*Births occurring over 80 years ago, marriages occurring over 50 years ago and deaths occurring over 40 year ago are considered genealogical and therefore you need only provide the name of the individual recorded on the vital record, the county where the event occurred and the year the event occurred. Multiple years may be searched at a fee of $1.00 per additional year searched.


Updated 10/23/13

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Townhip of millstone

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TOWNHIP OF MILLSTONE

Application for a Certification or a Certified Copy of a Vital Record


A Certification of a vital record event is issued to those individuals with a distant or no relationship to the individual(s) listed on the vital record. It is issued for informational purposes only and cannot be used for legal or identification purposes.
A Certified Copy of a vital record is issued to those individuals who have a direct link to the individual(s) named on the vital record event, provided that the requestor is able to identify the vital record. A Certified Copy will contain the raised seal of the Township of Millstone and can be used for legal or identification purposes.
Please print or type. All items are required unless noted otherwise.* Proof of identity is required.

Make check or money order payable to “Township of Millstone”.

Do not mail cash.


Name of Applicant

Relationship to Person On

Requested Record



Reason for Request

[ ] Passport

[ ] Driver License

[ ] School/Sports

[ ] Social Security Card

[ ] Social Security Disability

[ ] Other Social Security Benefits

[ ] Veterans Benefits

[ ] Medicare

[ ] Welfare

[ ] Genealogy

[ ] Other (Specify)



Street Address

City State Zip Code

Telephone Number

Signature of Applicant

Date of Application

Birth


Full Name of Child at Time of Birth

Number of Copies Requested

Place of Birth (City, Town or Township)

County

Exact Date of Birth

Name of Hospital (Optional)

Mother’s Full Maiden Name

Father’s Name (if recorded on the record)

If Child’s Name Was Changed, Indicate New Name and How It Was Changed

Marriage
Civil Union


Domestic

Partnership


(Circle One)

Name of Husband/Partner Date of Birth

Number of Copies Requested

Maiden Name of Wife/Partner Date of Birth

Exact Date of Marriage

Place of Event (City, Town or Township)

County

Husband/Partner’s Mother’s Full Maiden Name & Fathers Name

Wife/Partner’s Mother’s Full Maiden Name & Fathers Name

Death



Name of Deceased

Exact Date of Death

Number of Copies

Place of Death (City, Town or Township)

County

Mother’s Full Maiden Name

Father’s Name (if recorded on the record)

FOR TOWNSHIP USE ONLY



Payment type:

[ ] Cash [ ] M/O [ ] Check _____ [ ] Waived



Payment Amount:

$_____________



ID Viewed:

Processed By:
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