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Important Notice The reverse side of this form …

State of New Jersey WANTAGE TOWNSHIP GOVERNMENT RECORDS REQUEST form Important Notice The reverse side of this form contains Important information related to your rights concerning government records. Please read it carefully. Requestor information Please Print Payment information First Name MI Last Name Company Mailing Address City State Zip Email Business Hours Telephone: Area Code Number Extension Preferred Delivery: Pick Up US Mail On Site Inspect E-Mail Circle One: Under penalty of 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 Maximum Authorization Cost $ Select Payment Method Cash Check Money Order Fees: Per Page letter legal Delivery: Delivery / postage fees additional depending upon delivery type.

State of New Jersey WANTAGE TOWNSHIP GOVERNMENT RECORDS REQUEST FORM Important Notice The reverse side of this form contains important information related to your rights concerning government records.

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