Document Text
--- Document: Request for Certified Copies Document ---
REG-37a
SEP 17
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
Passport
Driver’s License
School / Sports
Veterans’ Benefits
Social Security Card / Benefits
Medicare
Welfare / Disability
Other:
Current Mailing Address (must match address on ID)
Street
City
State
Zip Code
Email Address
@
.
BIRTH
Child’s Name at Birth
First
Middle
Last
No. Requested Copies Place of Birth
City
State
County
Date of Birth
Name of Child’s Parents (name given at birth or on birth certificate / Maiden Name)
Parent A First
Middle
Last
Parent B First
Middle
Last
If Child’s name was changed:
New Name
Describe Change
MARRIAGE
CIVIL UNION
DOMESTIC PARTNERSHIP
No. Requested Copies Place of Event
City
State
County
Date of Event
Name of Spouses (name given at birth or on birth certificate / Maiden Name)
Spouse A First
Middle
Last
Spouse B First
Middle
Last
DEATH
Name of Decedent
First
Middle
Last
No. Requested Copies Place of Death
City
State
County
Date of Death
Name of Decedent’s Parents (name given at birth or on birth certificate / Maiden Name)
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
/
/
/
/
/
/
/
/
Daytime Phone Number
( ) -
FOR STATE USE ONLY
Payment Type: Cash M/O Check Waived
Amount: $
ID Viewed
Processed By:
APPLICATION FOR A NON-GENEALOGICAL
CERTIFICATION OR CERTIFIED COPY OF VITAL RECORD
Borough of Bloomingdale Vital Statistics
101 Hamburg Tpke.
Bloomingdale, NJ 07403
973-838-0778 x 241
REG-37a
SEP 17
INSTRUCTIONS FOR OBTAINING
A COPY OF NON-GENEALOGICAL VITAL RECORDS
•
Non-Genealogical Records are births occurring within the last 80 years or if the individual is still living, marriages occurring
within the last 50 years, deaths occurring within the last 40 years and all civil union and domestic partnership records.
•
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.
An Apostille Seal can only be obtained by first requesting certified copy of the vital record from the State Office of Vital
Statistics and Registry. You would then 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.
Applications for a certification or certified copy of a Non-Genealogical record require the applicant to provide a completed
application, valid proof of identity1, payment of the fee and, if requesting a certified copy, proof that establishes you are:
o
the subject of the record;
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.
To request a certified copy of a Certificate of Birth Resulting in Stillbirth, use form REG-68, which is available on the New Jersey
Department of Health website at: http://nj.gov/health/vital/registration-vital/stillbirth/.
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 (2) 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 statement (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.
Borough of Bloomingdale Vital Statistics
101 Hamburg Tpke.
Bloomingdale, NJ 07403
973-838-0778 x 241
Borough of Bloomingdale
Vital Statistics and Registry
101 Hamburg Tpke., Bloomingdale, NJ 07403
Borough of Bloomingdale
Vital Statistics and Registry
101 Hamburg Tpke., Bloomingdale, NJ. 07403
8:00 AM - 4:00 PM
Monday thru Friday
Marriage Lic. .........$28.00
Certified Copies- Marriage,
Death & Birth .........$10.00 ea.
Marriage Cer. performed by
Mayor.....................$100.00