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REQUEST FOR RECORDS FORM SOUTHERN REGIONAL MEDICAL EXAMINER'S OFFICE 1175 DeHirsch Avenue Woodbine, NJ 08270 Name of Date of Death: Place or County of Death: Documents Requested: Autopsy/Toxicology:_______ View: Requested by: Provide name and Mailing Address: Relationship to Decedent: Reason for request (if not next of kin): If not next of kin this request must be accompanied by an authorization from next of kin authorizing us to release the records to you. Print and mail to the address given above. You will receive a response via us mail within 7 days after receipt of your request.