Request For Death Transcript: Number of copies _______ at $20.00/copy = $ ________ Name Of Deceased: ________________________________________ Date Of Death: ________________________________________ Reason For Obtaining Certificate: ________________________________________ Person Requesting Document: ________________________________________ *Relationship To The Deceased: ________________________________________ Address: ________________________________________ ________________________________________ Phone: ________________________________________

Please submit the following with your request:

• Copy of identification showing your name and address
• Self addressed stamped envelope
• Request fee of $20.00 - Cash or Money Order (made out to Glen Ridge Board of Health) only. No personal checks.

*Anyone other than the spouse of the decedent must provide additional information in order to receive a death transcript. Please call 973-748-8400 ext 221 or 233 for further information.

Please Note:  If you were divorced from the decedent at the time of death, you are not entitled to a death transcript.

Send your request to:
Vital Statistics
PO Box 66
Glen Ridge, New Jersey 07028