Application For Certified Verification Of A Dissolution Of Marriage printable pdf download

For Office Use Only

COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT

VITAL RECORDS SECTION/HSVRD-VR-A1

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Cash

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4300 Cherry Creek Drive South

ISS

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Denver, Colorado 80246-1530

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303-692-2200

vital.records@state.co.us

Other

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SF#

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Application for Certified Verification of a Dissolution of Marriage

INFORMATION ABOUT PERSONS WHOSE MARRIAGE DISSOLUTION IS REQUESTED -- please type or print

This office has indices for 1851 to 1939 and 1968 to present.

* The verifications for the years (1851-1939) also contain date of marriage and children of marriage

First

Middle

Last

Name of Husband

First

Middle

Last

Name of Wife

County Where Decree Was Issued

Date of Decree*

Today's Date

Purpose for copy

Relationship **see reverse side (Please submit proof of relationship)

Signature of Person Making Request

e-mail address ^

Daytime Phone

(

)

Street Address

City

State

Zip

^ I consent for communications via e-mail

All requests must be accompanied by a photocopy of the requestor's identification before processing. PLEASE RETURN

YOUR REQUEST WITH A PHOTOCOPY OF YOUR DRIVER'S LICENSE, STATE ID OR PASSPORT.

This office will not have a record of the divorce, separation, or annulment if the county did not forward the information for the State Index. Verifications

for the years 1940-1967 are not available from this office and must be obtained from the county where the dissolution was decreed. You may need

to contact each of the counties if you do not know where the decree was granted. District courts are located in the county seat. A list of counties,

county seats, and ZIP codes is provided for your convenience on the reverse side of this form.

Ways to order:

● Apply in person for same day service. Office hours are from 8:30 a.m. to 4:30 p.m., Monday-Friday.

● Order verifications online** at Verification(s) mailed mailed 2-3 days after receipt of all required

documentation.

● Fax your application with credit card information:** within continental USA fax 1-800-423-1108; outside continental USA fax:1-303-691-

9307. Verification(s) mailed in five business days upon receipt of all required documentation.

● Mail in application with check, money order, or credit card information**. Verification(s) mailed within three weeks upon receipt of all

required documentation.

*NOTE: If date is unknown, an additional

fee of $1.00 per year can be submitted.

**Convenience charge to be added. See fees below.

Charges:

(FEES NON-REFUNDABLE)

Search fee where date of dissolution

Make check or money order payable to to Vital Records Section. Please do not send cash.

is unknown....................................

Credit card orders:

$17 for 1st standard copy (or search

Card Type:

VISA

MasterCard

Discove r

American Express

when no record found)..................

Cardholder name:

$10 for each additional copy of same

record ordered at same time...........

Card Number:

Exp. Date:

$10 credit card convenience charge

(walk-ins excluded)........................

PLEASE COMPLETE THIS AREA

a) Regular mail ($0.00)

b) FedEx* (check, money order, cash orders

PRINT name and address of person to whom the verification

ONLY) ($20.00)

is to be mailed to or issued to over the counter:

c) Express Mail* ( $19.95)

d) UPS* (credit card orders ONLY)($19.00)

(circle one)......................................................

Name

Total Charges....................................

*Within continental U.S.

Address

City/State/Zip

mardis.pdf (Rev. 08/13)

Application For Certified Verification Of A Dissolution Of Marriage

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