Application for Copy of Public Marriage
License |
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This form may be filled in and mailed
as a Postal Service Request.
A three-part form is required when making an
In-person Request. |
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| PLEASE PRINT |
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Today's Date ________________________
No. of Copies Requested _______________ |
COUNTY
USE
ONLY |
| Cert __________ |
| Reel __________ |
| Image _________ |
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| Groom's Name _____________________________________________________________ |
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| Bride's Maiden or Previously Married Name _______________________________________ |
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| Date of Marriage ___________________ |
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| City Where License was Issued ________________________ |
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| PLEASE PRINT YOUR NAME AND MAILING ADDRESS FOR BOTH
PICK UP AND MAIL ORDERS |
Circle One:
| Pick Up Mail |
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| Your Name ________________________________________ |
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| Address __________________________________________ |
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| City/State & Zip Code _________________ |
RECEIVED _________________ |
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Text only 
Hours and Location