BOROUGHOFOLDTAPPAN OPENPUBLICRECORDSACTREQUESTFORM

227OldTappanRoad OldTappan NJ07675 2016641849MainNumber201 6643543Fax wwwoldtappannet

ImportantNotice
Thelastpageofthisformcontainsimportantinformationrelatedtoyourrightsconcerninggovernmentrecords Pleasereaditcarefully

RequestorInformation PleasePrint
FirstName EmailAddress MailingAddress City Telephone PreferredDelivery Pick Up USMail State Zip FAX On Site Inspect MI Last Name

PaymentInformation
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Select PaymentMethod Cash Check Money Order

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If youare requestingrecords containing personalinformation pleasecircleone Underpenalty ofN JSA 2C 28 3 Icertifythat I HAVE HAVENOT beenconvicted ofanyindictable offenseunder thelaws ofNew Jersey anyotherstate or the UnitedStates Signature Date

Actual Costofpaper copies notto exceed Fees 005 LetterSized Pages 007 LegalSized Pages Delivery Delivery postage fees additionaldepending upon deliverytype Extras Specialservicecharge dependentupon request

RecordRequestInformation Pleasebeasspecificaspossibleindescribingthe recordsbeingrequested Also pleasenotethatyour preferredmethodofdeliverywillonlybeaccommodatedifthecustodianhasthetechnologicalmeans andtheintegrityoftherecordswillnot bejeopardizedbysuchmethodofdelivery

AGENCY USEONLY
Est DocumentCost Est Delivery Cost Est ExtrasCost TotalEst Cost DepositAmount Estimated Balance

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DispositionNotes
Custodian Ifanypart ofrequest cannot be delivered insevenbusinessdays detailreasonshere Tracking Recd Date Ready Date TotalPages

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TrackingInformation
Total Deposit BalanceDue BalancePaid Records Provided

FinalCost

DepositDate

InProgress Denied Filled Partial

Open Closed Closed Closed Custodian Signature Date

1 Allgovernmentrecords aresubjecttopublicaccessundertheOpenPublicRecordsAct OPRA unless specifically exempt 2 Arequestforaccesstoagovernmentrecord underOPRAmustbeinwriting hand delivered mailed transmittedelectronically orotherwiseconveyedtotheappropriatecustodian NJSA 471A5g The seven 7 businessdayresponsetimedoesnotcommenceuntiltherecordscustodianreceivestherequest form IfyousubmittherequestformtoanyotherofficeroremployeeoftheBoroughof OldTappan that officeroremployee musteither forwardtherequest totheappropriatecustodian ordirectyou tothe appropriatecustodian NJSA 47 1A5h 3 Requestorsmay submitrequestsanonymously Ifyouelectnottoprovideaname address ortelephone number orothermeansofcontact thecustodianisnotrequiredtorespond untilyoureappear beforethe custodianseekingaresponseto theoriginalrequest 4 Thefeesforduplicationofagovernmentrecordinprintedformarelistedonthefrontofthis form Wewill notifyyouofanyspecialservicecharges orotheradditionalcharges authorizedbyStatelaworregulation beforeprocessing yourrequest Paymentshallbemadebycash checkormoneyorder payabletothe BoroughofOldTappan 5 Youmaybe chargeda50 orotherdepositwhenarequest forcopiesexceeds 25 The Boroughof OldTappan custodianwillcontactyouandadviseyouofanydepositrequirements Youagreetopaythe balancedueupondeliveryoftherecords Anonymousrequestsinexcessof 500require adepositof 100 ofestimatedfees 6 UnderOPRA acustodianmustdenyaccesstoapersonwhohasbeenconvictedofanindictableoffensein NewJersey any otherstate ortheUnitedStates and whoisseekinggovernmentrecordscontaining personalinformationpertainingtothepersons victimorthevictimsfamily Thisincludesanonymous requests forsaidinformation 7 By law theBoroughofOld Tappan mustnotifyyou thatitgrantsordeniesarequest foraccessto governmentrecordswithin seven 7 businessdaysafter theagency custodianofrecordsreceivesthe request Iftherecordrequestedisnotcurrently availableorisinstorage the custodianwilladviseyouwithin seven 7 businessdaysafterreceiptoftherequestwhentherecord canbemadeavailableandthe estimatedcostforreproduction 8 Youmaybedeniedaccessto agovernmentrecord ifyourrequestwould substantiallydisruptagency operations andthe custodianisunableto reachareasonable solutionwithyou 9 IftheBoroughofOldTappan isunabletocomplywithyourrequestforaccesstoagovernmentrecord the custodianwillindicatethereasons fordenialontherequestformorotherwritten correspondence andsend youasignedanddatedcopy 10 Exceptasotherwiseprovided bylaworbyagreementwiththerequester iftheagency custodianof records failstorespondtoyouwithinseven 7 business daysofreceivingarequest thefailuretorespondisa deemeddenialofyour request 11 Ifyourrequestforaccesstoagovernmentrecordhasbeendeniedorunfilledwithintheseven 7 business daysrequired bylaw youhavearighttochallengethedecisionbytheBoroughofOldTappan todeny access Atyouroption youmayeitherinstituteaproceedinginthe SuperiorCourtofNewJerseyorfilea complaintwiththe GovernmentRecordsCouncil GRC bycompletingthe DenialofAccessComplaint Form YoumaycontacttheGRCbytoll freetelephoneat8668500511 bymailatPOBox 819 Trenton NJ 08625 byemailatgrc@dca statenjus orat theirwebsiteat wwwstatenjusgrc TheCouncilcan also answerotherquestionsaboutthelaw AllquestionsregardingcomplaintsfiledinSuperior Courtshouldbe directedtotheCourtClerkinyourCounty 12 Informationprovided onthisform maybe subjectto disclosureunderthe OpenPublicRecordsAct