Form Vs113 - San Benito County Clerk Marriage Licenses - 2015 Page 8

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INSTRUCTIONS:
1.
ONLY individuals who are authorized by Health and Safety Code Section 103526 can obtain a Certified
Copy of a Marriage Record. (Page 1 identifies the individuals who are authorized to make the request.) All
others may receive a Certified Informational Copy which will be marked, “Informational, Not a Valid
Document to Establish Identity.”
2.
Complete a separate application form for each record of marriage requested.
3.
Provide as much information as possible to help us locate the specific record you are requesting. Complete
First Person and Second Person Information for marriage requests. If the information you provide is
incomplete or inaccurate, we may not be able to locate the record.
4.
SWORN STATEMENT:
The authorized individual requesting the certified copy must sign the attached Sworn Statement,
declaring, under penalty of perjury, that they are eligible to receive the certified copy of the marriage
record, and identify their relationship to the registrant (person listed on the certificate) – the
relationship must be one of those identified on Page 1.
If the application is being submitted by mail, the Sworn Statement must be notarized by a Notary
Public. (To find a Notary Public, see your local yellow pages or call your banking institution.) Law
enforcement and local and state governmental agencies are exempt from the notary
requirement.
You do not have to provide a Sworn Statement if you are requesting a certified informational copy
of the marriage record,
5.
Submit $15 for each certified copy requested. If no record of the marriage is found, the fee will be retained
for searching the record (as required by law) and a Certificate of No Public Record will be issued to the
applicant. Indicate the number of copies you want and include the correct fee(s) in the form of a personal
check, postal or bank money order (International Money Order for out-of-country requests) made payable to
the San Benito County Clerk. PLEASE SUBMIT CHECK OR MONEY ORDER – DO NOT SEND CASH.
(San Benito Clerk cannot be held responsible for fees paid in cash that are lost, misdirected, or
undelivered.)
6.
Mail this application with the fee(s) and a self-addressed stamped envelope to:
San Benito County Clerk/Recorder
440 Fifth Street, Room #206
Hollister, CA 95023
831-636-4029 (phone)
831-636-2939 (fax)
7.
Credit card orders may be processed on-line at
Additional costs apply for processing
orders using a credit card. Please follow the directions on Vitalchek’s website if ordering using a credit
card.
MARRIAGE RECORD
VS 113 (01/01/2015)

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