SOUTH BRUNSWICK TOWNSHIP
PO BOX 190
Monmouth Junction, NJ 08852
Phone: 732-329-4000
Fax: 732-329-9026
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: Pages 1-10 @$0.75 ea.
Pages 11-20 @$0.50 ea.
Pages 21 - @$0.25 ea.
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
Print Form
Reset Form
Requesting Access to Government Records Under the New Jersey Open Public Records Act (N.J.S.A. 47:1A-1 et seq.)
1. This form should only be used to submit records requests to the Township of South Brunswick.
2. Complete and date this request form and deliver it in person during regular business hours or by mail, fax or
electronically to the appropriate custodian of the record requested. Your request is not considered filed until
the appropriate custodian of the record requested has received a completed request form. If you submit the
request form to any other officer or employee of the Township of South Brunswick, that officer or employee
may not have the authority to accept your request form on behalf of the Township of South Brunswick and
your request will be directed to the appropriate division custodian. The seven business day response time will
not commence until the proper custodian reviews the request to determine if it is complete.
3. If you submit a request for access to government records to someone other than the appropriate custodian, do
not complete the Township of South Brunswick request form, or attempt to make a request for access by
telephone or fax; the Open Public Records Act and its deadlines, restrictions and remedies will not apply to
your request.
4. The fees for duplication of a government record in printed form are listed on the front of this form. We will
notify you of any special charges, special service charges or other additional charges authorized by State law
or regulation before processing your request. Payment shall be made by check or money order payable to the
Township of South Brunswick..
5. If it is necessary for the records custodian to contact you concerning your request, providing identifying
information, such as your name, address and telephone number or an e-mail address is required. Where
contact is not necessary, anonymous requests are permitted; except that anonymous requests for personal
information are not honored.
6. You may be charged a 50% or other deposit when a request for copies exceeds $25. The Agency custodian
will contact you and advise you of any deposit requirements. Anonymous requests, when permitted, require a
deposit of 100% of estimated fees. You agree to pay the balance due upon delivery of the records.
7. Under OPRA, a custodian must deny access to a person who has been convicted of an indictable offense in
New Jersey, any other state, or the United States, and who is seeking government records containing personal
information pertaining to the person’s victim or the victim’s family.
8. By law, the Township of South Brunswick must notify you that it grants or denies a request for access to
government records within seven business days after the custodian of the record requested receives the
request, provided that the record is currently available and not in storage. If the record requested is not
currently available or is in storage, the custodian will advise you within seven business days when the record
can be made available and the estimated cost. You may agree with the custodian to extend the time for
making records available, or granting or denying your request.
9. You may be denied access to a government record if your request would substantially disrupt agency
operations and the custodian is unable to reach a reasonable solution with you.
10. If the Township of South Brunswick is unable to comply with your request for access to a government
record, the custodian will indicate the reasons for denial on the request form and send you a signed and dated
copy.
11. Except as otherwise provided by law or by agreement with the requester, if the custodian of the record
requested fails to respond to you within seven business days of receiving a request form, the failure to respond
will be considered a denial of your request.
12. If your request for access to a government record has been denied or unfilled within the time permitted by
law, you have a right to challenge the decision by the Township of South Brunswick to deny access. At
your option, you may either institute a proceeding in the Superior Court of New Jersey or file a complaint in
writing with the Government Records Council (GRC). You may contact the GRC by toll-free telephone at
866-850-0511, by mail at PO Box 819, Trenton, NJ, 08625, by e-mail at grc@dca.state.nj.us, or at their web
site at www.nj.gov/grc. The Council can also answer other questions about the law.
13. Information provided on this form may be subject to disclosure under the Open Public Records Act.
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