Fillable Printable Application for Certified Copy of Divorce Record - California

Application for Certified Copy of Divorce Record - California

StateofCalifornia–HealthandHumanServicesAgencyCaliforniaDepartmentofPublicHealth

APPLICATIONFORCERTIFIEDCOPYOFDIVORCERECORD

INFORMATION:

DivorcerecordshavebeenmaintainedintheCaliforniaDepartmentofPublicHealthVitalRecordsonlyfrom1962toJune1984.

Fortheseyears,weareonlyabletoprovideyouwithaCertificateofRecord,whichidentifiesthenamesoftheparties,filing

date,county,andcasenumberof

thedivorce.CopiesoftheactualdivorcedecreecanonlybeobtainedfromtheSuperior

Courtinthecountywherethedivorcetookplace.Ourprocessingtimefordivorcerecordscanbequitelengthyandmay

exceedsixmonths.



INSTRUCTIONS:

1.Completeaseparateapplicationforeachdivorcerecordrequested.

2.CompletetheApplicantInformationsectionandprovideyoursignaturewhereindicated.ProvidebothFirstPerson

andSecondPersoninformationtoidentifythedivorcerecord.Iftheinformationyoufurnishisincompleteor

inaccurate,wemaynotbeableto

locatetherecord.

3.Submit$14foreachcopyrequested.Ifnodivorcerecordisfound,thefeewillberetainedforsearchingtherecord

(asrequiredbylaw)anda“CertificateofNoPublicRecord”willbeissuedtotheapplicant.Indicatethenumberof

copiesyouwantand

includethecorrectfee(s)intheformofapersonalcheckorpostalorbankmoneyorder

(InternationalMoneyOrderforout‐of‐countryrequests)madepayabletoCDPHVitalRecords.PLEASESUBMIT

CHECKORMONEYORDER̶DONOTSENDCASH(CDPHcannotbeheldresponsibleforfeespaidin

cashthatarelost,

misdirected,orundelivered).



4.Mailcompletedapplicationswiththefee(s)to:

CaliforniaDepartmentofPublicHeath

VitalRecords–MS5103

P.O.Box997410

Sacramento,CA95899‐7410

(916)445‐2684

Fee:

$14percopy(payabletoCDPHVitalRecords).PLEASESUBMITCHECKORMONEYORDER–DONOTSENDCASH

(CDPHcannotbeheldresponsibleforfeespaidincashthatarelost,misdirected,orundelivered).

APPLICANTINFORMATION(PLEASEPRINTORTYPE)Today’sDate:

AgencyName(ifapplicable)AgencyCaseNumberInmateIDNumber

PrintNameofApplicantSignatureofApplicantPurposeofRequest



MailingAddress–Number,Street



AmountEnclosed–DONOTSENDCASH



$________Check$________MoneyOrder

NumberofCopies

City



MailingAddressofPersonReceivingCopies,ifDifferentfromApplicant

State/ProvinceZIPCodeMailingAddressforCopies,ifDifferentfromApplicant

DaytimeTelephone(includeareacode)

()

CountryCityStateZIPCode

DIVORCERECORDINFORMATION(PLEASEPRINTORTYPE)

CompleteFirstPersonandSecondPersoninformationbelowasshownonthedivorcerecord,tothebestofyourknowledge.

NameofFirstPerson–FIRSTName



MIDDLEName



CURRENTLASTNameLASTName(BeforeMarriage/DomesticPartnership)



NameofSecondPerson̶FIRSTNameMIDDLENameCURRENTLASTNameLASTName(BeforeMarriage/DomesticPartnership)



DateofDivorce–Month,Day,Year(IfDateUnknown,EnterYear(s))CountyofDivorce

DIVORCE

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