Transcription of Requestor Information Please Print Payment Information
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Requestor Information Please Print Payment Information
P a g e | 1 PASSAIC VALLEY REGIONAL HIGH SCHOOL DISTRICT NO. 1 OPEN PUBLIC RECORDS ACT request FORM 100 East Main Street Little Falls, NJ 07424 Tel: 973/890-2500; FAX: 973/890-2562 Important Notice The last page 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 E-mail Address Mailing Address City State Zip Telephone FAX Preferred Delivery: Pick Up US Mail On-Site Inspect Fax _____ E-mail _____ If you are requesting records containing personal Information , Please 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.
Record Request Information: Please be as specific as possible in describing the records being requested. Also, please note that your Also, please note that your preferred method of delivery will only be accommodated if the custodian has the technological means and the integrity of the records will not
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