change of status - State of New Jersey

You must present the required six (6) points of identification as well as verification of your address. remember that you must confirm your decision e...

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CHANGE OF STATUS ORGAN & TISSUE DONATION

The Uniform Anatomical Gift Act allows a consenting individual to donate his or her organs and tissues upon death for the purpose of transplantation or medical research. You may express your wish to donate your organs and tissues for transplant by designating the words “Organ Donor” to appear on your NJ driver license or nondriver identification card. This designation is for individuals 18 or older (under age 18 requires consent of a parent or guardian). In order to document your decision to register as an organ and tissue donor, fill out (please print) the form below completely and legibly and return it to the address in the bottom. Incomplete or illegible registry applications will not be processed.

Full name Address City State Zip County Phone Date of birth Social Security Driver license # Please note: This is a legally binding document of gift under the New Jersey Uniform Anatomical Gift Act that cannot be revoked by anyone but you. Your family and friends can also make their donor designation online by visiting www.donatelifenj.org.

I hereby donate my organs and tissues for the purposes of transplantation and therapy, to take place upon my death. Signature line

I wish to remove the organ donor designation from my driver record. Signature line

If you would like to have the change in your Organ Donor Status reflected on your NJ Driver License, you must visit a Motor Vehicle Agency and request this change in person. You must present the required six (6) points of identification as well as verification of your address. Remember that you must confirm your decision each and every time you renew your license or non driver ID. Fore more information, visit njmvc.gov or call 888-486-3339. For more information about organ and tissue donation, please contact: New Jersey Organ and Tissue Sharing Network

1-800-ShareNJ Gift of Life Donor Program

1-800-DONORS-1 (1-800-366-6771) Online

visit www.donatelifenj.org where you can register as an organ donor online

 NJ Motor Vehicle Commission PO Box 137 Trenton, NJ 08666