Merchantville Police Department
REQUEST FOR PUBLIC RECORDS
1 West Maple Avenue Merchantville NJ 08109
(856) 662-0507 Fax # (856) 662-0896
ALL RECORDS ARE SUBJECT TO OPEN PUBLIC RECORDS ACT- N.J.S.A. 47:1A1
AND MAY NOT BE ABLE TO BE RELEASED
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Person Making Request (Print Full Name) Date of Request
I would like to request a copy of the following reports,
I was the [ ] Victim, [ ] Accused, [ ] Witness in the above listed case, which occurred on
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Date Incident Occurred
(If exact date not known, list month and year)
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Type of Incident (List what the incident was involving)
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Location of Incident (List address / if at a business, list name of business)
TYPE OF REPORTS REQUESTING FEE
[ ] Accident Reports $. 05 Per Page
[ ] Incident Report (Investigation / Calls for Service / Operation) $. 05 Per Page
[ ] Complete Discovery (I’m representing myself) $. 05 Per Page
(SOME REQUESTS MAY TAKE LONGER THAT OTHERS)
(OFFICE STAFF WILL CONTACT YOU VIA PHONE WHEN COMPLETE)
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Person Making Request (Signature) Contact Phone Number
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Address
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Home City / State / Zip
FOR OFFICE USE ONLY
_________________________ [ ] Cash [ ] Check [ ] M/O $_____________ __________________________
Person Receiving Request (Print) Type of Payment Payment Amount Person Completing Request (Print)
