Form REG-15 "Application to Amend a New Jersey Vital Record / Application for a Certified Copy of Amended Record" - New Jersey

What Is Form REG-15?

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 February 7, 2019;
  • 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-15 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-15 "Application to Amend a New Jersey Vital Record / Application for a Certified Copy of Amended Record" - New Jersey

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New Jersey Department of Health
Office of Vital Statistics and Registry
INSTRUCTIONS FOR COMPLETING THE REG-15 FORM
(For more information, go to: http://www.nj.gov/health/vital/correcting-vital/.)
PART 1 – APPLICATION TO AMEND A NEW JERSEY VITAL RECORD
To correct information on the parent(s), the parent’s birth
The required copy of documentary proof must be submitted with
the application and must include the full name and date of birth.
certificate or marriage certificate is required as documentary
Examples of proof include:
proof.
 Birth/Marriage/Divorce Record
To correct the sex field due to recording error, documentary
 School Admission Record
proof from a medical provider, or the child’s delivery record is
 Court Order
required.
 Certificate of Naturalization/ Petition of Name Change
 Baptismal Record
NOTE: This application form cannot be used to add a father to
 Hospital/Medical Record
a birth record. The Certificate of Parentage form must be used.
 Child Immunization Record
DEATH RECORD AMENDMENTS:
NOTE: A Driver’s License, Social Security card, or a hospital-
Non-Medical Corrections – All other individuals requesting an
issued, decorative birth certificate cannot be used as proof.
amendment must supply documentary proof.
BIRTH RECORDS AMENDMENTS:
Medical Corrections – The authority to amend the date, place of
A parent(s), legal guardian (if the child is under 18 years of age),
death or medical information is restricted to the physician who
or the named individual (if 18 years of age or older) may request
signed the death certificate or the Medical Examiner; except that
to change the birth record, or any other person with the
the funeral director may amend the location of death in the case
supporting document can request changes.
of a home death.
The item(s) of documentary proof must match the asserted
Domestic Status Corrections – Amendments to the domestic
facts. For example, if the affidavit says the name should be
status on the death record, that are not due to a funeral director
Mary Ann Doe, the proof must show the name to be Mary Ann
typographical error will require documentary proof and require
Doe.
the State office to permit the Informant a minimum of 30 days to
provide documentation supporting the information initially
If legal guardian(s) request the change, include certified court
reported before the requested amendment can be accepted.
order proving guardianship.
MARRIAGE / REMARRIAGE / CIVIL UNION /
Individuals born prior to 1/1/1993 must provide a certified court
REAFFIRMATION OF CIVIL UNION / DOMESTIC
order for legal name change amendment.
PARTNERSHIP RECORD AMENDMENTS:
No proof is required to change the first or middle name, if the
Changes to personal facts, such as minor spelling changes in
request is made prior to the child’s 7th birthday. Individuals born
name, date or place of birth, or residence, may be requested by
on 1/1/1993 or later can submit acceptable, verifiable
the person with documentary proof.
documentary proof to amend the surname.
PART 2 – APPLICATION FOR A CERTIFIED COPY OF AMENDED RECORD
1
2
Certified Copies have the raised seal of the office issuing the
identity
, payment of the fee
and proof that establishes you
record and are always issued on State of New Jersey safety
are:
 the subject of the record;
paper. Certified copies may be used to establish identity and
 the subject’s parent, legal guardian or legal
are legal documents.
representative;
Applications for a certified copy of a vital record require the
 the subject’s spouse/civil union partner, domestic
applicant to provide a completed application, valid proof of
partner, child, grandchild or sibling, if of legal age;
 a state or federal agency for official purposes; or
 requesting pursuant to a court order.
1
Valid photo driver’s license or photo non-driver’s license with current address OR valid driver’s license without photo and an alternate form of ID with
current address OR two (2) alternate forms of ID, one of which must show the current address. Alternate forms of ID are: vehicle registration, vehicle
insurance card, voter registration, US/foreign passport, permanent resident card (green card), Immigrant Visa, Federal/State ID, county ID, school ID,
utility bill (within the previous 90 days), bank statement (within previous 90 days) or W -2/tax return for current or previous year.
2
The fee for the search and resulting record is $25; additional copies of the same record ordered at the same time are $2 each. Make check or money
order payable to “Treasurer, State of NJ.” DO NOT MAIL CASH!!!
REG-15 (Instructions)
FEB 19
New Jersey Department of Health
Office of Vital Statistics and Registry
INSTRUCTIONS FOR COMPLETING THE REG-15 FORM
(For more information, go to: http://www.nj.gov/health/vital/correcting-vital/.)
PART 1 – APPLICATION TO AMEND A NEW JERSEY VITAL RECORD
To correct information on the parent(s), the parent’s birth
The required copy of documentary proof must be submitted with
the application and must include the full name and date of birth.
certificate or marriage certificate is required as documentary
Examples of proof include:
proof.
 Birth/Marriage/Divorce Record
To correct the sex field due to recording error, documentary
 School Admission Record
proof from a medical provider, or the child’s delivery record is
 Court Order
required.
 Certificate of Naturalization/ Petition of Name Change
 Baptismal Record
NOTE: This application form cannot be used to add a father to
 Hospital/Medical Record
a birth record. The Certificate of Parentage form must be used.
 Child Immunization Record
DEATH RECORD AMENDMENTS:
NOTE: A Driver’s License, Social Security card, or a hospital-
Non-Medical Corrections – All other individuals requesting an
issued, decorative birth certificate cannot be used as proof.
amendment must supply documentary proof.
BIRTH RECORDS AMENDMENTS:
Medical Corrections – The authority to amend the date, place of
A parent(s), legal guardian (if the child is under 18 years of age),
death or medical information is restricted to the physician who
or the named individual (if 18 years of age or older) may request
signed the death certificate or the Medical Examiner; except that
to change the birth record, or any other person with the
the funeral director may amend the location of death in the case
supporting document can request changes.
of a home death.
The item(s) of documentary proof must match the asserted
Domestic Status Corrections – Amendments to the domestic
facts. For example, if the affidavit says the name should be
status on the death record, that are not due to a funeral director
Mary Ann Doe, the proof must show the name to be Mary Ann
typographical error will require documentary proof and require
Doe.
the State office to permit the Informant a minimum of 30 days to
provide documentation supporting the information initially
If legal guardian(s) request the change, include certified court
reported before the requested amendment can be accepted.
order proving guardianship.
MARRIAGE / REMARRIAGE / CIVIL UNION /
Individuals born prior to 1/1/1993 must provide a certified court
REAFFIRMATION OF CIVIL UNION / DOMESTIC
order for legal name change amendment.
PARTNERSHIP RECORD AMENDMENTS:
No proof is required to change the first or middle name, if the
Changes to personal facts, such as minor spelling changes in
request is made prior to the child’s 7th birthday. Individuals born
name, date or place of birth, or residence, may be requested by
on 1/1/1993 or later can submit acceptable, verifiable
the person with documentary proof.
documentary proof to amend the surname.
PART 2 – APPLICATION FOR A CERTIFIED COPY OF AMENDED RECORD
1
2
Certified Copies have the raised seal of the office issuing the
identity
, payment of the fee
and proof that establishes you
record and are always issued on State of New Jersey safety
are:
 the subject of the record;
paper. Certified copies may be used to establish identity and
 the subject’s parent, legal guardian or legal
are legal documents.
representative;
Applications for a certified copy of a vital record require the
 the subject’s spouse/civil union partner, domestic
applicant to provide a completed application, valid proof of
partner, child, grandchild or sibling, if of legal age;
 a state or federal agency for official purposes; or
 requesting pursuant to a court order.
1
Valid photo driver’s license or photo non-driver’s license with current address OR valid driver’s license without photo and an alternate form of ID with
current address OR two (2) alternate forms of ID, one of which must show the current address. Alternate forms of ID are: vehicle registration, vehicle
insurance card, voter registration, US/foreign passport, permanent resident card (green card), Immigrant Visa, Federal/State ID, county ID, school ID,
utility bill (within the previous 90 days), bank statement (within previous 90 days) or W -2/tax return for current or previous year.
2
The fee for the search and resulting record is $25; additional copies of the same record ordered at the same time are $2 each. Make check or money
order payable to “Treasurer, State of NJ.” DO NOT MAIL CASH!!!
REG-15 (Instructions)
FEB 19
New Jersey Department of Health
FOR STATE USE ONLY
Vital Statistics and Registry
State File Number
Attention: Vital Record Modifications Unit
Applicant ID Number
P.O. Box 370
Trenton, NJ 08625-0370
Instructions: Complete Part 1 in order to make a change or correction to an existing vital record. The processing fee for a Legal Name Change or an
Adoption is $2. Complete Part 2 also if you wish to request a Certified Copy of the amended record. See detailed instructions for completing this form.
PART 1 - APPLICATION TO AMEND A NEW JERSEY VITAL RECORD
INFORMATION ON CURRENT RECORD (Required information must match current information on record)
REQUIRED INFORMATION
1. Record Type
2. Date of Event
Birth
Fetal Death
Remarriage
Reaffirmation of Civil Union
Death
Marriage
Civil Union
Partnership Domestic
3. Full Name on Current Record (First, Middle, Last)
4. Place of Event (City or County)
5. Father/Parent Full Birth Name (Spouse A for Marriage or Dissolution)
6. Mother/Parent Full Birth Name (Spouse B for Marriage or Dissolution)
7. Name of Person Requesting Correction
8. Relationship to Person on Record
Self
Parent(s)
Guardian
Informant
_____________
Funeral Director
Other:
ADDITIONAL INFORMATION
9. Return Mailing Address (Street Address or PO Box, City, State, Zip)
10. Telephone Number
11. Email Address
(
)
12. REQUESTED CHANGES TO RECORD (The record is incorrect or incomplete as listed.)
The record now shows:
The requested change is:
SIGNATURE
13. Signature
15. Comments
14. Date
Processing Fee
Initials
Date
FOR STATE USE ONLY
$____________
Instructions: Complete Part 2 if you wish to request a Certified Copy of the amended record. The fee for a Certified Copy is $25 for the first
copy plus $2 for each additional copy requested. You are required to provide the following items: an acceptable form of identification which
matches the mailing address provided in Part 1 and proof of relationship to the individual named on the record.
PART 2 - APPLICATION FOR A CERTIFIED COPY OF AMENDED RECORD
Number of Certified Copies Requested
Reasons for Request:
__________
Passport
Social Security Disability
Driver’s License
Other SS Benefits
School/Sports
Medicare
Preferred format (if available):
Veterans’ Benefits
Welfare
Computer-Generated copy of original.
Social Security Card
___________
Other
Digital Image/Photocopy of original.
Total Fee
Payment Type
Initials/Date
Type of ID Viewed
Initials/Date
FOR STATE
Check /
MO
$____________
USE ONLY
No.: ____________
Mail completed form to the address provided above, along with a check or money order made payable to “Treasurer, State of NJ.”
REG-15
FEB 19
For questions regarding this form, please email
records@doh.nj.gov
or telephone 609-292-4087.
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