New Jersey Department of Health

LOG OF VOIDED CERTIFIED COPY FORMS

Municipality

County

Page

Form Number

(Example:

REG-42B)	Sequential Number

of Voided Document	Reason Voided	Date	Initials of Person Voiding Form

REG-66

JUL 12

REG-66 Log of Voided Certified Copy Forms

REG-66, LOG, CERTIFIED COPY FORMS, VS SAFETY PAPER, VITAL STATISTICS, VOID

EWhite

2003-12-08

NJDOH