Request For Public Records
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Request For Public Records Form. This is a New Jersey form and can be use in Somerset Local County.
Tags: Request For Public Records, New Jersey Local County, Somerset
County of Somerset, New Jersey
Request for Public Records
(please print legibly)
NAME:
ORGANIZATION (if applicable):
MAILING ADDRESS:
CITY/STATE/ZIP:
HOME/BUSINESS PHONE:
REQUEST MADE VIA:
(
(
) Office Visit
) Correspondence
(
(
) Fax
) Electronically
Information Requested:
_____ Copy of Minutes (specifically board or entity, date, topic or other identifying information)
____
Copy of Ordinance or Resolution (specify date, number or other identifying information)
____
Other (specify):
Format Requested:
(Items shaded in gray to be completed by Custodian of Records)
Estimated Number of Pages:
The information request will be ready on or about:
Estimated Cost:
Deposit:
(required where the anticipated cost of reproduction exceeds $20.00)
All payments must be made by cash or money order payable to the Somerset County Treasurer.
The Applicant hereby acknowledges receipt of a copy of this form with the date on which the
information is expected to be available and the estimated cost. The Applicant hereby certifies that he
or she has not been convicted of any indictable offense under the laws of this State or any other State
or the United States and is not seeking government records containing personal information
pertaining to the victim or the victim’s family as provided by P.L. 2001, c. 404.
This completed form, when signed by the Custodian of Records, shall constitute a receipt for the
deposit made by the Applicant.
Applicant
Custodian of Records
Date Request Received
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