New Jersey Department of Health

Office of Vital Statistics and Registry

P. O. Box 370

Trenton, NJ 08625-0370

REPORT OF NO BIRTHS, MARRIAGES, CIVIL UNIONS,

DOMESTIC PARTNERSHIPS OR FETAL DEATHS

FOR THE MONTH OF
THIS REPORT TO BE SUBMITTED ON THE TENTH (10TH) OF EACH MONTH!

REMEMBER THE TENTH!

This report must be submitted on the tenth of the month when no births, marriages, civil unions, domestic partnerships or fetal deaths occurred in your district during the reported month. This completed report may be emailed to ovsr.reg5@doh.nj.gov or mailed to the Office of Vital Statistics and Registry at the mailing address listed above.

If records were received, then this report need not be sent. It is the duty of the Registrar to make every effort to have all births, marriages, civil unions, domestic partnerships and fetal deaths reported promptly, as required by N.J.S.A. 26:8-4. Violations of this law should be reported immediately to the State Registrar.

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I hereby report that no certificates of birth, marriage, civil union, domestic partnership or fetal death have been received by me for the month indicated and that to the best of my knowledge and belief no births, marriages, civil unions, domestic partnerships or fetal deaths occurred during the month indicated in my registration district.

Name of Local Registrar (Print):
Registration District:
Signature of Registrar:
Date:

REG-5

APR 16

REG-5 Report of No Births, Marriages, Civil Unions, Domestic Partnerships, Fetal Deaths of Deaths

REG-5, Report of No Births, Marriages, civil unions, domestic partnerships, fetal deaths, or deaths, REG, vital statistics, weekly report

Elaine White

2003-03-04

ewhite

NJDOH