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OPEN PUBLIC RECORDS ACT REQUEST FORM

2. <CENTER>BOROUGH OF EDGEWATER<BR> 55 River Road<BR> Edgewater, New Jersey 07020<BR> Phone 201-943-1700 Fax201-943-9242 </CENTER>

   BOROUGH OF EDGEWATER
   55 River Road
   Edgewater, New Jersey 07020
   Phone 201-943-1700 Fax201-943-9242

4. Important Notice: This link contains important information related to your rights concerning government records. Please read it carefully.
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6. First Name*

7. Last Name*

9. Email Address

11. Address*

13. City*

14. State*

15. Zip*

17. Telephone*

18. Fax

20. Prefered Delivery:*

    1. Pick Up
    2. US Mail

    1. On-Site Inspect

    1. Fax

    1. Email

22. If you are requesting records containing personal information, please check of one: Under penalty of N.J.S.A. 2C:28-3 I certify that I

    1. HAVE

    1. HAVE NOT

24. been convicted of any indictable offense under the laws of New Jersey, any other state, or the United States.

26. Signature: ____________________________________________ Date: _______________*

    By submitting this form you have consented to an electronic signature.

28. Record Request Information:*

    Please be 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 means of delivery.

30. Payment Information

    1. Cash

    1. Check

    1. Money Order

    Select a Payment Method
    Fees:
    Letter size packages - $0.05 per page
    Legal size: pages - $0.07 per page
    Other Materials: (CD, DVD, etc) - actual cost
    Delivery: Delivery / postage fees additional depending on delivery type.
    Extras: Special service charge dependent upon request.

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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

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