TOWNSHIP OF CHESTERFIELD
300 Bordentown-Chesterfield Road
Chesterfield, NJ  08515

REQUEST FOR ACCESS TO GOVERNMENT RECORDS
See Instructions Below

Name:
Address:
Telephone:  (daytime)

INFORMATION REQUESTED:
Copy of meeting minutes (specify board or committee, date of meeting, specific topic or other identifying information)

Copy of Ordinance or Resolution (specify date, number or other identifying information)

Information on Specific Property (specify address, block and lot, and information you are requesting)

Copy of Tax Map Page          Fee:

Municipal Lien Search for Block:       Lot:  
Assessed to:
(As provided in NJSA 54:5-11 et.seq., the fee is $10.00 and the designated search officer has 15 days to provide the information.)

List of Property Owners Within 200 feet of  Block:    Lot: (as provided in NJSA 40:55D-12, the fee is the greater of $.25 per name or $10.00)

Other:

A request for access to or for a copy of Government Records should be submitted on this form which has been adopted by the Municipal Clerk and the Custodian of Records.  Some records will be immediately available during normal business hours.  Some records will require time to compile and to make the copies requested, but will normally be available during normal business hours and within seven (7) business days. If any document or copy which has been requested is not a public record or cannot be provided within the seven (7) business days, you will be provided with a response with that information within the seven (7) business days.  Some record requested have specific fees or other response times established by statue.  There is no fee involved in simply inspecting a document during normal business hours. 

• Immediate access is ordinarily available to budgets, bills, vouchers, contracts, including collective negotiations agreements and individual employment contracts, and public employee salary and overtime information.
• Records which are not readily available or which require a search of records will be available as soon as possible and the applicant will be provided with an interim report within seven (7) business days indicating the time which will be required to provide the records.
• Except as otherwise provided by law or regulation, the fee assessed for the duplication of a printed record shall be: first page to tenth page, $0.75 per page; eleventh page to twentieth page, $0.50 per page; all pages over twenty, $0.25 per page; for a police accident report their is an additional fee when the request is not made in person of $5.00 for the first three (3) pages and $1.00 for each additional page, as provided by N.J.S.A. 39:4-131.
• Where a request is for a copy in a format other than a photocopy, reasonable effort will be made to provide the information in the format requested.  The cost will be based on the costs of producing the format requested.
• Where a legal determination must be made as to whether records are "public records" as provided by law, the request will be reviewed by the Municipal Attorney.

The term "public records" generally includes those records determined to be public in accordance with N.J.S.A. 47:1A-1.  The term does not include employee personnel files, police investigation records, public assistance files or other matters in which there is a right to privacy or confidentiality or inter-agency or intra-agency advisory, consultative or deliberative material or other material which is specifically exempted by law.

The applicant hereby acknowledges receipt of a copy of this form with the date on which the information is expected to be available and the estimated cost.  The applicant hereby certifies that he or she has not been convicted of any indictable offense under the laws of this State, any other State or the United States and is not seeking government records containing personal information pertaining to the victim or the victim's family as provided by N.J.S.A. 47:1A-1 et. seq.. 
This form, when signed by the municipal official, shall constitute a receipt for any deposit received.

This information will be ready on:_____________________________________________________

Estimated Number of Pages:___________________________

Estimated Cost: ________________________________

Amount of Deposit:____________________________ (when the anticipated costs exceed $5.00)