THE TOWNSHIP OF GARDEN STATE

999 Main Street

Garden State, New Jersey  08999

(555) 555-5555

 

SEE NOTICE ON REVERSE SIDE

 

Name:     ________________________________________________________________

 

Address: ________________________________________________________________

 

               ________________________________________________________________

 

Telephone: Day: _______________________ Evening: ___________________________

TO BE COMPLETED BY CUSTODIAN:   Date Available:   _____________ _____________                                     _____________ _____________   _____________ _____________   _____________ _____________   _____________   _____________ _____________

 

Date of request: _______________________ Time: ___________                                                                                                 

Information Requested:

 

[__] Minutes [specify date, topic or other identifying information]           

________________________________________________

________________________________________________

            [__] Ordinances or Resolutions [specify identifying  information]

________________________________________________

________________________________________________

[__] Planning Board Records [specify in as much detail as possible]

            ________________________________________________

            ________________________________________________

[__] Zoning Board Records [specify in as much detail as possible]      

            ________________________________________________

            ________________________________________________

[__] Police Report [specify in as much detail as possible]            ________________________________________________

[__] Other [specify in as much detail as possible]            ________________________________________________

            ________________________________________________

The documents listed below are not being provided because, upon review of your request, they have been determined not to be public records, or exempt, for the following reasons: ________________________________________________________________________

________________________________________________________________________________________________________________________________________________

 

You have a right to appeal the decision that the documents are not public records. You may take your appeal to the Government Records Council or to the New Jersey Superior Court in accordance with the procedures contained in N.J.S.A. 47:1A-6.

NOTICE

 

All requests for inspections or copies of Public Records must be submitted on this form. If any document that has been requested is not a public record or cannot be provided within the seven (7) business days, the applicant will be advised within the seven (7) business days. Please note that fees apply for obtaining copies of public records and must be pre-paid, subject to final adjustment at the time the records are picked up. There is no fee involved for simply inspecting a document during normal business hours. In general:

 

• Immediate access is ordinarily available for to budgets, bills, vouchers, contracts, including collective negotiations agreements and individual employment contracts, and public employee salary and overtime information.

 

• If records are not readily available or are in storage or archived, the applicant will be advised within seven (7) business days and will be given a date on which the records will be available. Minutes of public meetings will not be available until after the minutes have been approved.

 

• Records are available at 3:00 p.m. on the Date Available indicated on the reverse side. If requesting records for which there is immediate access, please allow 1-2 hours for processing. If copies are ordered at the time this Request is made, they will be available at the time indicated for inspection. If copies are ordered after inspection, the applicant will be advised when they will be available.

 

• Except as otherwise provided by law or regulation, the fee assessed for the duplication of a printed record shall be: first page to tenth page, $0.75 per page; eleventh page to twentieth page, $0.50 per page; all pages over twenty, $0.25 per page.

 

• Where a request is for a copy in a format other than a photocopy, reasonable efforts will be made to provide the information in the format requested. The cost will be based on the costs of producing the format requested.

 

• When a legal determination must be made as to whether records constitute “public records” as defined by law, the request will be reviewed by the Municipal Attorney.

 

The term “public records” is defined in N.J.S.A. 47:1A-1. The term does not include employee personnel files, investigation records, security information, attorney-client communications, and other matters in which there is a right of privacy or confidentiality or which are specifically exempted by law. Please refer to the Statute for the definition of “public records”, as well as the complete list of exemptions.

 

The Applicant hereby certifies, upon penalty of perjury, that he or she has not been convicted of any indictable offense under the laws of this State, any other state or the United States and is not seeking government records containing personal information regarding the victim or victim’s family, as prohibited by N.J.S.A. 47:1A-1 et seq.

                                                                                                                                                                                                                                                __________________________________

                                                                                     Applicant

 

The Applicant hereby acknowledges receipt of a copy of this form with the date and time on which the records are expected to be available and the estimated cost, if copies have been ordered.

 

Estimated Number of Pages: ________               Copies ordered:  _____Yes          _____No

Estimated Cost: $_________________               Amount Received: $__________________

 

 

_______________________________              __________________________________

Applicant                                                                    For the Custodian

Date: __________________                                             Date: _______________