Open Public Records The OPRA Request Form may be submitted to the GCIA as follows: Mail: GCIA- 2 South Broad Street, 2nd Floor, Woodbury, NJ 08096 Fax: 856-384-1262 Email: kbaker@gcianj.com OPEN PUBLIC RECORDS ACT REQUEST FORM Opra Form Name* First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* PhonePreferred Delivery* Pick Up US Mail On-Site Inspection Email if Possible Fee InformationFees: Letter size pages - $0.05 per page Legal size pages - $0.07 per page Other materials (CD, DVD, etc) – actual cost of material Delivery: Delivery/postage fees additional depending upon delivery type. Extras: Special service charge dependent upon request.Fee Information*CashCheckMoney OrderRecords Requested*Please be as specific as possible.Under penalty of N.J.S.A. 2C:28-3, I certify that I HAVE/HAVE NOT (click one) been convicted of any indictable offense under the laws of New Jersey, of any other state, of the United States, and I am not seeking government records containing personal information pertaining to the victim of a crime or the victim's family.Select one to clarify* Yes, I have No, I have not Under penalty of N.J.S.A. 2C:28-3, I certify that, I, or another person, WILL / WILL NOT use the requested government records for a commercial purposeSelect one to clarify* I Will I Will Not Under penalty of N.J.S.A. 2C:28-3, I certify that, I AM / AM NOT seeking records in connection with a legal proceeding.Select one to clarify* I Am I Am Not