Records Request Form - Municipal Court
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NEW JERSEY JUDICIARY
Records Request Form
MUNICIPAL COURT
See instructions on the reverse side.
PART A: Requestor Information
FIRST NAME
LAST NAME
MIDDLE INITIAL
COMPANY
ADDRESS
CITY
STATE
ZIP
EMAIL
DAYTIME TELEPHONE (INCLUDE AREA CODE)
PREFERRED DELIVERY
US MAIL
PICK UP
ON SITE INSPECT
EXT.
DATE
SIGNATURE
COPY FEES
PART B: Payment Information
Pages 1 - 10
@ $0.75 each
SELECT PAYMENT METHOD
Pages 11 - 20
@ $0.50 each
Page 21 - +
@ $0.25 each
CHECK
CASH
MONEY ORDER
PART C: Information Requested
INDIVIDUAL CASE REQUEST
CASE NUMBER
DEFENDANT NAME
RECORDS REQUESTED
Certifi ed or Exemplifi ed Copies (extra charge)
NO
YES
COPY
DISPOSITION
OTHER _______________
MULTIPLE CASES REQUEST
WHAT RECORDS ARE YOU SEEKING
WHEN DO YOU NEED THE INFORMATION
NO
Certifi ed or Exemplifi ed Copies (extra charge)
YES
JUDICIARY USE ONLY
FOR RECORD REQUESTS OVER $50
TOTAL EST. COST
DEPOSIT DATE
DEPOSIT AMOUNT
ESTIMATED BALANCE
RECEIVED BY
DISPOSITION INFORMATION
DELIVERED DATE
DENIED DATE
UNAVAILABLE DATE
If request is denied or records are unavailable, explain here:
Identifi cation provided for physical custody of fi le:
REVISED 10/2005, CN: 10595-english
SIDE 1 OF 2
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