Brick Township Public Schools Open Public Records Act Request Form
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2BRICK TOWNSHIP PUBLIC SCHOOLS
OPEN PUBLIC RECORDS ACT REQUEST FORM
101 Hendrickson Avenue, Brick, NJ 08724
732-785-3000 Ext. 1016, Fax: 732-458-3670
Custodian of Records:
James W. Edwards, Jr., CPA
Business Administrator/
Board Secretary
Requestor Information – Please Print
First Name
MI
Last Name
E-mail Address
Mailing Address
City
State
Zip
Telephone
FAX
Pick
On-Site
Preferred Delivery:
Up
US Mail
Inspect
Fax ________ E-mail _________
If you are requesting records containing personal information, please circle 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.
Signature
Date
RECORD REQUEST INFORMATION
Please be as specific as possible in describing the records being requested.
ITEM
APPROVED OR
DENIED/REASON
1.
2.
3.
4.
For Office Use Only
DATES/PAYMENT INORMATION
RECEIVED:
CONTACTED:
FEE FOR PAPER COPIES ($.05 each):
FEE FOR DVDs
($.25 each):
DELIVERY/POSTAGE:
TOTAL:
___________________________________________________
Signature of Custodian of Records
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