REG-27a
APR 19
FOR STATE USE ONLY
Payment Type:
Cash
M/O
Check
Waived
Amount: $
ID Viewed
Processed By:
APPLICATION FOR A NON-GENEALOGICAL CERTIFICATION
OR CERTIFIED COPY OF A VITAL RECORD
Certified Copy
Certified Copy for an Apostille Seal
Certification
Requestor’s Relationship to
Person on Record
(proof is required for certified copy)
Requestor’s Signature
Date (of request)
Middle
First
Last
Reasons for Request
Passport
Driver’s License
School / Sports
Veterans’ Benefits
Social Security Card / Benefits
Medicare
Welfare / Disability
Other:
Current Mailing Address
(must match address on ID)
Street
City State Zip Code
Email Address
@ .
BIRTH
Child’s Name at Birth
Last
No. Requested Copies
Date of Birth
Name of Child’s Parents
(name given at birth or on birth certificate / Maiden Name)
Parent A First Middle Last
Parent B First Middle Last
If Child’s name was changed:
New Name Describe Change:
MARRIAGE CIVIL UNION DOMESTIC PARTNERSHIP
No. Requested Copies
Place of Event
City State
County
Date of Event
Name of Spouses
(name given at birth or on birth certificate / Maiden Name)
Spouse A First Middle Last
Spouse B First Middle Last
DEATH
Name of Decedent
First Middle Last
No. Requested Copies
Place of Death
City State
County
Date of Death
Name of Decedent’s Parents
(name given at birth or on birth certificate / Maiden Name)
Parent A First Middle Last
Parent B
First Middle Last
Have you enclosed and completed
all required information?
*Do not send original documents.
Copies only*
Completed Application
Payment
Proof of Relationship
Acceptable Forms of ID
Mailing Address Matches ID
/
/
( ) -
Daytime Phone Number
/
/
/
/
/
/
First Middle
Place of Birth
City State
Name of Requestor
New Jersey Department of Health
Vital Statistics and Registry
P.O. Box 370 - Trenton, NJ 08625-0370
Click here to complete an application online, or visit:
http://www.nj.gov/health/vital/
J1023
New Jersey Department of Health
Vital Statistics and Registry
P.O. Box 370 - Trenton, NJ 08625-0370
Non-Genealogical Records are births occurring within the last 80 years or if the individual is still living, marriages occurring
within the last 50 years, deaths occurring within the last 40 years and all civil union and domestic partnership records.
Certified Copies have the raised seal of the office issuing the record and are always issued on State of New Jersey safety paper.
Certified copies may be used to establish identity and are legal documents.
Certifications are issued on plain paper with no seal and clearly indicate they are not valid for establishing identity or for legal
purposes. Certifications are generally useful for genealogy. Certifications of death records do not contain the Social Security
Number or the Cause of Death medical terminology.
Apostille Seal An Apostille Seal is an additional seal required for certain certified records that will be presented to a foreign
government that is a member of the Hague Treaty. The seal is often required on documents for international adoptions or
establishing dual citizenship. Contact the consulate of the country involved to determine if you need an Apostille Seal.
To get an Apostille Seal, first obtain a certified copy of the vital record from the State Office of Vital Statistics and Registry by
checking the Apostille Seal box on the application. You will receive a certified copy of the vital record issued by the State Office
of Vital Statistics and Registry. You must forward this document to the New Jersey Department of Treasury
, which issues the
Apostille Seal. Additional information is available at: http://www.state.nj.us/treasury/revenue/apostilles.shtml.
Applications for a certification or certified copy of a Non-Genealogical record require the applicant to provide a completed
application, valid proof of identity
1
, payment of the fee
2
and, if requesting a certified copy, proof that establishes you are:
o the subject of the record;
o the subject’s parent, legal guardian or legal representative;
o the subject’s spouse/civil union partner, domestic partner, child, grandchild or sibling, if of legal age;
o a state or federal agency for official purposes; or
o requesting pursuant to a court order.
To request a certified copy of a Certificate of Birth Resulting in Stillbirth, use form REG-68, which is available on the department’s
website at: http://nj.gov/health/vital/registration-vital/stillbirth/.
The State Office of Vital Statistics and Registry accepts walk-in applications at the location shown below. Office hours are 8:30 AM
through 4:00 PM, Monday Friday, excluding State holidays. There is up to a two-hour processing time and you must submit your
application by 3:30 PM to obtain your certified copy the same day.
Amendments to vital record and registrations of adoptions or legitimations are not processed at the walk-in counter. These
requests, along with supporting documentation and fees
3
, must be sent to the attention of the Record Modification Unit at the
application mailing address below.
Mailing Address:
New Jersey Department of Health
Vital Statistics and Registry
PO Box 370
Trenton, NJ 08625-0370
Walk-In Service Only:
Office of Vital Statistics and Registry
140 East Front Street
Trenton, NJ 08608
1
Valid photo driver’s license or photo non-driver’s license with current address OR valid driver’s license without photo and an alternate form of ID with current
address OR two (2) alternate forms of ID, one of which must show the current address. Alternate forms of ID are: vehicle registration, vehicle insurance card,
voter registration, US/foreign passport, permanent resident card (green card), Immigrant Visa, Federal/State ID, county ID, school ID, utility bill (within the
previous 90 days), bank statement (within previous 90 days) or W-2 for current or previous year. Requests for records to be mailed to an address other than that
which appears on the requestor's ID must be accompanied by a notarized letter which includes A) the alternate address, and B) a written request to mail
records to this alternate address.
2
The fee for the search and resulting record is $25; additional copies of the same record ordered at the same time are $2 each. Additional years searched for No
Record of Marriage are $1 per year. Make check or money order payable toTreasurer, State of NJ.” DO NOT MAIL CASH!!!
3
The fee for processing an adoption or legal name change is $2; include an additional $25 fee if you want to obtain a certified copy of the record after processing.
INSTRUCTIONS FOR OBTAINING
A COPY OF NON-GENEALOGICAL VITAL RECORDS
REG
-27
a
APR 19
J1023