HOW TO OBTAIN A MARRIAGE RECORD ORDER FORM I would like to order a copy of the following marriage record: Husband’s Name: (Please Print clearly) LAST FIRST M. Wife’s Name: (Please Print clearly) LAST (Maiden) FIRST M. Date of Marriage ______________ Type of Marriage Record Requested: ___________________ Duplicate Certificate $10.00Combination of Applicationand Duplicate Certificate $20.00 Reason for Copy of Record: (Social Security Name Change, Etc.) _______________________________________________________________ Enclosed is a money order or personal check payable to:“Clerk of Orphan’s Court” in the amount of $ _________ Please enclose stamped self-addressed envelope. NAME ADDRESS CITY STATE ZIP CODE PHONE: ( ) __________________________ MAIL TO:
I would like to order a copy of the following marriage record:
Husband’s Name: (Please Print clearly)
LAST FIRST M.
Wife’s Name: (Please Print clearly)
LAST (Maiden) FIRST M.
Date of Marriage ______________
Type of Marriage Record Requested: ___________________
Duplicate Certificate $10.00Combination of Applicationand Duplicate Certificate $20.00
Reason for Copy of Record: (Social Security Name Change, Etc.)
_______________________________________________________________
Enclosed is a money order or personal check payable to:“Clerk of Orphan’s Court” in the amount of $ _________
Please enclose stamped self-addressed envelope.
ADDRESS
CITY STATE ZIP CODE
PHONE: ( ) __________________________
MAIL TO:
