Form REG-62 "Request to Purchase Certified Copy of Vital Records Forms" - New Jersey

What Is Form REG-62?

This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2014;
  • The latest edition provided by the New Jersey Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form REG-62 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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Download Form REG-62 "Request to Purchase Certified Copy of Vital Records Forms" - New Jersey

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New Jersey Department of Health
STATE USE ONLY
Office of Vital Statistics and Registry
Co/Mun Code
PO Box 370
Trenton, NJ 08625-0370
REQUEST TO PURCHASE
CERTIFIED COPY OF VITAL RECORDS FORMS
Please mail this completed form along with your original Purchase Order to the attention
of the State Registrar at the above address. See other important instructions on page 2.
Name of Municipality
County
Date
Ship To Name (Registrar Only)
Bill To (Name and Address)
S
B
H
I
Alternate Ship To Name (Deputy or Alternate Deputy)
I
L
P
L
P
I
Ship To Address
I
N
N
G
G
Telephone Number
Fax Number
Email Address
(
)
(
)
Quantity
Cost Per
Packages
Form Number / Description of Item
Total Cost
Per Pkg.
Package
Requested
*
$31.50
Certified Copy of Vital Record (BLUE)
100
REG-42A
Size: 8-1/2 x 11”
(BLUE)
Revised prices are effective 3/18/14.
500
$73.50
*
$31.50
Certified Copy of Vital Record (BLUE)
100
REG-42B
Size: 8-1/2 x 14”
(BLUE)
Revised prices are effective 3/18/14.
500
$73.50
TOTAL COST FOR FORMS:
*
PLEASE NOTE: Smaller packages of 100 forms are available for purchase by those municipalities which use less than 250
forms annually. Packages of 100 forms may NOT be ordered in combination with packages of 500 (for example, to total
700 forms or 1100 forms).
NJDOH Authorization Signature
Date
FOR STATE
USE ONLY
REG-62
MAR 14
New Jersey Department of Health
STATE USE ONLY
Office of Vital Statistics and Registry
Co/Mun Code
PO Box 370
Trenton, NJ 08625-0370
REQUEST TO PURCHASE
CERTIFIED COPY OF VITAL RECORDS FORMS
Please mail this completed form along with your original Purchase Order to the attention
of the State Registrar at the above address. See other important instructions on page 2.
Name of Municipality
County
Date
Ship To Name (Registrar Only)
Bill To (Name and Address)
S
B
H
I
Alternate Ship To Name (Deputy or Alternate Deputy)
I
L
P
L
P
I
Ship To Address
I
N
N
G
G
Telephone Number
Fax Number
Email Address
(
)
(
)
Quantity
Cost Per
Packages
Form Number / Description of Item
Total Cost
Per Pkg.
Package
Requested
*
$31.50
Certified Copy of Vital Record (BLUE)
100
REG-42A
Size: 8-1/2 x 11”
(BLUE)
Revised prices are effective 3/18/14.
500
$73.50
*
$31.50
Certified Copy of Vital Record (BLUE)
100
REG-42B
Size: 8-1/2 x 14”
(BLUE)
Revised prices are effective 3/18/14.
500
$73.50
TOTAL COST FOR FORMS:
*
PLEASE NOTE: Smaller packages of 100 forms are available for purchase by those municipalities which use less than 250
forms annually. Packages of 100 forms may NOT be ordered in combination with packages of 500 (for example, to total
700 forms or 1100 forms).
NJDOH Authorization Signature
Date
FOR STATE
USE ONLY
REG-62
MAR 14
INSTRUCTIONS FOR COMPLETION
The following instructions are intended to help you complete the order form properly:
Ship To Name/ Alternate Name
Total Cost
Provide the name and telephone number of the
Multiply the cost per package by the number of
Registrar who will be responsible to accept and
packages requested. Add all entries in this column
sign for the forms when they are delivered. The
and enter it at the bottom. This will be the total cost
name of the Deputy or Alternate Deputy Registrar
for your order.
must be provided as a back up, in the event that the
Purchase Orders
Registrar is unavailable to accept delivery of the
The Office of Vital Statistics and Registry MUST
forms.
approve all Purchase Orders, BEFORE they can be
Ship To Address
submitted to R.R. Donnelley.
Provide a physical location address since these
Mail Purchase Orders directly to:
forms are delivered via a courier service, with a
receiving signature required. Do not provide a post
New Jersey Department of Health
office box.
Vital Statistics and Registry-Administration
P. O. Box 370
Bill To (Name and Address)
Trenton, NJ 08625-0370
Provide the name and address of the individual
to whom the bill should be mailed. Please enter
Updated Vendor Information
complete information even if it is the same as the
“Ship To” Address.
R.R. Donnelley
New Contract Number: A86247
Quantity Per Package
Effective Date: 03/18/14
The REG-42A and REG-42B forms are sold in
FEIN: 36-1004130
packages of 500 forms for most municipalities.
Packages of 100 forms are now routinely available
Payment for Processed PO’s
for purchase by those municipalities that use less
You MUST include the Invoice Number on your
than 250 forms annually.
check when you remit payment, or attach a
copy of the Invoice to your check.
If space
IMPORTANT NOTE: Packages of 100 forms MAY
permits, also include the purchase order number,
NOT be ordered in combination with packages of
name of municipality and name of county on your
500 forms (i.e., to total 700 forms or 1100 forms).
check.
Packages Requested
Enter the number of packages requested, NOT the
Send payment directly to R.R. Donnelley, at the
number of forms.
address provided on the Invoice.
           
IMPORTANT!
It is important to promptly remit payment for the forms ordered.
Outstanding balances due may result in future orders being delayed.
R. R. Donnelley can refuse to ship additional forms to any municipality with an
outstanding balance due.
Please direct all questions about the forms to the Office of Vital Statistics and
Registry at 866-649-8726, Ext. 505 or 500.
REG-62 (Instructions)
MAR 14
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