OPRA INSPECTION REQUEST
FORM

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

Requestor Information – Please Print

First Name:

MI:

Last Name:

Applicant Email:

Mailing Address:

City:

State:

Zip :

Telephone:

Fax:

Preferred Delivery:

Pick Up:

US Mail:

On-Site Inspect :

Fax:

E-mail :

If you are requesting records containing personal information, please circle 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.

Record Request Information:

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: