Free Request for Disclosure of Judicial Financial Reporting Statement - New Jersey

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REQUEST FOR DISCLOSURE OF JUDICIAL FINANCIAL REPORTING STATEMENT
I,
(Your name) (Please print)

Request disclosure of the Judicial Financial Reporting Statement(s) for:
(Please print)

Address:
(Please print)

Telephone Number: I would like to review the Judicial Financial Reporting Statement(s) at the Richard J. Hughes Justice Complex, 25 West Market Street, Trenton, NJ, on (date) I would like the Judicial Financial Reporting Statement(s) mailed to me at the address that I have listed above. Signature: Date of Request:

To be completed by the Communications staff:

Pages copied: Fee: SC receipt# Copies provided by:

The Office of Communications receipt

Requester receipt A fee will be charged for copies, as permitted by N.J.S.A. 47:1A-2. Fees are: pages 1-10, $.75 per page; pages 11-20, $.50 per page; pages 21 and over, $.25 per page. The Communications staff will calculate the fee based on the number of pages copied and will notify you of the exact amount due. Copies will be provided upon receipt of payment. Make checks payable to the Clerk of the NJ Supreme Court. No cash or credit cards will be accepted. Please return the completed Request for Disclosure of Judicial Financial Reporting Statement to: The Office of Communications Winnie Comfort, Director To be completed by the Communications staff: P.O. Box 037 Pages copied: Trenton, New Jersey 08625 Fee: SC receipt# 609-292-9580 ­ phone Copies provided by: 609-394-0182 - fax

Revised 03/2004, CN 10461-English

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