Divorce Certificate Mail Order Form - Free Download
4.4,
2948
votes
Please vote for this template if it helps you.
Washington State Department of Health
Marriage / Divorce Certificate Mail Order Form
Complete payment and mailing information below:
Total number of certified certificates:
x $20.00 =
$
First Class Mail (allow 2-3 weeks for delivery)
no additional charge
*USPS Express Mail Delivery (street address or PO Box)
$18.30 =
$
*Fed Ex to continental US (no PO Box)
$15.00 =
$
*Fed Ex to AK/HI/Canada/Mexico (no PO Box)
$25.00 =
$
TOTAL AMOUNT DUE
$
Instructions
• Print clearly.
• We issue certificates for marriages and divorces that took place in Washington State only.
• For marriages and divorces before 1968, contact the local County Auditor for marriage or County Clerk for divorce.
• We only accept checks or money orders for mail orders. Do not send cash or credit card information.
• $20.00 per certificate.
• Visit www.doh.wa.gov for more information and ordering options, or call 360-236-4300, Monday through Friday,
between 8:00 a.m. and 5:00 p.m. Pacific Time.
Contact
Information
Name of person ordering certificate(s):
Company Name (if applicable):
Address sending certificate(s) to:
(Street address required for FedEx Orders)
City:
State:
ZIP Code:
Daytime Phone: (______) ______________________
Email Address:
Complete Person A and Person B information below, to the best of your knowledge. Exact date or county information not required.
Marriage Certificate Request
Number of Certificates Ordering_________
Person
A
Legal Name Before Marriage:
(First) (Middle) (Last)
Birth Last Name (if different): Circle one: Bride, Groom, Spouse
Person
B
Legal Name Before Marriage:
(First) (Middle) (Last)
Birth Last Name (if different): Circle one: Bride, Groom, Spouse
Approximate Date of Marriage or 10-year
Search Range (after January 1, 1968):
Licensing County, if known:
Divorce Certificate Request
Number of Certificates Ordering_________
Spouse
A
Name Listed on Divorce Decree:
(First) (Middle) (Last)
Birth Last Name (if different): Circle one: Wife, Husband, Spouse
Spouse
B
Name Listed on Divorce Decree:
(First) (Middle) (Last)
Birth Last Name (if different): Circle one: Wife, Husband, Spouse
Approximate Date of Divorce or 10-year
Search Range (after January 1, 1968):
Filing County, if known:
Make checks or money orders
payable to DOH.
MAIL ORDERS TO:
Department of Health
PO Box 9709
Olympia WA
98507-9709
*Signature is required at time of delivery for USPS Express Mail and Federal Express Orders.
DOH 422-104 May 2013 *Additional charges for express delivery are per order mailed, not per certificate.
source: foreigncredits.s3.amazonaws.com/
