Winfield OPRA Request Form

This document outlines a form for requesting public records from the Township of Winfield in New Jersey. It requests contact and payment information from the requestor and details costs for copying and delivering records. The form is used to track requests, costs, and the final disposition of fulfilling or denying the public records request.

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Winfield OPRA Request Form

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The Citizens Campaign

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TOWNSHIP OF WINFIELD OPEN PUBLIC RECORDS ACT REQUEST FORM

12 Gulfstream Avenue Winfield NJ 07036 908-925-3850 fax 908-925-4526 [email protected]

Requestor Information Please Print

First Name E-mail Address Mailing Address City Telephone Preferred Delivery: Pick Up US Mail State Zip FAX On-Site Inspect MI Last Name

Payment Information
Maximum Authorization Cost $

Select Payment Method Cash Fees: Check Money Order

Fax E-mail _

If you are requesting records containing personal information, please 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

Letter size pages - $0.05 per page Legal size pages - $0.07 per page Other materials (CD, DVD, etc) actual cost of material Delivery: Delivery / postage fees additional depending upon delivery type. Extras: Special service charge dependent upon request.

Record Request Information: Please be as 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 method of delivery.

AGENCY USE ONLY

Est. Document Cost Est. Delivery Cost Est. Extras Cost Total Est. Cost Deposit Amount Estimated Balance

AGENCY USE ONLY

Disposition Notes Custodian: If any part of request cannot be delivered in seven business days, detail reasons here. Tracking # Recd Date Ready Date Total Pages

AGENCY USE ONLY

Tracking Information Total Deposit Balance Due Balance Paid Records Provided Final Cost

Deposit Date

In Progress Denied Filled Partial

Open Closed Closed Closed Custodian Signature Date

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Winfield OPRA Request Form

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Winfield OPRA Request Form

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TOWNSHIP OF WINFIELD OPEN PUBLIC RECORDS ACT REQUEST FORM

12 Gulfstream Avenue Winfield NJ 07036 908-925-3850 fax 908-925-4526 [email protected]

Requestor Information Please Print

Select Payment Method Cash Fees: Check Money Order

Fax ________ E-mail _________

AGENCY USE ONLY

AGENCY USE ONLY

AGENCY USE ONLY

In Progress Denied Filled Partial

Open Closed Closed Closed Custodian Signature Date

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Fax E-mail _