Divorce Certificate Request Form - Alaska Page 2
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1
2STATE OF ALASKA
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DIVORCE CERTIFICATE REQUEST FORM
•
You may type directly on this form and print it or you may print the form first and then complete it by hand. If you enter the ordering
information on this form the fees and shipping charges will automatically be calculated.
•
If completed by hand, be sure that all information is printed neatly and is legible.
•
Expedited (Rush) requests must be faxed to 907.465.3618 for processing. Do not mail expedited requests. Please call 907.465.3391
Monday-Friday, 8 a.m. to 4 p.m. Alaska time, to confirm the receipt of your fax.
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Please read the instructions on the previous page. Incomplete or inaccurate requests or requests that do not include a copy of a
government-issued ID with a signature below the ID will be returned unprocessed.
FULL Name of the Husband:
(First, Middle, and Last Name on the Divorce Certificate )
FULL Name of the Wife:
(First, Middle, and Last Name on the Divorce Certificate )
Date of Marriage (for this divorce):
Date of Divorce:
City or Village of Divorce:
Purpose of the request:
(Personal Records, Legal Purposes, Inheritance/Estate Settlement, Govt. Assistance/Benefits, Insurance/Pension, Retirement, etc. )
Your Relationship to the Persons Named on the Record:
(Husband, wife, legal representative, etc. )
Signature of the Person
Contact Phone Number:
Requesting the Record:
You may enter the ordering information in this form and the fees
# Copies
Amount
and shipping charges will automatically be calculated.
Mail this form with a money order, a check, or
Divorce Certificates: $30 first copy; $25 each additional copy of
credit card information. Checks must be
the same record ordered at the same time.
preprinted with your name and address. Please
Apostille fee (please see instructions for fees)
note there is a $30.00 NSF fee for returned checks.
Country needed for:
Expedited (Rush) requests must be faxed to
907.465.3618 for processing.
Expedited (Rush) Service* (Add $11.00)
*Does not include shipping fees.
Make Checks Payable to:
Ship by:
Regular Mail (no additional fee)
Bureau of Vital Statistics
P.O. Box 110675
Priority Mail (Add $5.60)
(Call our office
Juneau, AK 99811-0675
Registered Mail (Add $11.20)
for shipping
Phone: (907) 465-3391
rates outside
Express Mail (Add $19.95)
Fax: (907) 465-3618
the U.S)
FedEx (No PO Box / Add $18.50)
Total
PLEASE ENTER YOUR MAILING ADDRESS BELOW
Name:
Street:
City, State, Zip
Credit Card Information (When paying by credit card)
Name on credit card:
Billing address:
Expiration date:
Number:
Visa
MasterCard
Discover
Cardholder signature (required):
(Rev. 04/13)
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