Revised: 11/08/2017, CN: 10200 page 1 New Jersey Judiciary Records Request Form Request Date Preferred Delivery Pick Up US Mail Request Needed By On Site Inspection Fa x Email Part A: Requestor I dentification Last Name First Name Middle Initial Address Daytime Telephone (Include area code) ext. City State Zip Code Fax/E mail (optional) Part B: Re cords Request Processing Location Please select one of the locations below to process your records request. County Appellate Division Clerk222s Office Office of the Administrative Director Division Supreme Court Clerk222s Office Municipal Cour t Superior Court Clerk222s Office Tax Court Clerk222s Office Other Part C: Case Identification Case Name Docket /Complaint/Ticket Number* *In Criminal and Municipal Cases, if you do not know the docket number, please provide Defendant222s information: Defendant Name and alias(es), if any Defendant Birth Date Last 4 digits of Defendant222s Social Security Number Indictment/Arrest Date Indictment/Accusation/ Complaint/Municipal Number Appeal Number Sentencing Date Part D: Records Requested by Division Please describe records requested as completely as possible. Include any case numbers, dates and names of individuals involved. Attach additional pages if necessary. Part E: Copy Fees Copy Fees: Special Copy Requests - Additional fees will be charged Are you a named party or attorney in this case? 5242 per page letter size Seal only Certified without Seal 7242 per page legal s ize Certified with Seal Exemplified (includes Seal) Yes No For Judiciary Use Only Disposition Disposition Date Delivered Denied Unavailable If request is denied or record s are unavailable, explain here. Attach additional pages if necessary. For Tax Court Records return this form to: txctrecords.mailbox@njcourts.gov For all other requests return this form to: SCCO.Mailbox@njcourts.gov American LegalNet, Inc. www.FormsWorkFlow.com