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Fillable Printable Application for Certified Copy of Divorce Record - California

Fillable Printable Application for Certified Copy of Divorce Record - California

Application for Certified Copy of Divorce Record - California

Application for Certified Copy of Divorce Record - California

StateofCaliforniaHealthandHumanServicesAgencyCaliforniaDepartmentofPublicHealth
APPLICATIONFORCERTIFIEDCOPYOFDIVORCERECORD
INFORMATION:
DivorcerecordshavebeenmaintainedintheCaliforniaDepartmentofPublicHealthVitalRecordsonlyfrom1962toJune1984.
Fortheseyears,weareonlyabletoprovideyouwithaCertificateofRecord,whichidentifiesthenamesoftheparties,filing
date,county,andcasenumberof
thedivorce.CopiesoftheactualdivorcedecreecanonlybeobtainedfromtheSuperior
Courtinthecountywherethedivorcetookplace.Ourprocessingtimefordivorcerecordscanbequitelengthyandmay
exceedsixmonths.
INSTRUCTIONS:
1.Completeaseparateapplicationforeachdivorcerecordrequested.
2.CompletetheApplicantInformationsectionandprovideyoursignaturewhereindicated.ProvidebothFirstPerson
andSecondPersoninformationtoidentifythedivorcerecord.Iftheinformationyoufurnishisincompleteor
inaccurate,wemaynotbeableto
locatetherecord.
3.Submit$14foreachcopyrequested.Ifnodivorcerecordisfound,thefeewillberetainedforsearchingtherecord
(asrequiredbylaw)anda“CertificateofNoPublicRecord”willbeissuedtotheapplicant.Indicatethenumberof
copiesyouwantand
includethecorrectfee(s)intheformofapersonalcheckorpostalorbankmoneyorder
(InternationalMoneyOrderforoutofcountryrequests)madepayabletoCDPHVitalRecords.PLEASESUBMIT
CHECKORMONEYORDER̶DONOTSENDCASH(CDPHcannotbeheldresponsibleforfeespaidin
cashthatarelost,
misdirected,orundelivered).
4.Mailcompletedapplicationswiththefee(s)to:
CaliforniaDepartmentofPublicHeath
VitalRecordsMS5103
P.O.Box997410
Sacramento,CA958997410
(916)4452684
Fee:
$14percopy(payabletoCDPHVitalRecords).PLEASESUBMITCHECKORMONEYORDERDONOTSENDCASH
(CDPHcannotbeheldresponsibleforfeespaidincashthatarelost,misdirected,orundelivered).
APPLICANTINFORMATION(PLEASEPRINTORTYPE)Today’sDate:
AgencyName(ifapplicable)AgencyCaseNumberInmateIDNumber
PrintNameofApplicantSignatureofApplicantPurposeofRequest
MailingAddressNumber,Street
AmountEnclosedDONOTSENDCASH
$________Check$________MoneyOrder
NumberofCopies
City
MailingAddressofPersonReceivingCopies,ifDifferentfromApplicant
State/ProvinceZIPCodeMailingAddressforCopies,ifDifferentfromApplicant
DaytimeTelephone(includeareacode)
()
CountryCityStateZIPCode
DIVORCERECORDINFORMATION(PLEASEPRINTORTYPE)
CompleteFirstPersonandSecondPersoninformationbelowasshownonthedivorcerecord,tothebestofyourknowledge.
NameofFirstPersonFIRSTName
MIDDLEName
CURRENTLASTNameLASTName(BeforeMarriage/DomesticPartnership)
NameofSecondPerson̶FIRSTNameMIDDLENameCURRENTLASTNameLASTName(BeforeMarriage/DomesticPartnership)
DateofDivorceMonth,Day,Year(IfDateUnknown,EnterYear(s))CountyofDivorce
DIVORCE
Page1of1
VS113B(01/14)
PLEASE ATTACH CHE CK HERE
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