Burlington OPRA Form

Published on December 2016 | Categories: Documents | Downloads: 48 | Comments: 0 | Views: 262
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Burlington OPRA Form

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CINDY A. CRIVARO
MUNICIPAL CLERK

PATRICIA E. TOCCI
DEPUTY MUNICIPAL CLERK

REQUEST FOR ACCESS TO GOVERNMENT RECORDS

Date of Request: ____________________
1.

Received from: _________________________________________________________
(Name)

______________________________________________________________________
(Address)

2.

Telephone No.: ____________________Home____________________Work

3.

Document / Information Requested: _______________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

For Office Use
Rec’d by:
Date given:
Given by:
Copier Fee:

____________________
____________________
____________________
____________________

Telephone (609)-386-0200 x101 & x102
Fax (609)-733-1051
www.burlingtonNJ.us

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