Statement of Information Form [PDF-writable]

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Statement of Information

The Statement of information form is used when an offer to mediate a denial of access complaint has been denied by one or more of the parties, or mediation did not resolve the complaint.

Custodians may seek assistance in completing the Statement of Information from legal counsel; however, the Records Custodian must sign the completed Statement of Information.  This Statement of Information provides you an opportunity to respond to the complaint and to provide the GRC with any information and documents you want the GRC to consider in deciding a denial of access complaint.

In the Statement of Information, please ensure that you provide any legal briefs, a document index using the table format contained on the form, and all documents and information concerning the circumstances surrounding the alleged unlawful denial of access.  The GRC requires that all Statements of Information be signed by the Records Custodian with a legal certification under penalty of perjury consistent with New Jersey Court Rules.  (The legal certification format is provided on the last page of the Statement of Information form.) 

Statements of Information that are incomplete will be returned to records custodians for completion, thus prolonging the adjudication process of the denial of access complaint.  THE GRC WILL ONLY RETURN AN INCOMPLETE STATEMENT OF INFORMATION ONCE TO RECORDS CUSTODIANS.  If a Statement of Information remains incomplete, the GRC will adjudicate the matter based only on information submitted in the Denial of Access Complaint by the requestor of the records.

Please note that all records custodians responding to denial of access complaints must provide a complete document index containing certain information pursuant to the New Jersey Superior Court decision in Paff v. NJ Dep't of Labor, 392 N.J. Super. 334 (App.Div. 2007).  Additionally, this court decision requires records custodians to indicate the details regarding (1) the search undertaken to satisfy the request, (2) the records retention and destruction schedules for the records responsive to the request, as well as (3) the last date on which documents that may have been responsive to the request were destroyed.  Paff, 329 N.J. Super. at 341.

                    Please forward the completed Statement of Information to:  

                   Government Records Council
                   In Care of [Name of Case Manager assigned to complaint]
                   101 South Broad Street
                   PO Box 819
                   Trenton, New Jersey   08625-0819
                   Fax: (609) 633-6337

For additional assistance please contact your assigned Case Manager.