Fillable FREEHOLD TOWNSHIP OPEN PUBLIC RECORDS ACT REQUEST FORM (The State of New Jersey)

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FREEHOLD TOWNSHIP OPEN PUBLIC RECORDS ACT REQUEST FORM (The State of New Jersey)

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FREEHOLD TOWNSHIP
1 MUNICIPAL PLAZA
FREEHOLD, NJ 07728
EMAIL: clerk@twp.freehold.nj.us
FAX: 732-462-7910
OPEN PUBLIC RECORDS ACT REQUEST FORM
Requestor’s Name:
____________________________________________________________________
Requestor’s Address: _____________________________________________________________________
Requestor’s E-Mail:
_____________________________________________________________________
Telephone [Cell] ( ) Telephone [Work] ( )___________________
Preferred Delivery: Email____ Fax____ US Mail ____ Pick Up____ On-Site Inspection____
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.
Records on the Specific Property: Address_________________________________ Block_______ Lot_______
Records Requested: (must be specific)
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.
Applicant’s Signature:
____________________________Date:____________________________
Fees:
Letter size pages $0.05 per page, Legal size pages $0.07 per page, and CDs, DVD, etc. are actual cost of material
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Privileged or Protected Category Authority
The document or documents listed below and requested by you are not being provided because
the document or documents are not public records as provided by law, as noted below:
Autopsy Reports N.J.S.A. 47:1A-1.1, et seq.
Child abuse or sex assault victim name or address N.J.S.A. 2A:82-46b
Court records sealed Executive Order 69
Computer security information N.J.S.A. 47:1A-1.1, et seq.
Criminal investigatory records N.J.S.A. 47:1A-1.1, et seq.
Credit Card Numbers N.J.S.A. 47:1A-1.1, et seq.
Grand Jury testimony, information Court Rule 3:6-7
Grievance information with public employer N.J.S.A. 47:1A-1.1, et seq.
Domestic Violence data N.J.S.A. 2C:25-33
Driver’s license numbers N.J.S.A. 47:1A-1.1, et seq.
DYFS information N.J.S.A. 9:6-8.10
Electronic Surveillance Materials N.J.S.A. 2A:156A-19
Emergency or security information or procedures N.J.S.A. 47:1A-1.1, et seq.
Employee sexual harassment complaints N.J.S.A. 47:1A-1.1, et seq.
Fingerprint cards Executive Order 69
Inter-agency or intra-agency advisory communications N.J.S.A. 47:1A-1.1, et seq.
Juvenile records N.J.S.A. 2A:4A-60
Labor Negotiation information, strategy or positions N.J.S.A. 47:1A-1.1, et seq.
Medical Examiner Photographs N.J.S.A. 47:1A-1.1, et seq.
Otherwise inappropriate material Executive Order 69
Pension and personnel records N.J.S.A. 47:1A-1.1, et seq.
Photographs N.J.S.A. 47:1A-1.1, et seq.; Executive Order 69
Pre-Sentence Investigations State v. DeGeorge, 113 NJ Super.542 (App. Div. 1971)
Public Agency insurance communications N.J.S.A. 47:1A-1.1, et seq.
Safety of persons or public N.J.S.A. 47:1A-1.1, et seq.; Executive Order 69
Security measures and surveillance techniques N.J.S.A. 47:1A-1.1, et seq.
Social Security Numbers N.J.S.A. 47:1A-1.1, et seq.
Unlisted Telephone Numbers N.J.S.A. 47:1A-1.1, et seq.
Victim locations (Domestic Violence) N.J.S.A. 2C:25-26c
Victim records N.J.S.A. 47:1A-1.1, et seq.
Record has been destroyed/not retained pursuant to: Records Retention and
Disposition Schedule (NJ Dept. of State, Div. of Archives Mgmt.)
Other
You have a right to appeal the decision that the document or documents are not public records.
You may take your appeal to the Public Records Council or to the New Jersey Superior Court,
as provided by N.J.S.A. 47:1A-6 and 7.
Date___________________ Freehold Twp. Clerk_______________________
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FREEHOLD TOWNSHIP OPEN PUBLIC RECORDS ACT REQUEST FORM (The State of New Jersey)

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Completed 10 July 2021

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