OPRA REQUEST FORM

 

 

State of New Jersey

 

 

 

BOROUGH OF HOPEWELL

 

 

GOVERNMENT RECORDS REQUEST FORM

 

 

 

 

Important Notice

The reverse side of this form contains important information related to your rights concerning government records. Please read it carefully.

 

 

Requestor Information – Please Print Payment Information
First Name

 

MI

 

Last Name

 

Company

 

Mailing Address

 

City

 

State

 

Zip

 

Email

 

Business Hours Telephone:

Area Code

 

Number

 

Extension

 

Preferred Delivery:

Pick Up

 

US Mail

 

On Site Inspect

 

 

Circle One:  Under penalty of N.J.S.A. 2C:28-3, I certify that I  HAVE  /  HAVE NOT  been convicted of any indictable offense under the laws of New Jersey, any other state, or the United States.
Signature

 

Date

 

                                                         

 

 Maximum Authorization Cost   $

 

 

Select Payment Method

 

Cash

 

Check

 

Money Order

 

 

Fees: 8 1/2 x 11″ @$0.05
  8 1/2 x 14″ @$0.07
     
Delivery: Delivery / postage fees additional depending upon delivery type.
Extras: Extraordinary service fees dependent upon request.
               

 

 
Record Request Information: To expedite the request, be as specific as possible in describing the records being requested.  Also, please include the type of access requested (copying or inspection), and if data, the medium requested.
 

 

AGENCY USE ONLY

 

AGENCY USE ONLY

 

AGENCY USE ONLY
Est. Document Cost    
Est. Delivery Cost    
Est. Extras Cost    
Total Est. Cost    
Deposit Amount    
Estimated Balance    
     
Deposit Date    
     
     

 

 

Disposition Notes

Custodian: If any part of request cannot be delivered in seven business days,
detail reasons here.

 

 

 

   
In Progress

Open  
Denied

Closed  
Filled

Closed  
Partial

Closed  

 

Tracking Information

Final Cost

Tracking #     Total  
Rec’d Date     Deposit  
Ready Date     Balance Due  
Total Pages     Balance Paid  
Records Provided
 
 
 
 

 

 

 

 

 

 

Custodian Signature
 
Date