Birth Certificate Request Form Jersey County Clerk

To obtain a certified copy of a birth certificate, you must be one of the following: ? Of legal age (18 or an emancipated minor with certified court documents) if requesting your own. ? The mother or father (if listed on the certificate) of the child whose certificate is being requested. ? A legal guardian with certified court documentation providing verification of guardianship. ? An agent having a notarized letter from any of the above authorizing you access to the record ? A legal representative, i.e. an attorney acting on behalf of the person named on the certificate (must have authorizing documentation) ? An agent authorized by power of attorney that specifically states that the record can be obtained. ? An agent approved by the State Registrar. ? A person with a genealogical interest if the record is over 75 years old.

Please complete and sign this form and provide a copy of your current Photo ID