Dch-0569-Div - Michigan Divorce Or Annulment Record Form Page 2
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1
2MAIL OR COUNTER APPLICATION FOR A
____________________________
MICHIGAN DIVORCE OR ANNULMENT RECORD
STATE FILE NUMBER
(If Known)
APPLICANT
(PERSON REQUESTING RECORD)
PLEASE PRINT CLEARLY AND LEGIBLY
DATE:
/
/
Applicant=s Name:
Address:
City/State/Zip:
K K
K K
APPLICANT= = S SIGNATURE:
(Sign Here) _____________________________________________________________
Must be signed in order to process
Daytime Phone:
(
) _______________________________
Home Phone: (
) _________________________________
REQUESTED
If the exact date of the divorce or annulment is unknown, please indicate
DATE OF DIVORCE OR
DIVORCE
which year you want us to search. If the record is not found in that year= = s
ANNULMENT
OR
files, we will search the files for the year before and the year after. If you
ANNULMENT
want additional years searched, please see the payment box for additional
_____________________________________
INFO
Month
Day
Year
information.
NAME OF HUSBAND:
First
Middle
Last
WIFE= = S NAME AT TIME
OF DIVORCE OR
ANNULMENT:
First
Middle
Last
COUNTY WHERE DIVORCE OR ANNULMENT WAS GRANTED:
REQUESTING A MICHIGAN DIVORCE OR ANNULMENT
PAYMENT MUST BE MADE IN U.S. FUNDS BY CHECK OR
MONEY ORDER PAYABLE TO THE A A STATE OF MICHIGAN@ @
RECORD
The Michigan Vital Records office has records of divorces that occurred in
Fees are established by state statute. A search fee covers the cost of the
Michigan and were filed with the state since 1897. Some records were not
basic search and includes either one copy of the record or an official statement
filed with the state. We have no divorce records for Detroit for 1973 and
that the record could not be located in the state files. Payment for additional
1974.
copies will be refunded if the record cannot be located. A refund check would
be mailed to you by the Department of Treasury, usually within 3-4 weeks.
Anyone is eligible to request a copy of a Michigan divorce or annulment
record if the application is completed and signed and the required fee is
Search (Non-Refundable)
$
26.00
$
paid.
Includes One Certified Copy
$
12.00
$
_______ Additional Copies (Each)
PURPOSE FOR REQUESTING RECORD
$
10.00
$
* EXPEDITED SEARCH (Non-Refundable)
__________________________________________________________
Additional
(In addition to the regular search fee)
__________________________________________________________
No. Years
* Additional Search When Exact Date is
Unknown:
________
$26.00 fee includes a 3-year search
TURN-AROUND TIME
- For regular and expedited mail requests, please
Each additional year is $12.00 per year
allow additional time for mailing and our department=s receipting of your
payment.
Specify Which Additional Years to be
Searched:
$
12.00
$
* EXPEDITED SEARCH
- If you pay the expedited search fee (in addition to the
_______________________________
each
regular search fee), a counter request will be processed in 1-3 hours if divorce year is
1925 to the present. For a mail request, if divorce year is 1925 to the present, your
TOTAL ENCLOSED:
$
request will be processed within 2 weeks of receipt in the vital records office. For a
counter or mail request, if divorce year is prior to 1925, the processing time will be 3
weeks.
WE CANNOT PROCESS YOUR REQUEST WITHOUT PAYMENT.
IF
MAILING, PLEASE REMEMBER TO INCLUDE CHECK OR MONEY ORDER.
* EXPEDITED SERVICE
- Applies to standard three-year searches. Not available
for extra year searches.
IF REGULAR SEARCH MAIL TO:
IF EXPEDITED SEARCH MAIL TO:
VITAL RECORDS REQUESTS
VITAL RECORDS RUSH
REGULAR SEARCH
- If the divorce year is 1925 to the present, your request will be
PO Box 30721
PO Box 30721
processed within 4 weeks of receipt in the vital records office. If the divorce year is prior
Lansing MI 48909
Lansing MI 48909
to 1925, the processing time will be 1-3 months.
QUESTIONS: (517) 335-8666
DCH-0569-DIV Rev 3/9/06 By Authority of MCL 333.2882(1)(d), MCL 333.2883(2) and MCL
333.2891(1-4)
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