2. For Municipal Use Only
4. Date Request Received
   Date Request Received
5. Date Response Provided
   Date Response Provided
7. See Instructions Below Name
8. Address
10. City
11. State
12. Zip Code
14. Telephone (Day)
15. Information Requested

    1. Police Accident Report
    2. Other
17. Identify Accident*
18. Specify
20. A request for a copy of Government Records should be submitted on this form which ahs been adopted by the Municipal Clerk for requests related to the Police Department Records. Some records will be immediately available during normal business hours. Some records will require time to locate and to make the copies requested, but will normally be available during normal business hours and within 7 business days. If any document or copy which has been requested is not a public record or cannot be provided within the 7 business days, you will be provided with a response with that information within the 7 business days. Some records requested have specific fees or other response times established by statute. There is no fee involved in simply inspecting a document during normal business hours. This request may be filed electronically, In general:
    -Except as otherwise provided by law or regulation, the fee assessed for the duplication of a printed record shall be: 1st page to 10th page, $0.75 per age; 11th page to 20th page, $0.50 per page; all pages over 20, $0.25 per page; for a police accident report there is an additional fee when the request is not made in person of $5 for the first 3 pages and $1 for each additional page, as provided by N.J.S.A. 39:4-131.
    -Where a request is for a copy in a format other than a photocopy, reasonable efforts will be made to provide the information in format requested. The cost will be based on the costs of producing the format requested.
    Where a legal determination must be made as to whether records are "public records" as provided bylaw, the request will be reviewed by the Municipal Attorney.
    -The term "public records" generally includes those records determined to be public in accordance with N.J.S.A. 47: IA-I. The term does not include employee personnel files, police investigation records, or other matters in which there is a right of privacy or confidentiality or which is specifically exempted by law.
    
    The applicant hereby acknowledges receipt of a copy of this form with the date on which the information is expected to be available and the estimated cost. The applicant hereby certifies that he or she has not been convicted of any indictable offense under the laws of this State, any other state or the United States and is not seeking government records containing personal information pertaining the victim or the victims family as provided by N.J.S.A. 47:1A-1 et seq.
    
    This form, when signed by the municipal official shall constitute a receipt for any deposit received.
    A request for a copy of Government Records should be submitted on this form which ahs been adopted by the Municipal Clerk for requests related to the Police Department Records. Some records will be immediately available during normal business hours. Some records will require time to locate and to make the copies requested, but will normally be available during normal business hours and within 7 business days. If any document or copy which has been requested is not a public record or cannot be provided within the 7 business days, you will be provided with a response with that information within the 7 business days. Some records requested have specific fees or other response times established by statute. There is no fee involved in simply inspecting a document during normal business hours. This request may be filed electronically, In general:
    -Except as otherwise provided by law or regulation, the fee assessed for the duplication of a printed record shall be: 1st page to 10th page, $0.75 per age; 11th page to 20th page, $0.50 per page; all pages over 20, $0.25 per page; for a police accident report there is an additional fee when the request is not made in person of $5 for the first 3 pages and $1 for each additional page, as provided by N.J.S.A. 39:4-131.
    -Where a request is for a copy in a format other than a photocopy, reasonable efforts will be made to provide the information in format requested. The cost will be based on the costs of producing the format requested.
    Where a legal determination must be made as to whether records are "public records" as provided bylaw, the request will be reviewed by the Municipal Attorney.
    -The term "public records" generally includes those records determined to be public in accordance with N.J.S.A. 47: IA-I. The term does not include employee personnel files, police investigation records, or other matters in which there is a right of privacy or confidentiality or which is specifically exempted by law.
    
    The applicant hereby acknowledges receipt of a copy of this form with the date on which the information is expected to be available and the estimated cost. The applicant hereby certifies that he or she has not been convicted of any indictable offense under the laws of this State, any other state or the United States and is not seeking government records containing personal information pertaining the victim or the victims family as provided by N.J.S.A. 47:1A-1 et seq.
    
    This form, when signed by the municipal official shall constitute a receipt for any deposit received.
22. Estimated Number of Pages
23. Estimated Cost
24. Deposit
    Required Where the Anticipated Cost of Reproduction Exceeds $5
26. Applicant
27. Municipal Police Official
29. Date
    Date
30. Date
    Date
32. Public Records Request Response
    To
33. 
    Date
    
    Date
35. The documents or documents listed below and requested by you are not being provided because the document or documents are not public records as provided by law, for the following reason:
    You have aright to appeal the decision that the document or documents are not public records. You may take your appeal to the Government Records Council established in the Department of Community Affairs or to the New Jersey Superior Court, as provided by N.J.S.A. 47:1A-1 et seq. If your request has been denied, a statement of the procedures for the appeal will be attached.
37. Det. Lieutenant David Szalkowski, Municipal Police Official
38. Date*
    Date
40. I hereby acknowledge that I have received the documents requested except for any documents specifically listed above on which a determination has not been provided, I have received information on the procedures for any appeal of the determination.
41. Date
    Date
Leave This Blank:


42. Print Only

* indicates a required field