Application For Authenticated Statement Of No Marriage In Michigan - Michigan Department Of Health
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1
2APPLICATION FOR AUTHENTICATED STATEMENT OF NO MARRIAGE IN MICHIGAN
Michigan Department of Health and Human Services
REQUESTING A SEARCH FOR A STATEMENT OF NO MARRIAGE: Most foreign governments require an official
statement of NO MARRIAGE (or SINGLE STATUS) that contains an “ apostille” to be presented by a US citizen in order
to be married in a foreign country. The statement needs to indicate that a statewide search was conducted and would confirm
that there is NO RECORD of a marriage recorded for the applicant in the State of Michigan and the years searched would be
specified.
PART 1 - APPLICANT’S INFORMATION
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 - SPECIFY COUNTRY OF USE
PART 5 - INFORMATION NEEDED TO SEARCH
□
□
Are you the
BRIDE
or
GROOM
A separate search is needed for the prospective bride and groom, if both
Begin Search With Year _________
are residents of Michigan. The search should be conducted for the years
when the applicant resided in Michigan since the age of 18, or since the
Additional Years To Be Searched
year of the latest divorce. The country of use may also require
___________ to ____________
authenticated copies of previous marriages and divorces.
(See Part 6 for fees)
Y
Y
D
OUR
OUR
ATE
N
B
AME
OF
IRTH
First
Middle
Last
mm/dd/yyyy
Y
OUR
F
’
ATHER
S
N
AME
First
Middle
Last
Y
OUR
M
’
OTHER
S
N
AME
First
Middle
Last
If you have been married and
divorced since the age of 18,
please indicate date and place.
Date (mm/dd/yyyy)
County
State
PART 6 - FEES Includes one certified copy or no-find letter
Base Fee
Includes One Year Search
$42.00
$ 42.00
Additional Certified Copies (Each)
$26.00
$
Additional Years Search (# of years) _____ x $12.00
Indicate years you want searched ______ ______
$
______ ______ ______ ______ ______ _____
EXPEDITED “RUSH” SERVICE (Additional)
$25.00 $
For Accounting Use Only
Is your request complete?
PAYMENT TO “STATE OF MICHIGAN”
TOTAL $
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