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City of Cape May
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GOVERNMENT RECORDS
REQUEST FORM
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Requester
Information – Please Print
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Payment Information
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First Name
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MI
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Last Name
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Company
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Mailing Address
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City
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State
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Zip
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Email
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Telephone:
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Area Code
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Number
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Extension
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Fax
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Area Code
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Number
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Preferred Delivery:
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Pick Up
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US Mail
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On Site Inspect
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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.
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Signature
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Date
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I agree to pay for fees related to this request
no greater than
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$
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Select Payment
Method
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Cash
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Check
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Money Order
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Fees:
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Pages 1-10
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@ $0.75
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Pages 11-20
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@ $0.50
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Pages 21 -
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@ $0.25
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Delivery:
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Delivery / postage fees additional depending upon delivery type.
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Extras:
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Extraordinary service fees dependent upon request.
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Record Request
Information: To
expedite the request, be as specific as possible in describing the records
being requested.
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Request Access to:
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Inspect
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Or Receive a Copy
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CITY USE ONLY
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Estimated
Record Cost
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Special
Cost
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Total
Cost Estimated
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Comments:
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Denied
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Approved-Records
to be granted
in
seven business days
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Approved
– Records will take longer than seven business days
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Tracking Information
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Final Cost
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ID
#
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Total
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Ready
Date
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Deposit
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Date
Mailed or Picked Up
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Balance Due
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Total Pages
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·
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Balance
Paid
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Date
Paid
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Records
Provided
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Custodian Signature
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Date
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