DOH Forms
Additional Health Department Forms

Forms for Vital Statistics and Registration


For the General Public (Para el publico en general)
Form # Title PDF/WORD Instruction/ Comments
REG-2 Delegation of Authority to Receive Certified Copy of Vital Record (Birth/Death) pdf 14k
doc 31k
 
REG-3 Delegation of Authority to Receive Certified Copy
(Marriage/Civil Union)
pdf 14k
doc 32k
 
REG-7E Application for a Certified Copy of a "No Record of Marriage" Statement (English/Spanish) pdf 22k
doc 119k
 
REG-20 Authorization for Release of Cause of Death
Autorización para la Emision de Causa de Muerte
(Combined English and español)
pdf 18k
doc 38k
 
REG-27 Application for a Non-Genealogical Certification or Certified Copy of a Vital Record
Aplicación Para Copias Certificadas ó Certificaciones de Registros Civiles No-Ancestro
(Combined English/español)
(Updated January, 2014)
pdf 52k
doc 56k
English Instructions (REG-27A)
pdf 22k
doc 40k

Español Instrucciones (REG-27B)
pdf 22k
doc 46k  
REG-28 Application for a Genealogical Certification or Certified Copy of a Vital Record
Aplicación Para Copias Certificadas ó Certificaciones de Registros Civiles Ancestro
(Combined English/español)
pdf 51k
doc 52k
English Instructions (REG-28A)
pdf 20k
doc 38k

español Insturcciones (REG-28B)
pdf 20k
doc 42k  
REG-31 Consent of Parents or Guardian to Marriage or Civil Union of Minor
Consentimiento Paterno ó de Guardian Legal para Matrimonio o Unión Civil de un Menor
(Combined English/español)
pdf 89k
doc 50k
 
REG-44 Report of Adoption
Registrar una Adopción
pdf 16k
doc 43k
English Instructions

español Instrucciones  
REG-64 Consent for Artificial Insemination
(Updated December, 2014)
pdf 13k
doc 33k
 
REG-68 Request to Place on File a Certificate of Birth Resulting in Stillbirth
Solicitud para Archivar un Registro de Partida de Nacimiento Resultando en Parto Muerto
pdf 14k
doc 36k
Guidelines (Guia), (English/español) (REG-D34)
pdf 31k
doc 37k  
REG-77 Application for Marriage, Remarriage, Civil Union, or Reaffirmation of Civil Union
Aplicación para Licencia: Matrimonio, Unión Civil, Rematrimonio, y Reafirmación de Unión Civil
(Updated August, 2014)
pdf 24k
doc 98k
 
REG-D7 Notice of Rights and Obligations of Domestic Partners pdf 21k
doc 38k
 
REG-D7A Notice of Rights and Obligations of Domestic Partners (Spanish) pdf 25k
doc 43k
 
REG-D30 "Entering into a Marriage or Civil Union in New Jersey" Brochure pdf 14k
doc 31k
 
REG-D30A "Entering into a Marriage or Civil Union in New Jersey" Brochure (español) pdf 24k
doc 47k
 
REG-D30B Entering into a Marriage or Civil Union in New Jersey Brochure (Russian) pdf 157k
doc 39k
 
REG-D30C Entering into a Marriage or Civil Union in New Jersey Brochure (Korean) pdf 118k
doc 47k
 
REG-D33 "Registering a Domestic Partnership in New Jersey" Brochure pdf 15k
doc 30k
 
REG-D33A "Registering a Domestic Partnership in New Jersey" Brochure (español) pdf 23k
doc 47k
 
REG-D33B Registering a Domestic Partnership in New Jersey (Russian) pdf 121k
doc 41k
 
REG-D33C Registering a Domestic Partnership in New Jersey (Korean) pdf 120k
doc 49k
 
REG-D34 Guidelines for Requesting to Place on File a Certificate of Birth Resulting in Stillbirth (English/español) pdf 31k
doc 44k
 

For Professional Partners (Para Socios Profesionales)
Form # Title PDF/WORD Instruction/ Comments
REG-1 Quarterly Report of Domestic Partnerships Registered
(Updated March, 2014)
pdf 14k
doc 39k
 
REG-4 Module 1, Birth Certificate Worksheet, Prenatal Information pdf 23k
doc 69k
 
REG-4 Module 2, Birth Certificate Worksheet, Labor and Delivery pdf 106k
doc 49k
 
REG-4 Module 3, Birth Certificate Worksheet, Newborn Delivery pdf 61k
doc 79k
 
REG-4 Module 4, Birth Certificate Worksheet, Parent Information Module pdf 26k
doc 98k
 
REG-4 Module 5, Birth Certificate Worksheet, Newborn Discharge Module(Legal-Sized Format) pdf 38k
doc 71k
 
REG-4 Module 5, Birth Certificate Worksheet, Newborn Discharge Module (Letter-Sized Format) pdf 40k
doc 90k
 
REG-4 Module 6, Birth Certificate Worksheet, Parent /Guardian Module pdf 19k
doc 44k
 
REG-4 Module 7, Birth Certificate Worksheet, Mother's Discharge Information pdf 72k
doc 37k
 
REG-4A Module 4, Birth Certificate Worksheet, Parent Information Module (Spanish)(Legal-Sized Format) pdf 69k
doc 99k
 
REG-4A Module 4, Birth Certificate Worksheet, Parent Information Module (Spanish)(Letter-Sized Format) pdf 102k
doc 99k
 
REG-5 Report of No Births, Marriages, Civil Unions, Domestic Partnerships, Fetal Deaths or Deaths
(Updated July, 2012)
pdf 17k
doc 26k
 
REG-10 Module 3, Fetal Death Certificate Worksheet, Delivery Module pdf 96k
doc 89k
 
REG-10A Module 4, Fetal Death Certificate Worksheet, Parent Information Module (Spanish) (Legal-Sized Format) pdf 81k
doc 98k
 
REG-10A Module 4, Fetal Death Certificate Worksheet, Parent Information Module (Spanish) (Letter-Sized Format) pdf 87k
doc 100k
 
REG-10 Module 4, Fetal Death Certificate Worksheet, Parent Information Module pdf 30k
doc 97k
 
REG-13 Certified Municipal Registrar Recertification Course Tracking Log
(Updated July, 2012)
pdf 10k
doc 46k
 
REG-24X Template for Electronic Marriage License and Certificate
(Updated 1/24/14)
 
doc 54k
 
REG-25 Notification of Marriage/Civil Union
(Updated October, 2013)
pdf 11k
doc 27k
 
REG-34 Request for Correction to NJ Vital Record of Birth, Death, Fetal Death, Marriage, Civil Union, Domestic Partnership pdf 23k
doc 56k
 
REG-35 Correcting a Birth Record for Child Whose Natural Parents Married After Its Birth pdf 17k
doc 42k
 
REG-37 Application for Non-Genealogical Certification or Certified Copy of a Vital Record (Local Use)
(Updated February, 2014)
pdf 52k
doc 57k
 
REG-38 Application for Genealogical Certification or Certified Copy of a Vital Record (Local Use) pdf 60k
doc 52k
 
REG-42D(1) Birth Template (One Parent)
for use on REG-42A Certified Copy Paper
(Updated April, 2014)
 
doc 28k
 
REG-42D(2) Birth Template (Parent, Parent)
for use on REG-42A Certified Copy Paper
(Updated April, 2014)
 
doc 29k
 
REG-42E Birth Template (No Parent Names)
for use on REG-42A Certified Copy Paper
(Updated April, 2014)
 
doc 28k
 
REG-42F(1) Marriage Template (long form with Parents' Names)
for use on REG-42A Certified Copy Paper
(Updated November, 2013)
 
doc 30k
 
REG-42F(2) Marriage Template (short form without Parents' Names)
for use on REG-42A Certified Copy Paper
(Updated November, 2013)
 
doc 28k
 
REG-42G Death Template
for use on REG-42A Certified Copy Paper
(Updated April, 2014)
 
doc 30k
 
REG-42H Domestic Partnership Template
for use on REG-42A Certified Copy Paper
(Updated April, 2014)
 
doc 29k
 
REG-42I (1) Civil Union Template (without Parent Names)
for use on REG-42A Certified Copy Paper
(Updated April, 2014)
 
doc 27k
 
REG-42I(2) Civil Union Template (with Parent Names)
for use on REG-42A Certified Copy Paper
(Updated April, 2014)
 
doc 31k
 
REG-42J Remarriage Template
for use on REG-42A Certified Copy Paper
(Updated October, 2013)
 
doc 29k
 
REG-42K Reaffirmation of Civil Union Template
for use on REG-42A Certified Copy Paper
(Updated April, 2014)
 
doc 29k
 
REG-45 Request for Legal Name Change to Original Record of Birth, Marriage, Civil Union or Domestic Partnership pdf 29k
doc 42k
 
REG-56 Correcting a Birth Record for Out-of-Wedlock Child Whose Mother Married a Man Other Than the Natural Father pdf 16k
doc 41k
 
REG-60 Correcting the Birth Record of a Child Said to Have Been Born Out-of-Wedlock and Whose Natural Parents Have Not Married Each Other pdf 19k
doc 43k
 
REG-62 Request to Purchase Certified Copy of Vital Records Forms
(Updated March 18, 2014)
pdf 25k
doc 40k
 
REG-66 Log of Voided Certified Copy Forms pdf 10k
doc 57k
 
REG-69 Quarterly Report of Non-EDRS Burial Permits Issued
(Updated March, 2014)
pdf 14k
doc 39k
 
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