Full Text
OFFICE USE ONLY Date Processed: Deputy Initials: Cert Certified Copy of Marriage Certificate Request Form • Anoka County Vital Records is not responsible for deliveries that do not require a signature. • Deliveries outside the United States must include a prepaid express delivery envelope with your application. • If the request is coming from outside the United States, you must supply an email for contact purposes. Today’s Date: Name of Parties BEFORE Marriage (required) Party 1 First: Middle Initial: Last: Party 2 First: Middle Initial: Last: Name of Parties AFTER Marriage Party 1 First: Middle Initial: Last: Party 2 First: Middle Initial: Last: Date of Marriage (use approximate date if unsure): Requestor Information Name: Mailing Address (UPS will not deliver to PO boxes or APO addresses): Apt/Unit City: State: ZIP Code: Phone Email (required if outside US): Number of certificates requested: $9 for each certificate Enter Certificate cost: (Total number of certificates x $ Standard process fee: $0 Expedite process fee: $20 (processed ahead of standard requests; does not include delivery time) Enter Process fee: $ Grand Total Due: (certificate cost + process fee) $ DO NOT SEND CASH If paying by check/money order, send this form along with payment to: ANOKA COUNTY VITAL RECORDS 2100 3RD AVE ANOKA, MN 55303 Checks returned for non-payment will result in a $30 charge to you. If paying by credit card, submit completed application to: