Department of Health and Human Services
Maine Center for Disease Control and Prevention
220 Capitol Street
11 State House Station
Augusta, Maine 04333-0011
Tel.: (207) 287-3771; Fax: (207) 287-1093
Toll Free: 1-888-664-9491
TTY Users: Dial 711 (Maine Relay)
Application for Certificate of Marital Status in Maine
INSTRUCTIONS: Complete every item carefully and sign the certification statement in the presence of a notary public. Incomplete
applications will be rejected. The fee for a certificate of marital status is $50.00 for every five (5) years searched. Checks or money
orders should be made payable to: Treasurer, State of Maine. Please mail the completed application to the address provided above.
Current First Name
Current Middle Name(s)
Current Last Name
Suffix (Jr., etc.)
List all other possible names of individual (including the
maiden name of applicant previously married)
Birthplace State
Birthplace Country
Date of Birth (mm/dd/yyyy)
Age
Sex
Female
Male
Applicant’s Mailing Address (Street or PO) (Apt/Unit)
City/Town
County
State
Country
Zip Code
Phone Number (xxx) xxx-xxxx
E-mail
Name of Foreign Country Requesting Marital Status
Years to Search (please indicate the five (5) years to be searched)
Name of Former Spouse(s)
Year of Marriage
Year of Divorce/Death
State of Occurrence
I hereby certify that the information provided above is correct to the best of my knowledge and belief and that I am
free to marry under the laws of Maine. I understand this form is to establish a single status for the State of Maine
during for the five (5) years specified on this application form.
Signature of Applicant
Date Signed (mm/dd/yyy)
►
The above named applicant has personally appeared before me and made oath to the truth and foregoing statement:
Signature of Notary Public
Date Signed (mm/dd/yyy)
►
Printed Name of Notary Public
My Term Expires
City/Town
County
State
The processing time for a certificate of marital status in Maine takes approximately 10 – 15 business days. Appointments may
be scheduled by calling the Data, Research, and Vital Statistics (DRVS) office at (207) 287-3771.
Marital Status Application 10/2017