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    Elsinboro OPRA Request Form

    Uploaded by

    The Citizens Campaign
    This document is an open public records act request form for Elsinboro Township. It requests information from requestors such as name, email, address, payment details, and a description of the specific records being requested. The form notes that the last page contains important information about rights to government records and requires requestors to certify whether they have been convicted of any indictable offenses. It provides details on fees for records, such as per page costs for printing, delivery fees, and potential special service charges depending on the request. The township uses the form to provide an estimate of costs to fulfill the request and to track request information such as disposition, number of pages, and final costs.

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    Elsinboro OPRA Request Form

    Uploaded by

    The Citizens Campaign
    13 views1 page
    This document is an open public records act request form for Elsinboro Township. It requests information from requestors such as name, email, address, payment details, and a description of the specific records being requested. The form notes that the last page contains important information about rights to government records and requires requestors to certify whether they have been convicted of any indictable offenses. It provides details on fees for records, such as per page costs for printing, delivery fees, and potential special service charges depending on the request. The township uses the form to provide an estimate of costs to fulfill the request and to track request information such as disposition, number of pages, and final costs.

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    Elsinboro OPRA Request Form

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    This document is an open public records act request form for Elsinboro Township. It requests information from requestors such as name, email, address, payment details, and a description of the specific records being requested. The form notes that the last page contains important information about rights to government records and requires requestors to certify whether they have been convicted of any indictable offenses. It provides details on fees for records, such as per page costs for printing, delivery fees, and potential special service charges depending on the request. The township uses the form to provide an estimate of costs to fulfill the request and to track request information such as disposition, number of pages, and final costs.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    13 views1 page

    Elsinboro OPRA Request Form

    Uploaded by

    The Citizens Campaign
    This document is an open public records act request form for Elsinboro Township. It requests information from requestors such as name, email, address, payment details, and a description of the specific records being requested. The form notes that the last page contains important information about rights to government records and requires requestors to certify whether they have been convicted of any indictable offenses. It provides details on fees for records, such as per page costs for printing, delivery fees, and potential special service charges depending on the request. The township uses the form to provide an estimate of costs to fulfill the request and to track request information such as disposition, number of pages, and final costs.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    of 1

    OPENPUBLIC RECORDS ACT REQUEST FORM ELSINBORO TOWNSHIP

    619 Salem- Ft. Elfsborg Road Salem,NJ 08079 Phone: 856-935-2200 / Fax: 856-935-9011 Email: muclerk@elsinborotownship.com Marty R. Uzdanovics, Custodian of Records
    lmportant Notice The lastpageof thisformcontains important information related to yourrightsconcerning government recofds.pleasereadit carefullv.

    - Please print Requestor Information


    FirstName E-mailAddress Mailing Address City
    Telephone Ml Last Name

    Payment lnformation
    aximum Authorization Cost $

    Select Payment Method

    Cash

    Check

    Money Order

    State

    Zip FAX on-Site Inspect

    Pick Preferred Delivery: Up _

    US Mail_

    Fax

    E-mail

    r9c9r!scontaining personal information, please penalty circteone: Under !fy99 arerequesting of N.J.S.A. 2C:28-3, I certify thatI HAVE/ HAVEA/Of beenconvicted of anyindictable offense under the lawsof New Jersey, anyother state, or the United States.
    Signature

    Lettersize pages - $0.0S per page Legal size pages- $0.07 per page (CD,DVD, O t h e rm a t e r i a l s etc)- actualcost of material Delivery: Delivery/ postagefees a d d i t i o n ad l epending upon deliverytype. Fees: Extras: Specialservicecharge dependentupon request.

    RecordRequestInformation:Pleasebe as specific as possible in describing the records beingrequested. Also,pleasenotethatyour preferred method of delivery will onlybe accommodated if the custodian hasihe technological rieans and the intejrityof the remrdswill not
    be jeopardized by such methodof deli

    AGENCY USEONLY
    Est.Document Cost Est.Delivery Cost Est.Extras Cost TotalEst.Cost D e p o sA itmount Estimated Balance

    AGENCY USEONLY
    D i s p o s i t i o nN o t e s Custodian:lf any part of requestcannot be deliveredin seven businessdays, detail reasons here, Tracking# Rec'd Date Ready Date Total Pages

    AGENCY USEONLY
    Tracking Information F i n a lC o s t

    Total Deposit B a l a n cD e ue Balance Paid


    Records Provided

    Deposit Date

    In Progress Denied Filled Partial

    Open Closed Closed Closed CustodianSignature

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