New Jersey Consent for Artificial Insemination (REG-64)
Official state formParentage and paternityForm REG-64Free downloadLast verified November 10, 2026
Consent signed by the birth mother and her spouse or civil union partner before the birth. A licensed physician, physician assistant or advanced practice nurse completes Section II. One copy is filed with the Artificial Insemination Processing Unit of Vital Statistics and Registry in Trenton.
Who can use this form
- Section I: the birth mother and her spouse or civil union partner, each 18 or older
- Section II: the licensed physician, physician assistant or advanced practice nurse who supervised the insemination
- The form says the clinician is required by law to file a copy with the Department of Health if a child is conceived
What to send with it
- The form prepared and signed in duplicate
- One copy filed with the Artificial Insemination Processing Unit before the birth of the child
- The consent is valid for one year or until the birth of a live child, whichever comes first
Where to send it
- Mail to
- New Jersey Department of Health Vital Statistics and Registry P. O. Box 370 Trenton, NJ 08625-0370
- State fee
- Not provided
- Typical processing
- Not provided
- Form revision
- JUN 19
- Source
- Official government page