Type Full Name :
Sign With Hand
(Proof is required for certified copy)
Applicant Details
Zip*
Required Documents*
Welfare
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.
To Request a Certified Copy of a Birth, Marriage, Civil Union, Domestic Partnership or Death Record
Veteran's Benefits
Applications filed by mail will require NOTARIZED copies of valid proofs of identity, a completed application and payment of $25.00 for each certified copy requested. Checks or money orders are to be made payable to "Township of South Orange Village." Please include a self-addressed envelope. Copies will be mailed within 24-48 hours from the date of the request.
IN PERSON
How would you like to receive the record?
Social Security Disability
IMPORTANT!
Application for a Non-Genealogical Certification or Certified Copy of a Vital Record
Driver's License
BY MAIL
Fill in the appropriate tabs that apply to the documents requesting.
Click the 'Select Files' button to attach files.
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*
Your Town
Present your completed application, valid proofs of identity, and payment of $25.00 for each certified copy requested.
Other SS Benefits
You can attach proof of identity to this application. Proof of identify is:
Reason for Request (check all that apply)
A payment of $25.00 is required for each certified copy
Fee
City*
If available, I prefer the format of the certified copy to be:
www.yourtown.gov
(Must match address on ID)
123 Main Ave
First Name*
(555) 555-5555
b) the subject's parent, legal guardian or legal representative, or
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/tax return for current or previous year.
Your Town, USA 00000
School/Sports
Social Security Card
e) a bank, title or insurance company requesting a copy of a death certificate for official business.
a) Proof that establishes you, the applicant, as the subject of record, or
Email*
* Indicates required field
Last Name*
Phone #*
Applicant Signature
Mailing Address
Passport
c) The subject's spouse/civil union partner, domestic partner; child, grandchild or sibling, if of legal age, or
Other (please specify)
Relationship to person on record
d) Court Order, or
  • 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
Name of Husband / Partner
Maiden Name of Wife / Partner
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