REQUEST FOR MARRIAGE OR DIVORCE SEARCH OF RECORDS - Nevada

[Pages:1]State of Nevada

Division of Public and Behavioral Health Bureau of Preparedness, Assurance, Inspections and Statistics

Office of Vital Records and Statistics 4150 Technology Way, Suite 104 Carson City, Nevada 89706 Telephone (775) 684-4242

REQUEST FOR MARRIAGE OR DIVORCE SEARCH OF RECORDS

X TYPE OF SEARCH (Please check one) MARRIAGE DIVORCE

The fee for a marriage or divorce search is $10.00. The search fee is non-refundable. Make payment payable to: Office of Vital Records. Checks, money orders and credit cards are accepted.

Please include an Authorization for Credit Card Use form and photo ID if paying by credit card.

NAME OF SPOUSE (1):

NAME OF SPOUSE (2): DATE OF EVENT:

Any other information or comments:

Applicant's Printed Name Applicant's Address

FOR OFFICE USE ONLY Receipt number: _________________________

Rev. (05/08/2017)

Applicant's Signature Applicant's Phone Number

Date: ______________________

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