New Jersey Statutes Title 26. Health and Vital Statistics 26 § 6-22

The emergency burial or removal permit shall be issued in the following form:

“It being impossible to obtain a burial or removal permit from the registrar of vital statistics on account of (state here the reason), I, a judge of the Superior Court (or a judge of a municipal court of the ...... of .....), do hereby grant this emergency permit for the burial or removal of .........., whose death has been duly certified to me.”

The permit shall be dated and signed by the judge and shall be given to the person delivering the certificate of death. The judge shall, within five days thereafter, transmit the certificate to the State registrar. The judge shall be entitled to $1.00 for the issuance of an emergency permit.