REG-38a
MAY 18
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
Name of Requestor
First Middle
Last
Reasons for Request
Genealogy
Dual Citizenship
Estate Matters
Other:
Current Mailing Address
(must match address on ID)
Street
City State Zip Code
Email Address
@ .
Daytime Phone Number
BIRTH (OVER 80 YEARS AGO)
Child’s Name at Birth
First Middle Last
No. Requested Copies
Place of Birth
(optional)
City State
Date of Birth / Years
(to search)
Name of Childs Parents
(name given at birth or on birth certificate / Maiden Name) (optional)
Parent A First Middle Last
Parent B First Middle Last
If Child’s name was changed:
New Name Describe Change
MARRIAGE (OVER 50 YEARS AGO)
No. Requested Copies
Place of Event
(optional)
City State
Event Date / Years
(to search)
Name of Spouses (name given at birth or on birth certificate / Maiden Name)
Spouse A First Middle Last
Spouse B First Middle Last
DEATH (OVER 40 YEARS AGO)
Name of Decedent First Middle Last
No. Requested Copies
Place of Death
(optional)
City State
Date of Death / Years
(to search)
Name of Decedent’s Parents (name given at birth or on birth certificate / Maiden Name) (optional)
Parent A First Middle Last
Parent B First Middle Last
Have you enclosed and completed all
required information?
Completed Application
Payment
Proof of Relationship
Acceptable Forms of ID
Mailing Address Matches ID
/
/
( ) -
FOR STATE USE ONLY
Payment Type: Cash M/O Check Waived
Amount: $
ID Viewed
Processed By:
APPLICATION FOR A GENEALOGICAL CERTIFICATION
OR CERTIFIED COPY OF A VITAL RECORD
Township of Chesterfield
Vital Statistics and Registry
295 Bordentown-Chesterfield Rd
Chesterfield, NJ 08515
Genealogical Records are birth occurring more than 80 years ago (unless the individual is still living), marriages
occurring more than 50 years ago and deaths occurring more than 40 years ago.
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)
MAY 18
INSTRUCTIONS FOR APPLICATION
OBTAINING COPY OF GENEALOGICAL VITAL RECORDS
Applications for a certification or certified copy of a 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’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.
All genealogy applications must be filed by mail and require the applicant to provide copies of the above documents.
NOTE: ALL items not marked as optional are required.
Location Address:
Hours of Operation:
Mailing Address:
Fees:
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 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 state (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.
REG-38a
Township of Chesterfield
Vital Statistics and Registry
295 Bordentown-Chesterfield Rd
Chesterfield, NJ 08515
Township of Chesterfield
Vital Statistics and Registry
295 Bordentown-Chesterfield Rd
Chesterfield, NJ 08515
Township of Chesterfield
Vital Statistics and Registry
295 Bordentown-Chesterfield Rd
Chesterfield, NJ 08515
8:30 AM - 4:00 PM
Monday - Friday
Each Copy..................$10.00