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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VS113‐B(01/14)

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