Records Request Form Kearny Municipal Court
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1
2NEW JERSEY JUDICIARY
Records Request Form
KEARNY
MUNICIPAL COURT
See instructions on the reverse side.
PART A: Requestor Information
MIDDLE INITIAL
FIRST NAME
LAST NAME
COMPANY
ADDRESS
CITY
STATE
ZIP
EMAIL
DAYTIME TELEPHONE (INCLUDE AREA CODE)
PREFERRED DELIVERY
PICK UP
US MAIL
ON SITE INSPECT
EXT.
SIGNATURE
DATE
COPY FEES
PART B: Payment Information
Pages 1 - 10
@ $0.5 each
SELECT PAYMENT METHOD
Pages 11 - 20
@ $0.5 each
Page 21 - +
@ $0.5 each
CHECK
MONEY ORDER
CASH
PART C: Information Requested
INDIVIDUAL CASE REQUEST
CASE NUMBER
DEFENDANT NAME
RECORDS REQUESTED
Certified or Exemplified Copies (extra charge)
YES
NO
DISPOSITION
COPY
OTHER _______________
MULTIPLE CASES REQUEST
WHAT RECORDS ARE YOU SEEKING
WHEN DO YOU NEED THE INFORMATION
Certified or Exemplified Copies (extra charge)
YES
NO
JUDICIARY USE ONLY
FOR RECORD REQUESTS OVER $50
TOTAL EST. COST
DEPOSIT AMOUNT
ESTIMATED BALANCE
DEPOSIT DATE
RECEIVED BY
DISPOSITION INFORMATION
DELIVERED DATE
DENIED DATE
UNAVAILABLE DATE
If request is denied or records are unavailable, explain here:
Identification provided for physical custody on file
REVISED 10/2005, CN: 10595-english
SIDE 1 OF 2
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