ZIP
State
{[PNAME]}
Applicant Information
Current Mailing Address (must match address on ID)
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
www.mountainside-nj.com
City
First Name
Email
Middle Name
Last Name
Phone #
Current Mailing Address
  • Instructions
  • Request
  • Birth
  • Marriage, Civil Union, Domestic Partnership
  • Death
  • Submit

A Completed Application for Genealogical or Non-Genealogical Copy of a Vital Record

Valid Identification: 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

Vehicle Registration Card

Vehicle Insurance Card

Voter Registration Card

US/Foreign Passport

Immigrant Visa

Permanent Residence Card (Green Card)

Federal/State ID

School ID

Utility Bill or Bank Statement (within last 90 days)

W-2 for current or the previous tax year

 

If you are requesting a certification, (an informational copy of a vital record not valid for legal purposes) you do not need to provide proof of relationship.

 

If you are looking for a certified copy, proof of relationship is required that establishes you are:

  • The subject of the record
  • The subject’s parent, legal guardian or legal representative
  • The subject's spouse/civil union partner/domestic partner; child, grandchild or sibling, if of legal age
  • A state or federal agency for official purposes
  • Pursuant to court order

To establish proof of relationship for. ....

                                       Your own birth certificate, your valid ID is acceptable; however, if you have assumed your spouse’s or civil union partner’s surname, provide a copy of your marriage or civil union certificate to link the name on your current ID to the name on your birth certificate.

                                       Your child’s birth certificate, if the name on your identification matches the name of the child’s parent then your identification will establish your relationship, If your current name does not match the name as recorded on the birth certificate, as the parent you will need to supply a copy of your marriage or civil union certificate or legal name change.

                                       Your spouse’s/civil union partner's birth record, provide a copy of your marriage/civil union certificate.

                                       Your parent’s or sibling's vital record, provide a copy of YOUR birth certificate with parents’ names.

                                       Your grandparent’s vital record, you must establish that you are the person’s grandchild by linking the name on your ID to the name of the grandparent. For example, if you changed your last name after marriage/civil union and want a grandparent’s vital record, you must: 1.) Provide your marriage/civil union certificate to show your name at birth, 2.) provide your birth certificate to identify your parent, and 3.) provide the parent's birth certificate to identify the grandparent.

 

If you are looking for a certified copy of a record and are...

                                       An executor of an estate, you must supply proof of appointment as the executor.

                                       The legal representative of the executor of an estate, you must supply proof of legal retainer by the executor and proof of the appointment of the individual as the executor.

                                       The legal representative of an individual that is eligible to receive a certified copy of a vital record, you must supply proof of legal retainer by the eligible individual and their proof of relationship.

 

If you are not a person qualified to get a certified copy of a record but......

                                       You are helping person receive a certified copy of a vital record they are eligible to receive......you must show your valid ID and a notarized, written release authorizing you to get the record on that person’s behalf OR, you can supply a written release from the person you are helping along with a copy of that person’s valid photo ID.

                                       In need of a vital record and are not the legal representative of an eligible person, you must obtain a court order directing the State Registrar to issue a certified copy of the record. A subpoena is not sufficient to issue a copy of a vital record.

Application Requirements for Certified Copies
If Other (specify)
Veteran's Benefits
Medicare
Driver's License
Request for
Passport
Social Security Card
Welfare/Disability
Request Details
School/Sports
Reasons for Request (select as many as necessary)
Type of Record
Relationship to Person on Record
Parent B First Name
Name of Child Given at Birth
Last Name
County
Date of Birth
Middle Name
Parent A First Name
City
Last Name
Name of Child's Parents (Name given at birth or on birth certificate/Maiden Name)
State
Middle Name
Describe Change
Last Name
Middle Name
Birth Certificate Details
First Name
# of Copies
Place of Birth
New Name
If the child's name was changed please indicate:
City
Middle Name
Spouse B First Name
County
Last Name
Place of Event
Name of Spouses (Name given at birth or on birth certificate/Maiden Name)
Certificate Details
Date of Event
Last Name
# of Copies
Middle Name
State
Spouse A First Name
County
Middle Name
State
Middle Name
Parent A First Name
First Name
# of Copies
Death Certificate Details
Place of Death
Last Name
Name of Decedent's Parents (Name given at birth or on birth certificate/Maiden Name)
Last Name
Name of Decedent
Last Name
Middle Name
Date of Death
Parent B First Name
City
Type Full Name :
Sign With Hand
By signing, I hereby certify that I am the applicant named above and that I am authorized to request a certified copy of the record for the above-named individual. I understand that penalties are described by law for misrepresentation of this request.
Required Documents
Fee Schedule
The application fee is $15.00 per copy
Certification
Please attach the necessary proofs of identity and relationship, as set out in the instructions.
Application Fee
Applicant Signature