AFFIDAVIT TO OBTAIN CERTIFIED

COPIES OF MARRIAGE CERTIFICATES

Fee: $10.00 per copy

BY PROVIDING EXACT INFORMATION

NAME of BRIDE: ____________________________________________________________

EXACT NAME OF BRIDE AS RECORDED ON THE MARRIAGE RECORD

NAME OF GROOM: __________________________________________________________

EXACT NAME OF GROOM AS RECORDED ON THE MARRIAGE RECORD

PLACE WHERE MARRIAGE OCCURRED (MUNICIPALITY)

EXACT PLACE WHERE THE MARRIAGE OCCURRED (CITY)

DATE OF MARRIAGE: __________________________________________

EXACT DATE THE MARRIAGE EVENT OCCURRED (MONTH, DAY, YEAR)

NUMBER OF COPIES: _________

PURPOSE FOR WHICH CERTIFICATE IS NEEDED: ____________________________________________________________________________________

YOUR NAME:________________________________________________________________________

PLEASE PRINT

YOUR ADDRESS: ____________________________________________________________________

____________________________________________________________________

CITY STATE ZIP CODE

YOUR TELEPONE NUMBER: (________)_________________

AREA CODE

YOUR RELATIONSHIP TO ABOVE NAMED: ____________________________________

YOUR SIGNATURE:_________________________________________________________

DATE

FOR OFFICE USE ONLY:

IDENTIFICATION PROVIDED ________________________________________________________

(1 REQUIRED IF PHOTO

2 REQUIRED IF NO PHOTO) ________________________________________________________

RECEIPT NUMBER: ___________________CHECK OR CASH: ___________________

CERTIFICATE NUMBER(S) ________________________________________FORM NO.____________

PERSON PREPARING CERTIFIED COPY: _________________________________________