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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
Mailing Address
City State ZIP
Business Hours
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
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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