New Jersey Department of Health

NOTIFICATION OF MARRIAGE/CIVIL UNION
License Number

Municipality Issued In

County

Date Issued

This form is to be used to notify Registrars of another municipality of the use of a Marriage/Civil Union License issued by them. Section 26:8-42 N. J. Statutes, requires that such notification be forwarded within five (5) days.
Full Name of Spouse A/Partner A (List name given at birth or on birth certificate/Maiden name) (Print or Type)

Full Name of Spouse B/Partner B (List name given at birth or on birth certificate/Maiden name) (Print or Type)

Place of Event (City, Borough or Township)

Date of Event

County of Event

Name of Registrar (Print or Type)

Signature of Registrar

X	Date of Signature

Address of Registrar

REG-25

NOV 16

REG-25, Notification of Marriage/Civil Union

REG-25, REG, notification of marriage, civil union, vital statistics, vital records

ewhite

2016-10-26

NJDOH