Department of Child and Family Well-Being Vital Statistics 920 Broad Street, Room 111 Newark, New Jersey 07102 (973) 733-6510
For Birth Certificate Only OMB-1208-102
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Do not apply here unless affidavit occurred in Newark, NJ. Do not request certificate unless you have legal right to it: IDENTIFICATION REQUIRED.
Certified copies are $25.00 for the 1st copy and $4.00 each additional copy of the same record.
Full name of person
Did birth occurr in Newark, NJ?
(If not in Newark, do not apply)
Date of Birth
Full name of father
Full maiden name of mother
Name and address of person requesting certificate
Relationship or authorization
Date of application
DO NOT FILL BELOW THIS LINE
Certificate No. Filing date No. of years searched