Certificate Of Absolute Divorce Or Annulment Form
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1Docket No.
Division
The Commonwealth of Massachusetts
Department of Public Health
Registry of Vital Records and Statistics
CERTIFICATE OF ABSOLUTE
DIVORCE OR ANNULMENT
(G.L. Chap. 208, Sec. 46)
R-408
Husband-Name
First
Middle
Last
1.
Usual Residence-Street Address
City, Town, or Location
HUSBAND
2a.
2b.
County
State
Date of Birth
Number of this Marriage
(mo., day, yr.)
(1st, 2nd, specify)
2c.
2d.
3.
4.
Wife-Name
First
Middle
Last
Maiden Name
5a.
5b.
Usual Residence-Street Address
City, Town, or Location
WIFE
6a.
6b.
County
State
Date of Birth
Number of this Marriage
(mo., day, yr.)
(1st, 2nd, specify)
6c.
6d.
7.
8.
Number of Children Born Alive of this Marriage
Number of Children under Age 18 in this Family
Date of this Marriage (mo., day, yr.)
9.
10a.
10b.
FOR COURT USE ONLY
County of Judgment
Title of Court
11.
11a.
JUDGMENT
Date of Judgment Nisi
Type of Judgment -
Date of Judgment Absolute
(mo., day, yr.)
Divorce or Annulment
(mo., day, yr.)
12.
13.
14.
Docket Number
Name of Plaintiff
Cause for which Granted
15.
16.
17.
Signature of Certifying Official
Title of Official
18a.
18b.
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