Records Request Form
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NEW JERSEY JUDICIARY
Records Request Form
SURROGATES’ JUDICIARY RECORDS
See instructions on the reverse side.
PART A: Requestor Information
MIDDLE INITIAL
FIRST NAME
LAST NAME
COMPANY
ADDRESS
CITY
STATE
ZIP
EMAIL
DAYTIME TELEPHONE (INCLUDE AREA CODE)
PREFERRED DELIVERY
US MAIL
PICK UP
ON SITE INSPECT
EXT.
DATE
SIGNATURE
FEES [as provided in N.J.S.A. 22A:2-30]
PART B: Payment Information
Search of Index
$ 10 each search
Copies
$
3 per page
SELECT PAYMENT METHOD
Copies of tape, disks, microfi che
CHECK
CASH
MONEY ORDER
or other non-paper medium
$150 per medium
PART C: Information Requested
INDIVIDUAL CASE INFORMATION
DOCKET / INDEX INFORMATION
DOCKET NUMBER
CASE NAME
DOCUMENTS REQUESTED
LETTERS TESTAMENTARY
LETTERS OF ADMINISTRATION
LETTERS OF GUARDIANSHIP OF A MINOR
RENUNCIATION
LETTERS AD PROSEQUENDAM
APPLICATION
INDEX FROM ________________________________________ TO ________________________________________ (PROVIDE DATES)
OTHER (SPECIFY)
NO
Certifi ed or Exemplifi ed Copies (extra charge)
YES
JUDICIARY USE ONLY
FOR RECORD REQUESTS OVER $50
DEPOSIT DATE
TOTAL EST. COST
DEPOSIT AMOUNT
ESTIMATED BALANCE
RECEIVED BY
DISPOSITION INFORMATION
UNAVAILABLE DATE
DELIVERED DATE
DENIED DATE
If request is denied or records are unavailable, explain here:
Identifi cation provided for physical custody of fi le:
Promulgated 09/25/2007 by Directive #8-07, CN: 10964-English
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