State of New Jersey

Department of the Treasury

Division of Revenue and Enterprise Services

(609) 292-9292

www.nj.gov/treasury/revenue

Regular mail address:

(USPS Express, Priority, Certified)

State of New Jersey

DORES

PO Box 452

Trenton, NJ 08646

Address for Fed Ex, UPS, DHL

State of New Jersey

DORES

33 West State Street, 5th FL

Trenton, NJ 08608

Attn: Notary Unit

Apostille/Certificate of Authentication Request Form

Please print legibly or type. Documents MUST be submitted with original signatures and/or official seals.
Attach your document(s) and check or money order (if applicable) to this form.
Remit to address listed at the top of this form according to mailing method (regular mail OR courier service)

Requestor’s Name/Mailing Address:

Country document(s) will be used in: Number of documents to be Authenticated:

Phone number: Email Address:

(Providing phone number and/or email address does not guarantee that you will be contacted if the form is incomplete, if payment is insufficient for indicated service, or if the documents are not in acceptable form.)

NUMBER OF DOCUMENTS/FEES: (Select only one type of service per request form. Order will be rejected if Regular Service
and Expedited Service are selected on the same form).

Regular service: Avg. processing time;15 business days

No. of documents: X $25= $

Adoption documents: X $25= $

Expedited service: Processing time 8.5 business hours

No. of documents: X $40=$

Adoption documents: X $40=$

FORM OF PAYMENT: (check the box that applies)If paying by credit card, card holder MUST sign below.

Check/money order #:

(Must be drawn on U.S. bank; Made payable to Treasurer-State of New Jersey” “)

Credit/Debit card:

MasterCard Visa American Express Discover

Card number: CCV # Expiration Date:

Name as it appears on card:

Billing Address:

City: State Zip Code:

Payment Authorization: I authorize the State of New Jersey, Department of the Treasury to charge my credit/debit card for the amount due for the authentication services provided by the Department of the Treasury, Division of Revenue and Enterprise Services.

Signature:

Date: