Application For Certified Copy Of Marriage Or Divorce Certificate Form January 2001

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STATE OF WYOMING

APPLICATION FOR CERTIFIED COPY OF MARRIAGE OR DIVORCE CERTIFICATE

A request for a certified copy of a marriage or divorce certificate should be submitted on this form along with the fee of $12.00 per copy. A

money order or a personalized check from the person making the request should be made payable to VITAL RECORDS SERVICES. Please

enclose a self-addressed, stamped envelope with the application. Send to:

Vital Records Services

Hathaway Building

Cheyenne, WY 82002

(307)777-7591

If a record is not located, your $12.00 fee will be retained as a searching fee.

Type of record requested: (check one)

Marriage ___ Divorce ___

Enclosed is $ ______________ for ____________ certified copy(ies).

Name of Husband - First

Middle Name

Last Name

Name of Wife - First

Middle Name

Surname at Marriage

Date of occurrence (month, day, year)

Place of Occurrence - City or County

_______________

Signature of husband or wife named on certificate >

Address to which copy is to be mailed:

____________________________________________________

____________________________________________________

____________________________________________________

W.S. 35-1-428 requires Vital Records Services to collect a $5.00 surcharge on all certified copies and searches of files to be deposited in the Wyoming Children's Trust Fund. This surcharge is included

in the fee. The fund is used for the prevention of child abuse and neglect.

1/23/01