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2. Fees
   • Up to Letter size: 5 cents/page
   • Legal or Larger: 7 cents/page
   • Maps: $1.80/page
   • Delivery: Delivery/postage fees additional depending upon delivery type.

   Extras

   Extraordinary service fees dependent upon request.

4. First Name
5. Middle Initial
6. Last Name
8. Company
10. Mailing Address
12. City
13. State
14. Zip
16. Email Address
17. Business Hours Telephone
19. Preferred Delivery Method
    -- Select One --Pick UpUS MailOnsite InspectionEmail
21. Record Request: To expedite the request be as specific as possible. Also, please include the type of access requested (copying or inspection) and if data the medium requested.
23. Under penalty of N.J.S.A. 2C:28-3, I certify that

    1.  I   HAVE/HAVE NOT   been convicted of any indictable offense under the laws of New Jersey, any other state, or the United States;

    
    

24. HAVE/HAVE NOT*

    1. HAVE
    2. HAVE NOT

26. 2.  I, or another person, WILL/WILL NOT use the requested government records for a commercial purpose;

27. WILL/WILL NOT*

    1. WILL
    2. WILL NOT

29. 3.  I AM/AM NOT seeking records in connection with a legal preceeding.

30. AM/AM NOT*

    1. AM
    2. AM NOT
32. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
34. Electronic Signature
36. Payment Information
38. Maximum Authorization Cost
39. Select Payment Method
    -- Select One --CashCheckMoney Order
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41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field