Application For Certified Copy Of A Confidential Marriage Certificate Template Page 2
Download a blank fillable Application For Certified Copy Of A Confidential Marriage Certificate Template in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Application For Certified Copy Of A Confidential Marriage Certificate Template with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2APPLICATION FOR CERTIFIED COPY OF A CONFIDENTIAL MARRIAGE
CERTIFICATE - $17.00 PER COPY IN ALAMEDA COUNTY
Marriage Certificate Information
Number of copies requested: ____________
1
Name of Party A: ________________________________________________________________________________________
Last (Before Marriage)
First
Name of Party B: ________________________________________________________________________________________
Last (Before Marriage)
First
Date of Marriage: ________________________ City Where License was Purchased:__________________________________
Month/Day/Year
Applicant Information
(If ordered online) Confirmation #: _____________________
2
Last Name: ________________________________________ First Name: ________________________________________
GF
GF
Home Address: __________________________________________________________________________________________
(P.O. Box not acceptable) Number and Street (APT #)
City
State
Zip Code
Shipping Address: _______________________________________________________________________________________
(If Different than home)
Number and Street (APT #)
City
State
Zip Code
Telephone Number: _(_____)___________________________Email Address: _______________________________________
Certified copies of Confidential Marriage Certificates may be obtained only by a party to the marriage or by
3
court order. Requests made by any other person or agency will not be honored.
Authority to Request a Copy (Check One):
Party to the Marriage (Groom/Bride or Party A / B)
o
Court Order (Please include a copy of the court order)
o
I, ________________________________________________, swear under penalty of perjury that I am an authorized person, as
4
(Print Your Name)
defined in California Health and Safety Code Section 103526 (c), and am eligible to receive a certified copy of the marriage
record identified on this application form. Sworn this __________________ day of _________________________, 20________,
at ______________________________________________
Signature: ___________________________________________
(City and State)
Acknowledgment
5
A notary public or other officer completing this certificate verifies only the
State of ________________________
identity of the individual who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or validity of that document.
County of _______________________
On ____________ before me, __________________________________________________, personally appeared
(name and title of the officer)
____________________________ who proved to me on the basis of satisfactory evidence to be the person whose
name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her
authorized capacity, and that by his/her signature on the instrument the person, or the entity on behalf of which the
person acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true
and correct.
WITNESS my hand and official seal:
________________________________________
Signature of Notary Public
(Notary Seal)
J:\RECDOCS\New Clerk-Recorder Form Inventory\2015\Vitals & GB
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business