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Center for Health Statistics Data Request Form

Name*:
Title:
Organization*:
E-mail Address*:
Phone:**
Fax:
Address:
Subject:
Type your message here*:

Do not fill out this form to request a copy of a vital record (i.e., birth, death, or marriage certificate) or to check on the status of a request .

Please visit the Bureau of Vital Statistics website, e-mail or call 609-292-4087 to request copies of certificates or to check on the status of a certificate request .

* Required fields are marked with an asterisk.
**Occasionally, an e-mail is returned as undeliverable. We will only call you if our reply does not go through to you.


 
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Copyright © State of New Jersey, 1996-2004
Department of Health and Senior Services
P. O. Box 360
Trenton, NJ 08625-0360

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