Vermont Secretary Of State - Marriage Checklist Template printable pdf download

Vermont Secretary Of State - Marriage Checklist Template

Completing the

Civil Marriage Certificate

We have prepared these guidelines to assist you in completing the OFFICIANT section of the Vermont

Certificate of Civil Marriage (items 18a-g). On this page, there are step-by-step instructions for filling out

each item. On the back page, there is a checklist. If you have questions or would like additional copies of

these guidelines, contact the Vital Records Unit of the Vermont Department of Health, or any Town Clerk.

Please type or use black ink.

This will increase the chances that readable copies can be made from the certificate for the next 100 years.

OFFICIANT

This license authorizes the marriage IN VERMONT ONLY of the above named parties by any person duly

authorized to perform a marriage.

18b. WHERE MARRIED – CITY OR TOWN

18a. I CERTIFY THAT THE ABOVE PERSONS

WERE MARRIED ON (Month, Day, Year)







18c. SIGNATURE OF PERSON PERFORMING CEREMONY

18d. TITLE









18e. NAME (Type/Print)

18f. TELEPHONE NUMBER





18g. MAILING ADDRESS OF PERSON PERFORMING CEREMONY (Number and Street, City or Town, State, Zip Code)

 



Block 18a –

Type or print the date you perform the marriage ceremony. Be sure the date falls between

the “VALID FROM ____TO___” dates (item 17d of the CERTIFICATION section of the forms). Write out

the name of the month, rather than the number of the month (e.g., July 1, 2000, not 7/1/2000).



Block 18b –

Type or print the city or town where you perform the marriage ceremony. Please indicate

City or Town if applicable.



Block 18c & e –

Sign your name in 18c, and type or print your name in 18e.



Block 18d –

Type or print your title here (e.g., Justice, Minister, Rabbi, Priest).



Block 18f –

Type or print your daytime telephone number.



Block 18g –

Type or print your mailing address here.

Upon completion of the OFFICIANT section, return the certificate to the issuing town clerk (see 17b & c of



the CERTIFICATION section).The law requires that the officiant return the certificate to the clerk within 10

days so the marriage can be legally registered. Do not give the completed certificate to the couple.



Block 18g –

Type or print your mailing address here.

VT Dept. of Health – Vital Records Unit – 108 Cherry Street, PO Box 70, Burlington, VT 05402

863-7275 or 800-439-5008

September 2012

Vermont Secretary Of State - Marriage Checklist Template

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