131 N. MAPLE
AVENUE
__________________________________________________________________
FOR MUNICIPAL USE ONLY
Date Received: Date
of Response:_____________________
Name: __________________________________________________________________
Address: __________________________________________________________________
__________________________________________________________________
Telephone (day) _______________________________________________________________
Information Requested:
[____] Copy of
Minutes [specify board or entity, date topic or other
identifying information]
__________________________________________________________________________________
__________________________________________________________________________________
[____] Copy
of Ordinance or Resolution [specify date, number, or other identifying information]
____________________________________________________________________________________________________
____________________________________________________________________________________________________
[____] Police Accident Report Fee: __________________________
Date/Location: ___________________________________________________________________
[____] Other [specify] ___________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
[____] License Information [specify] _________________________________________________________
____________________________________________________________________________________ ____________________________________________________________________________________
Information on a Specific Property Address_________________________________
Block ______________ Lot _____________
[____] Municipal Lien Search Fee: ______10.00
[____] List
of Property Owners with 200’ Fee: ___________
As provided in N.J.S.A. 40:55D-12, the fee is greater of $.25 per name or $10.00
Information
on a specific property, (continued)
Address_________________________________
Block
_______________ Lot________________
Address_________________________________
Block________________
Lot________________
Additional
property information, please attach list
[_____] Water Lien Search
[_____] Deed
[_____] Tax Map: Large [___]
Small [___] Fee:
___________________________
[____] Other [specify] __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
____________________________________________
Relationship
to Subject of Record
___________________________________________________________________________
Reason
for Requesting Certified Record
BIRTH
RECORD
_________________________________________________ _____________________
Full
Name of Child at time of Birth Date
of Birth
________________________________________________ ______________________________
Mother’s
Full Maiden Name Father’s Name
________________________________________________ ______________________
Full
Name of Decedent Date
of Death
________________________________________________ ________________________________
Mother’s Full Maiden Name Father’s Name
_______________________________________________
_________________________________________
Groom’s
Name Bride’s Full Maiden Name
___________________________________ ___________________________________________
Date of Marriage Place
of Marriage
FOR STAFF USE ONLY
I. D. ( IF PASSPORT COUNTRY OF ISSUANCE & #)
A request for access to or for a copy of Government Records should be submitted on this form which has been adopted by the Municipal Clerk as the Custodian of Records. Some records will be immediately available during normal business hours. Some records will require time to compile and to make the copies requested, but will normally be available during business hours and within seven (7) business days. If any document or copy which has been requested is not a public record or cannot be provided within the seven (7) business days, you will be provided with a response with that information within the seven (7) business days. Some records requested have specific fees and other response times established by statute. There is no fee involved in simply inspecting a document during normal business hours. This request may be filed electronically. In general:
· Immediate access is ordinarily available for the budgets, bills, vouchers, contracts, including collective negotiations agreements and individual employment contracts, and public employee salary and overtime information. Minutes of public meetings will be generally available immediately after the minutes have been approved.
· Records which are not readily available or which will require a search of records will be made available as soon as possible and the applicant will be provided with an interim report within seven (7) business days indicating the time which will be required to provide the records.
· 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 to the twentieth page, $0.50 per page; all pages over twenty, $0.25 per page; for a police accident report there is an additional fee when the request is not made in person of $5.00 for the first 3 pages and $1.00 for each additional page, as provided by N.J.S.A. 39:4-131.
· When 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 cost of producing the format requested.
· Where a legal determination must be made as to whether records are “public records” as provided by law, the request will be reviewed by the Municipal Attorney.
The term “ public record” generally includes those records determined to be public in accordance with N.J.S.A. 47:1A-1. The term does not include employee personnel files, police investigation records, public assistance files or other matters in which there is a right of privacy or confidentiality or inter-agency or intra-agency advisory, consultative, or deliberative material or other material which is specifically exempted by law.
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 law of this
State, any other state of the United States and is not seeking government
records containing personal information pertaining the victim or the victim’s
family as provided by N.J.S.A. 47:1A-1 et seq..
This form, when signed by
the municipal official shall constitute a receipt for any deposit required.
The information requested
will be ready on _______________________________
Estimated number of pages _______________________________
Estimated Cost _______________________________
Deposit _______________________________
[required when the anticipated cost of reproduction exceeds $5.00]
_______________________________________ _________________________________________
Applicant Municipal
Official
Date: __________________________________ Date: ____________________________________