Application For A Certified Copy - Michigan Divorce Record
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1
2MICHIGAN DIVORCE RECORD
CERTIFIED
APPLICATION FOR A
COPY
REQUESTING A MICHIGAN DIVORCE RECORD: The Michigan Vital Records office has records of divorces that oc-
curred in Michigan and were filed with the state since 1897. Occasionally, some records were not filed with the state. Anyone
is eligible to request a copy of a Michigan divorce or annulment record if the application is completed and signed and the re-
PART 1: APPLICANT’S INFORMATION
(Person Requesting Record)
Applicant’s
Name:______________________________________________________________________________________________
Mailing Address: ______________________________________ City: ____________________ State: _____ Zip: ________
Daytime Phone (
) ________________________________ Other Phone: (
) ________________________________
PART 2: CERTIFICATION OF INFORMATION PROVIDED
By signing this application, I understand that I am agreeing to pay for a search of the State of Michigan Vital Records with the
information that I provided. This does not guarantee that a record will be found.
►
_________________________________
: __________
Applicant’s Signature:
Date
PART 3: PURPOSE FOR REQUESTING THE RECORD
PART 4: INFORMATION NEEDED TO SEARCH FOR RECORD
Date of Divorce or Annulment
If the exact date of divorce is unknown, please indicate the year you want searched.
If you need additional years searched, please see the payment box for fee information.
The State of Michigan will only have the record of divorce. If you need the actual
(mm/dd/yyyy) ________________________
divorce judgment, you will need to contact the court that finalized the divorce.
FULL NAME
MALE
FEMALE
At time of divorce
or annulment
First
Middle
Last
FULL NAME
MALE
FEMALE
At time of divorce
or annulment
First
Middle
Last
COUNTY WHERE DIVORCE OR
ANNULMENT WAS GRANTED:
PART 5: FEES -
Includes one certified copy or no-find letter
Base Fee:
Includes One Year Search
$34.00
$ 34.00
Additional Certified Copies (Each)
____ x $16.00
$
Additional Years Search (Number of years)
____ x $12.00
$
(when exact year unknown)
Indicate years you want searched: _____ _____ _____
EXPEDITED “RUSH” SERVICE (Additional)
$12.00
$
For Accounting Use Only
PAYMENT TO “STATE OF MICHIGAN”
TOTAL:
Is your request complete? See checklist on back!
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