Western Monmouth Utilities Authority

103 Pension Road, Manalapan, NJ 07726

GOVERNMENT RECORDS REQUEST FORM

Requesting Access to Government Records Under the New Jersey Open Public Records Act (N.J.S.A. 47:1A-1 et seq.)

1. This form should only be used to submit records requests to the WESTERN MONMOUTH UTILITIES AUTHORITY ("WMUA").

2. Complete and date this request form and deliver it in person during regular business hours or by mail, fax or electronically to the appropriate custodian of the record requested. Your request is not considered filed until the appropriate custodian of the record requested has received a completed request form. If you submit the request form to any other officer or employee of the"WMUA", that officer or employee may not have the authority to accept your request form on behalf of the "WMUA" and your request will be directed to the appropriate division custodian. The seven business day response time will not commence until the proper custodian reviews the request to determine if it is complete.

3. If you submit a request for access to government records to someone other than the appropriate custodian, do not complete the "WMUA" request form, or attempt to make a request for access by telephone or fax; the Open Public Records Act and its deadlines, restrictions and remedies will not apply to your request.

4. The fees for duplication of a government record in printed form are listed on the front of this form. We will notify you of any special charges, special service charges or other additional charges authorized by State law or regulation before processing your request. Payment shall be made by check or money order payable to the WESTERN MONMOUTH UTILITIES AUTHORITY.

5. If it is necessary for the records custodian to contact you concerning your request, providing identifying information, such as your name, address and telephone number or an e-mail address is required. Where contact is not necessary, anonymous requests are permitted; except that anonymous requests for personal information are not honored.

6. You will be charged a 50% or other deposit when a request for copies exceeds $25. The ''WMUA" custodian will contact you and advise you of any deposit requirements. Anonymous requests, when permitted, require a deposit of 100% of estimated fees. You agree to pay the balance due upon delivery of the records.

7. Under OPRA, a custodian must deny access to a person who has been convicted of an indictable offense in New Jersey, any other state, or the United States, and who is seeking government records containing personal information pertaining to the person's victim or the victim's family.

8. By law, the "WMUA" must notify you that it grants or denies a request for access to government records within seven business days after the custodian of the record requested receives the request, provided that the record is currently available and not in storage. If the record requested is not currently available or is in storage, the custodian will advise you within seven business days when the record can be made available and the estimated cost. You may agree with the custodian to extend the time for making records available, or granting or denying your request.

9. You may be denied access to a government record if your request would substantially disrupt agency operations and the custodian is unable to reach a reasonable solution with you.

10. If the "WMUA" is unable to comply with your request for access to a government record, the custodian will indicate the reasons for denial on the request form and send you a signed and dated copy.

11. Except as otherwise provided by law or by agreement with the requester, if the custodian of the record requested fails to respond to you within seven business days of receiving a request form, the failure to respond will be considered a denial of your request.

12. If your request for access to a government record has been denied or unfilled within the time permitted by law, you have a right to challenge the decision by the "WMUA ,to deny access. At your option, you may either institute a proceeding in the Superior Court of New Jersey or file a complaint in writing with the Government Records Council (GRC). You may contact the GRC by toll-free telephone at 866-850--0511, by mail at PO Box 819, Trenton, NJ, 08625, by e-mail at grc@,dca.state. nj.us, or at their web site at www.nj.gov/grc. The Council can also answer other questions about the law.

13. Information provided on this form may be subject to disclosure under the Open Public Records Act.

Requestor Information --- If filling out form by hand, please print

First Name, Last Name

Company

Mailing Address: (Address Line 1)
(Address Line 2) (City)
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming (State) (Zip Code)

Email address

Confirm Email address*

Business Telephone (include an extension if needed)

Preferred Form of Delivery *
Pick Up
On Site Inspection
US Mail

Choose 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 *
HAVE
HAVE NOT

Electronic Signature Disclosure and Consent Statement

You consent and agree that your use of a key pad, mouse or other device to select an item, button, icon, check box, to enter text, or to perform a similar act/action, while using the Western Monmouth Utilities Website secure forms, for the purpose of accessing or making any transactions regarding any agreement, acknowledgment, consent, terms, disclosures or conditions, constitutes your signature, acceptance and agreement as if actually signed by you in writing.

You further acknowledge and agree that the taking of any such actions by you evidence your intent to sign any such agreement, acknowledgment, consent, terms, disclosures or conditions.

You also agree that no certification authority or other third party verification is necessary to the validity of your electronic signature; and that the lack of such certification or third party verification will not in any way affect the enforceability of your signature or any resulting contract.

I, the applicant for/on this Government Records Request Form, warrant the truthfulness of the information provided in this application. Please type your Legal First and Last Name below.

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree that I have typed my name and checked the box myself. *
Check box to submit your electronic signature

Payment Information:

Maximum Authorization Cost:

Choose 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 *
Cash
Check
Money Order

Fees: Pages 1-10 @$0.75 - Pages 11-20 @$0.50 - Pages 21- @$0.25

Delivery: Delivery/postage fees additional depending upon delivery type

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. Also, please include the type of access requested (copying or inspection), and if data, the medium requested.

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