NEW YORK STATE DEPARTMENT OF HEALTH
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Copy of Marriage Record
|TYPE OF RECORD DESIRED (Check One) |
| | |
|Search and Fee $10.00|Search and Fee $10.00 |
|Certification per |Certification per copy |
|copy | |
| |A Certified Transcript includes all of the items of information |
|A Certification, an abstract from the marriage record issued |occurring on the original record of marriage. |
|under the seal of the Health Department, includes the names of the | |
|contracting parties, their residence at the time of the license was issued |A Certified Transcript may be needed where proof of |
|as well as date and place of birth of the bride and groom. |parentage and certain other detailed information may be |
| |required such as: passports, veteran's benefits, court |
|A Certification may be used as proof that a marriage occurred. |proceedings, or settlement of an estate. |
|PLEASE COMPLETE FORM AND REMIT FEE |
| |
|FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps. |
|There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits. |
| |
|PLEASE PRINT OR TYPE |
|Name (First) (Middle) (Last) |Name (First) (Middle) (Last) |
|of |of |
|Groom |Bride |
|Groom's Age |Bride's Age |
|or Date of |or Date of |
|Birth |Birth |
|Residence (County) (State) |Residence (County) (State) |
|of |of |
|Groom |Bride |
|Date of Marriage |If Bride Previously |
|or Period Covered |Married, State Name |
|by Search |Used at That Time |
|Place Where |Place Where |
|License Was |Marriage Was |
|Issued |Performed |
| |
|For what purpose is this information required? |What is your relationship to person whose record is requested? |
| |If self, state "self" |
|_________________________________________________ |______________________________________________________ |
| | |
|_________________________________________________ |______________________________________________________ |
|In what capacity are you acting? |If attorney: Name and relationship of your client to persons |
| |whose marriage record is required. |
|_________________________________________________ |______________________________________________________ |
| | |
|_________________________________________________ |______________________________________________________ |
| |
|Signature of Applicant |Date |
| | |
| | |
|Address of Applicant |Please print name and address where record is to be sent. |
| | |
| | |
| | |
DOH-301 (3/93) VS-34M
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
Related searches
- new york state department of education
- new york state department of financial services
- new york state department of corporations
- new york state department of the professions
- new york state department of state licensing
- new york state department of professions
- new york state department of education nyc
- new york state department of public service
- new york state department of nursing
- new york state department of professional licensing
- new york state department of health licensure
- new york state department of health nysdoh