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UTAH DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS AND STATISTICS 288 NORTH 1460 WEST (PHYSICAL ADDRESS) PO BOX 141012 (MAILING ADDRESS) SALT LAKE CITY UT 84114-1012 PHONE (801) 538-6105 • FAX (801) 538-7012 www.health.utah.gov/vitalrecords MARRIAGE/DIVORCE CERTIFICATE REQUEST FORM Certificates Available: Marriages or divorces that occurred in Utah from 1978 - 2010. We carry a limited number of marriage records from 2011-present. All other years are available at the county clerk's office where application was made (marriages) or courthouse where divorces occurred (divorces).
VITAL RECORDS VALIDATION ONLY
WARNING: It is a criminal violation to make false statements on vital records request forms or to fraudulently obtain a vital records certificate. Instructions: 1. An application must be complete for each certificate requested. 2. ID is REQUIRED of the person that signs this request. ID must be either a government issued photo ID, or two other proofs (see list of acceptable identifications on reverse). If request is presented in person, provide ID to clerk. If request is mailed, include a legible COPY of a nonexpired ID. 3. Please check your certificate(s) for accuracy. Your certificate can be replaced within 90 DAYS from the issuance date. After 90 days, you must repay applicable fees. If requestor does not respond to a written request for information within 90 days, Vital Records may retain all monies paid.
IDENTIFYING INFORMATION TYPE OF REQUEST:
MARRIAGE
DIVORCE
SPOUSE 1 NAME (FIRST)
(MIDDLE)
(SURNAME - MAIDEN NAME IF APPLICABLE)
(FIRST)
(MIDDLE)
(SURNAME - MAIDEN NAME IF APPLICABLE)
SPOUSE 2 NAME MARRIAGE INFORMATION (MARRIAGE DATE)
(PLACE OF MARRIAGE)
DIVORCE INFORMATION (IF APPLICABLE)
(DIVORCE DATE)
(PLACE OF DIVORCE)
REQUESTOR RELATIONSHIP:
SELF
PARENT
SIBLING
SPOUSE
CHILD
GRANDPARENT
GRANDCHILD
OTHER (SPECIFY)
PRINTED NAME ADDRESS EMAIL ADDRESS SIGNATURE 1
PHONE #
DATE
NUMBER OF CERTIFICATES REQUESTED SEARCH (NON REFUNDABLE) INCLUDES 1 CERTIFIED COPY ADDITIONAL CERTIFIED COPIES ($10.00 EACH) TOTAL FEE
$ $ $
18.00
+
OFFICE USE ONLY (DO NOT WRITE BELOW)
PAID:
CHECK
CASH
MONEY ORDER WAIT
CLERK'S INITIALS revision 6.21.16
MAIL
CREDIT CARD(IN PERSON ONLY) PICK UP
ID
ID EXP REQUEST #
UTAH DEPARTMENT OF HEALTH OFFICE OF VITAL RECORDS AND STATISTICS 288 NORTH 1460 WEST (PHYSICAL ADDRESS) PO BOX 141012 (MAILING ADDRESS) SALT LAKE CITY UT 84114-1012 PHONE (801) 538-6105 • FAX (801) 538-7012
ONLINE APPLICATION can be found at silver.health.utah.gov Acceptable Identification List to Obtain Vital Records ID MUST BE CURRENT Identification is required for all non-public Vital Records. Mailed requests must include an enlarged and easily identifiable photocopy of your identification from the list below or your application will be returned. If using a form of identification from the “Primary” column, one form of identification is required. If using a form of identification from the “Secondary” column, two forms of identification are required. Primary (Need 1) Government Issued Photo Drivers License Government Issued Photo Identification Government Issued Work Identification Employment Card U.S. Military Identification Card Tribal Identification Card Pilot License Alien Registration Card Permanent Resident Card Temporary Resident Card U.S. Passport Foreign Passport U.S. Certification of Naturalization Certificate of U.S. Citizenship U.S. Citizen Identification Card Matricula Consular Card Concealed Weapon Permit Mexican Voter Registration Card Jail/Prison Release Form (with picture)
Secondary (Need 2) Work Identification/Paycheck/W-2 School, University or College Identification Card Voter Registration Card Social Security Card U.S. Military Separation/DD-214 Motor Vehicle Registration/Title Marriage License (not issued by Utah State Vital Records) Court Order or Court Documents Jail/Prison Documents Probation Documents Property Tax Receipt Veterans Universal Access Identification Card Selective Service Card Hunting/Fishing License Insurance Card or Documents Utility Bill Business License Professional License
We Cannot Accept: Novelty Identification Card Driving Privilege Card
If you cannot provide acceptable identification you may have a spouse, parent, grandparent, sibling, or adult child who can provide appropriate identification request the certificate. Proof of relationship may be required.
