Type Full Name :
Sign With Hand
(Proof is required for certified copy)
Applicant Details
ZIP *
The following individuals are eligible to receive a certified copy as long as proof of relationship is submitted:
Required Documents
Parents, Legal Guardian, Legal representative
360 Elkwood Avenue,
New Providence, NJ 07974
Tel: (908) 665-1400 ext.0 | Fax: (908) 665-9272
www.newprov.org
Tax Return or W-2 for current/previous tax year
Welfare
Power of Attorney if proof is provided (must be power of attorney for individual on vital record)
Utility bill (within the previous 90 days)
People who are homeless can have a social worker or the coordinator of the homeless shelter where they are temporarily residing submit a request on their behalf. The request must be on the agency letterhead and provide the identifying information on the homeless person's vital record. The request must be accompanied by proof of employment by the agency and valid identification. The resulting copy of the vital record will be mailed to the agency.
To Request a Certified Copy of a Birth, Marriage, Civil Union, Domestic Partnership or Death Record
Veteran's Benefits
Vehicle insurance card
IN PERSON
County ID
Social Security Disability
Immigrant visa
IMPORTANT!
Please attach the required documents below by clicking "Select Files...": *
Driver's License
Permanent Resident Card (Green card)
Fill in the appropriate tabs that apply to the documents being requested.
Medicare
Please verify what town the event took place in. Certified copies of vital records are provided by the municipality where the event took place. A certification or certified copy of a vital record is available upon application only with proof of identity.
State *
Present your completed application, valid proofs of identity, and payment of $15.00 for each certified copy requested.
Other SS Benefits
You must provide acceptable ID in order to obtain a copy of any vital record. If you are requesting the copy by mail, the copy will be mailed only to the address listed on your identification.
Grandparents are not eligible to received certified copies of vital records unless authorization is given by the biological parents.
Voter registration
Reason for Request (check all that apply)
Applicant Signature *
Mailing Address Matches ID
Request for Certified Copy of Vital Statistic Record
The fee due is $15.00 per each certified copy requested.
How would you like to receive the Certified Copy of Vital Record?
US or foreign passport
Spouse, Civil Union or Domestic Partner
Child, grandchild, sibling (if of legal age)
Fee Schedule & Certification
City *
Federal/State ID
Borough of
New Providence
By signing below, I certify that all of the information provided in this application is true and accurate.
(Must match address on ID)
All Items on Application
First Name *
Amount Due
b) A current, valid driver’s license without photo AND one alternate form of ID with current address OR
People who are incarcerated can provide legal imprisonment, conviction or release documents that include the name, social security number and all possible aliases used in the past or identification from a prison/probation official.
School/Sports
School ID
Social Security Card
Certified Copies cannot be issued in response to a subpoena, only via a Court Order.
a) A current, valid photo driver's license or photo non-driver's license with current address OR
Email *
Proof of Relationship
Bank statement (within previous 90 days)
Last Name *
Phone # *
Acceptable Forms of ID
Mailing Address *
Passport
Vehicle registration
c) Two alternate forms of ID, one of which must have current address.
Other (please specify)
Relationship to person on record *
Application Checklist: Please make sure all required information are enclosed and completed.
Alternate forms of ID are:
  • Birth
  • Marriage, Civil Union or Domestic Partnership
  • Death
Father's Name (if on record)
County
Exact Date of Birth
How was it changed?
Full Name of Child at the time of Birth
Number of copies
New Name
Mother's Full Maiden Name
If the child's name was changed please indicate:
Place of Birth (City, Town)
Number of copies
Exact Date of Event
Place of Event (City, Town)
County
Spouse A (name given at birth)
Spouse B (name given at birth)
Name of Deceased
Name of Deceased Individual's Father
Place of Death (City,Town)
County
SSN #
Number of copies
Exact Date of Death
Maiden Name of Deceased Individual's Mother