227 OLD TAPPAN ROAD OLD TAPPAN, NJ 07675 (201) 664-1849, ext. 10 Fax: (201) 664-3543
MARY MONTAGNE, CMR
2010 REQUIREMENTS TO OBTAIN CERTIFIED COPY OF A VITAL RECORD COMPLETE ALL ITEMS ON APPLICATION Enclosed is an application form for a certified copy of a Vital Record. The person completing the form is the APPLICANT. Complete the section for the Vital Record you are requesting. Note the information on the application form MUST match the Vital Record . NO MATCH - NO CERTIFIED COPY. PAYMENT The fee for a vital record is $15.00 per copy. Please make the check payable to the Borough of Old Tappan. ACCEPTABLE FORMS OF ID The Applicant must enclose a copy of their photo driver’s license. The driver’s license must be legible, meaning your name, address and photo must be clear enough for us to read and see. If you do not have a photo driver’s license, send a copy of your non-photo driver’s license and copies of two bills that have your current name and address. PROOF OF RELATIONSHIP Who can obtain a certified copy of a Vital Statistics Record? Subject of record (Birth & Marriage) Grandchildren of subject Surviving spouse (Death) Siblings Current spouse Legal Guardian Subject’s parents Legal Representative Child of subject Court Order MAILING ADDRESS MATCHES ID To receive a certified copy via mail, a self-addressed stamped envelope must be provide.
All requests will be expedited as long as all of the above requirements are met. Submit your request to:
Sincerely, Mary Montagne, Registrar
Borough of Old Tappan 227 Old Tappan Road Old Tappan, N.J. 07675 Attn: Vital Statistics Dept.
227 Old Tappan Road Old Tappan, NJ 07675 (201)664-1849 ext. 10
APPLICATION FOR A CERTIFIED COPY OF A VITAL RECORD
I would like a Certified Copy. Name of Applicant
*
To receive a certified copy via mail, a self-addressed stamped envelope must beReasons provided. for Request:
Relationship to person on record (Proof is required.)
Passport Driver’s License
Current Mailing Address (Must Match address on ID)
City
State
Zip Code
School/Sports Veterans’ Benefits Social Security Card
Daytime Telephone Number
Social Security Disability Other SS Benefits Applicant’s Signature
Date of Application Medicare Welfare Other
No. Requested Copies
Full Name of Child at Time of Birth
Place of Birth ( City, Town)
___________
Exact Date of Birth
County
BIRTH
Child’s Father’s Name (if on record)
Child’s Mother’s Full Maiden Name
If the Child’s Name was Changed, Indicate New Name and How it was Changed:
Name of Husband/ Partner
No. Requested Copies
CIVIL UNION
Maiden Name of Wife/ Partner
Exact Date of Event
DOMESTIC PARTNERSHIP
Place of Event (City, Town)
County
MARRIAGE
Name of Deceased
DEATH
Exact Date of Death
Social Security Number
Place of Event (City/Town)
Maiden Name of Deceased Individual’s Mother
No. Requested Copies
County
Name of Deceased Individual’s Father
Application Check List: Have you enclosed and completed all required information? All Items on Application
Payment
Acceptable Forms of ID
Mailing Address Matches ID
Proof of Relationship
* REG-27 July 2010
*
To receive a certified copy via mail, a self-addressed stamped envelope must be provided.
