State of New Jersey
Department of Transportation/
Transportation Trust Fund Authority
GOVERNMENT RECORDS REQUEST FORM
The reverse side of this form contains important information related to your rights concerning government records. Please read it carefully.
In addition, please note that you may complete and submit requests electronically on the Internet at
Requester Information – Please Print
I agree to pay for fees related to this
request no greater than
Select Payment Method
Business Hours Telephone:
Letter size pages $0.05 each
Legal size pages $0.07 each
ON SITE INSPECT
(CD,DVD, etc.) –
actual cost of
Check One: Under penalty of N.J.S.A. 2C:28-3, I certify that I _____HAVE / _____HAVE NOT been convicted of
any indictable offense under the laws of New Jersey, any other state, or the United States.
Delivery: Delivery / postage fees
additional depending upon
Extras: Extraordinary service fees
dependent upon request.
Record Request Information: To expedite the request, be as specific as possible in describing the records being requested.
STATE USE ONLY
Estimated Record Cost
or Picked Up
Total Cost Estimated
Approved-Records to be granted
in seven business days
Approved – Records will take
longer than seven business days