request for access to a government record has been denied or unfilled within seven (7) business days required by law, you have a right to challenge the decision by the Name of Agency 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 toll-free telephone at 866-850-0511, by mail at PO Box 819, Trenton, NJ, 08625, by e-mail at grc@dca.state.nj.us, or at their website at www.state.nj.us/grc. The Council can also answer other questions about the law.
Information provided on this form may be subject to disclosure under the Open Public Records Act.
A public record under the common law is one required to be kept, or necessary to be kept in 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 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.
Requester Information
Legal Size Pages (8.5'' x 14'')
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 the reproduction of the documents.
Requesting Access to Government Records Under the New Jersey Open Public Records Act (N.J.S.A. 47:1A-1 et seq)
Under penalty of N.J.S.A. 2C:28-3, I certify that I
Applicant Signature
Please be as specific as possible in describing your request.
Telephone #
Note that you may only submit one (1) request per form. After pressing "Submit" below you will have the option to enter additional in a second request.
You may be denied access to a government record if you request would substantially disrupt agency operations and the custodian is unable to reach a reasonable solution with you.
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 $50 to reproduce.
You may be charged a 50% or other deposit when a request for copies exceeds $25. The Name Agency custodian will contact you and advise you of any deposit requirements. Anonymous requests, when permitted, require a deposit of 100% of estimated fees. You agree to pay the balance due upon delivery of the records.
Does this record fall under the common law?
123 Main Ave
Requesters may submit request anonymously. Note that if you elect not to provide a name, address, 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.
Last Name
If the information requested is a "public record" under common law and the requester 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.
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 the State law or regulation before processing your request. Payment shall be made by cash, check or money order payable to the Name of Agency.
* Indicates required field
How would you like to receive the information requested?
@ $0.05 per page
Record Request Information
If you are requesting records containing personal information, please certify the statement below.
2. The integrity of the records will not be jeopardized by such method of delivery.
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 (7) business days of receiving a request, the failure to respond is a deemed denial of your request.
Your Town
If the Name of Agency is unable to comply with your request for access to the government record, the custodian will indicate the reasons for denial on the request form and send you a signed and dated copy.
Fee Schedule