Revised: 07/12/2011, CN: 10200 page 1
New Jersey Judiciary
Records Request Form
Request Date Preferred Delivery
Pick Up
US Mail
Request Needed By On Site Inspection
Fax
Email
Part A: Requestor Identification
Last Name Middle Initial First Name
Address Daytime Telephone (Include area code)
ext.
City State Zip Code Fax/Email (optional)
Part B: Records Request Processing Location
Please select one of the locations below to process your records request.
County Appellate Division Clerk’s Office
Office of the Administrative Director
Division Supreme Court Clerk’s Office
Municipal Court
Superior Court Clerk’s Office Tax Court Clerk’s Office
Other
Part C: Case Identification
Case Name Docket/Complaint/Ticket Number*
*In Criminal and Municipal Cases, if you do not know the docket number, please provide Defendant’s information:
Defendant Name and alias(es), if any Defendant Birth Date Last 4 digits of Defendant’s
Social Security Number
Indictment/Arrest Date Indictment/Accusation/
Complaint/Municipal Number
Appeal Number Sentencing Date Name of Sentencing Judge
Part D: Records Requested by Division
Please describe records requested as completely as possible. Include any case numbers, dates and names of individuals involved.
Attach additional pages if necessary.
Part E: Copy Fees
Copy Fees:
Special Copy Requests -
A
dditional fees will be charged
Are you a named party or
attorney in this case?
5¢ per page letter size
Seal only Certified without Seal
7¢ per page legal size Certified with Seal Exemplified (includes Seal) Yes No
For Judiciary Use Only
Disposition
Disposition Date
Delivered Denied Unavailable
If request is denied or records are unavailable, explain here. Attach additional pages if necessary.
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