Form REG-1 "Quarterly Report of Domestic Partnerships Registered" - New Jersey

What Is Form REG-1?

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, 2018;
  • 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-1 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-1 "Quarterly Report of Domestic Partnerships Registered" - New Jersey

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New Jersey Department of Health
Office of Vital Statistics and Registry
P. O. Box 370
Trenton, NJ 08625-0370
QUARTERLY REPORT OF DOMESTIC PARTNERSHIPS REGISTERED
NOTICE TO REGISTRAR:
The form below is to be used when forwarding Domestic Partnership Registration Fees to the New Jersey
Department of Health, Office of Vital Statistics and Registry, in accordance with the Domestic Partnership Act.
INSTRUCTIONS:
1.
Fill in your 4-digit Municipality Code.
2.
Enter the Period Ending Date. On the right side of the form, select the appropriate quarterly period to
correspond to the Period Ending Date.
3.
Enter the number of Domestic Partnerships Registered for the quarter.
4.
Multiply the number of Domestic Partnership Registrations from Line 3 by the appropriate fee (currently
$25.00). Enter the total amount due for the quarter.
5
Print the name of your municipality and county.
6.
Sign and date the form.
The reports are to be completed and submitted with your payment on a quarterly basis and must be sent within
the 30-day period following the end of each quarter. If no Domestic Partnerships were registered during the
quarter, indicate “NONE” on Line 3 and fax the form to (609) 341-2007.
Registrar: Please complete all requested information.
REG-1
MAR 18
This report identifies the number of Domestic
1.
Municipality Code ...........................................
Partnership Registrations for the indicated
calendar year (entered into #2 on left):
2 0
/
/
2.
Period Ending Date
October-November-December
July-August-September
3.
No. of Domestic Partnership Registrations .....
April-May-June
X $25.00 =
January-February-March
$
4.
Total Amount Due .............................
Make check for “Total Amount Due” payable to:
“TREASURER, STATE OF NEW JERSEY”
5.
Municipality/County Name:
Mail to:
NJ Department of Health
Office of Vital Statistics and Registry
6.
Signature/Date:
Domestic Partnership Registration Fees
P. O. Box 370
Trenton, NJ 08625-0370
New Jersey Department of Health
Office of Vital Statistics and Registry
P. O. Box 370
Trenton, NJ 08625-0370
QUARTERLY REPORT OF DOMESTIC PARTNERSHIPS REGISTERED
NOTICE TO REGISTRAR:
The form below is to be used when forwarding Domestic Partnership Registration Fees to the New Jersey
Department of Health, Office of Vital Statistics and Registry, in accordance with the Domestic Partnership Act.
INSTRUCTIONS:
1.
Fill in your 4-digit Municipality Code.
2.
Enter the Period Ending Date. On the right side of the form, select the appropriate quarterly period to
correspond to the Period Ending Date.
3.
Enter the number of Domestic Partnerships Registered for the quarter.
4.
Multiply the number of Domestic Partnership Registrations from Line 3 by the appropriate fee (currently
$25.00). Enter the total amount due for the quarter.
5
Print the name of your municipality and county.
6.
Sign and date the form.
The reports are to be completed and submitted with your payment on a quarterly basis and must be sent within
the 30-day period following the end of each quarter. If no Domestic Partnerships were registered during the
quarter, indicate “NONE” on Line 3 and fax the form to (609) 341-2007.
Registrar: Please complete all requested information.
REG-1
MAR 18
This report identifies the number of Domestic
1.
Municipality Code ...........................................
Partnership Registrations for the indicated
calendar year (entered into #2 on left):
2 0
/
/
2.
Period Ending Date
October-November-December
July-August-September
3.
No. of Domestic Partnership Registrations .....
April-May-June
X $25.00 =
January-February-March
$
4.
Total Amount Due .............................
Make check for “Total Amount Due” payable to:
“TREASURER, STATE OF NEW JERSEY”
5.
Municipality/County Name:
Mail to:
NJ Department of Health
Office of Vital Statistics and Registry
6.
Signature/Date:
Domestic Partnership Registration Fees
P. O. Box 370
Trenton, NJ 08625-0370