NJ Government Records Request Form

State of New Jersey
Government Records Request Form

Important Notice
The GRC site contains important information related to your rights to request government records. Please read it carefully. Instructions to complete the form are available.
At this time, not all State agencies are able to accept online requests. If the agency is not listed here, visit the agency web sites for instructions and forms.

Requestor Information for Treasury/Office of Information Technology

Payment Information

First Name	MI	Last Name

Company

Mailing Address

City	State	ZIP
		-
Email

Business Hours
Telephone:

Area Code	Number	Extension
	-

Preferred Delivery:

E-Mail

Pick Up

US Mail

On Site

Select One: Under penalty of N.J.S.A. 2C:28-3, I certify that I Have Not Have been convicted of any indictable offense under the laws of New Jersey, or any other state, or in United States.

Shaded Fields Are Required!

Maximum Authorized Cost
$


Select Payment Method
	Cash
	Check
	Money Order

Fees:	Letter Size	@ $0.05/page
	Legal Size	@ $0.07/page

Electronic Records:	shall be provided free of charge, but agency may charge for cost of media, programming, clerical, supervisory assistance and/or substantial use of information technology.
Delivery:	Delivery / postage fees additional depending upon delivery type.
Additional Charges:	may be charged if extraordinary time/effort required, depending 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, inspection, or examination); and if data, the medium requested.

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