- Application for Marriage Certificate - Alaska
- Application for Marriage License or Certificate - Colorado
- Application for Marriage License or Certificate - Florida
- Application for Marriage License or Certificate - Texas
- Mail-in Application for Copy of Marriage Certificate - New York
- Application for Certified Marriage Certificate - West Virginia
Fillable Printable Application for Certified Copy of Marriage Certificate - Kansas
Fillable Printable Application for Certified Copy of Marriage Certificate - Kansas
Application for Certified Copy of Marriage Certificate - Kansas
APPLICATION
FOR
CERTIFIED
COPY
OF
KANSAS
MARRIAGE
CERTIFICATE
MARRlACE
CERTIFICATES
ARE
ON
FILE
FROM
MAY
1.19
13
TO
PRESENT
(PLEASE
PRINT)
$12.00
t;OK ONE
CERTIFIED
COPY
AND
$7.00
FOR
EACH
ADDITIONAl.
CERnFIED
COPY
OF
THE
SAME
RECORD
KllhlBEK
OF
CEK1'IFIC'-iTES
REULiESI'EU
FEE
1NFOR.WATION
ON
REVERSE
SIDE
CFRTIFIED
COI'ILS
--
TOTAL
FEE
DA'I'L
UI:
GROOM
--.
-
R
I
KTH
FIRST hllDTI1.E
LAST
MO
DAY
LK
BRIDE
B
1
K'TH
FIRST
MIDDLE
LAST
h10
DAY
YR
(MAll)l?N
OR
PREVIOUS
MAKI<1FI)
SIIRNAI\.lE)
D:ITLr:
OF
MiZKKIrlGE
hlcll\l-TI
I
DAY
Y
!.i,qI<
PLACE
IN
IV'I
IICH
k1ARRIAGE LICENSE
WAS
ISSUED
COUNTY
STATE
(11
lIS.1'
Bli
L-iKSAF\
CITY
IN
WHICH
MARRIAGE
TOOK
PLACE
YOU
MUST
INCLUDE
A
COPY
OF
PHOTO
ID
WITH
THIS
FORM
OR
TWO
ALTERNATIVE
DO-SEE
REVERIE
SIDE
FOR
LIST1
YOUR
M.4lLlNC;
AUUKESS
-
-
CITY
STATE
ZIP
CODE
KE!ZSON
FOR
REVLIEST
(PLEASE
BE
SPECIFIC)
(We
ask
(1115
so
that
wc
can
pruvtde
npprofr1:ttc
xrvicr:
lor
your
11ccds)
YOUK
UAk'l'IhlE
TEI
EPHONE
NUhlUER
k'OLlR
RE1,ATIOKSIiIP
'TO
PERSON
NAMED
ON
CERTIFICATE (REQUIRED)-
(See
rcvcrsc
side
f'or
elig~bll
~t
rcquirwnents)
YOUR
SIGNATURE
(REQUIRED)
-
TODAY'S
DATE
KANSAS
DEPJ
RTMENT
01:
HEALTH
AND
ENVIKONhlENT
CENI'EK
FOR
HEAI.TH
AND
BNVIRONMEKTAL
STATISTICS
hl.lILIKC
AIIDRESS:
OFFICE
OF
I'ITAI,
STATISI'ICS
1000 S\Y
JACKSON,
su
I-r~,
120
'I'OPEKA,
KS
16612-2221
\VALK-IN
CUSTOAIEK
SERVICE
HOllRS:
q.00
-
4:00,
MONDAY
-
FRIUAY
OFFICE
HOURS:
8:OU
-
f;:00,
MONDAY
-
FRIDAY,
PIIONE
(785)
296-1400
PLEASE
ENCLOSE
A
B
iJSINESLS
SIZE
SELF-ADDRESSED
STAM
PEU
ENVELOPE.
ID
IS
REQUIRED
OF
PERSON
COMPLETlNG
FORM
Due
to
ideutity
theft
and
othcr
friudulent
use
of
vital
records,
acceptable
ID
is
limited.
DO NOT
send
original
ID
with
application
YOU
MUST
INCLUDE
A
PHOTOCOPY
OF
A
GOVERNMENT
(STATE
OR
FEDEKAL)
ISSUED
PHOTO
ID.
THIS
CAN
BE
ISSUED
BY
THE
U.S.
OR
OTHER
COUNTRY
OF
RESIDENCE.
ACCEPTABLE
IDENTIFICATIONS
INCLUDE:
Photocopy of Driver's License Photocopy
of
Passport
or
Visa
Photocopy
of'
State
1D
Card Photocopy
of
Military
ID
IF
YOU
DO
NOT
HAVE
A
GOVEHNMEN'I'
ISSUED
PHOTO
ID,
YOU
hlUST
SEND
PHOTOCOI'IES
OF
ANY
TWO
OF
TIIE
FOL1,OWING:
Social Security
Number
Utilil; Bill
With
Current
Address
,
Bank Statement With Current
Address
I'ay
Stub
(must
include
you
name,
social security
Car Registration or Titlc With Currcnt
number
plus
name
and
address
of
business)
Address
FEE
INFORMATION
K.A.H.
28-17-6
requires
the
followi~~g
fcc(s).
The
correct
fee
tnust
be
submitted with the request.
The
fee
for
certified copies
of
marriage
licenses is
$12.00
for
one
certified
copy and
$7.00
for
each
additional certified copy of the
same
record ordered
at
the same time. This
fee
allows
a
5-year
search
of the records, including the
year
indicated
plus
two
years
before
and
two years
after,
or you
may
indicate
thc consecutive
5-year
period
you
want
searched.
You
may
specify
more
than
one
5-year
span,
but
each
search
costs
$12.00.
IF
TIIE
CERTIFICATE
IS
NOT
LOCATED,
A
512.00
FEE
MUST
RE
RETAINED
FOR
THE
RECORD
SEAKUH.
Make
cllecks
or money orders
payable
to
KANSAS
VITAL
STATISTICS.
For
your
protection,
clo
not
send
cash.
Fees expire
12
months
fro111
date
of
the
request.
MULTIPLE
REQUESTS
FOR
DIFFERENT
RECORDS
MAY
BE
HANDLED
AND
MAILED
SEPARATELY.
ELIGIBILITY
By
state
law,
vital records
filed
with
this
office
are
not open for public inspection and the requestor must
meet
eligibility
requirements
--
must
be
named
on
the
record,
an
immediate
family
member,
or
someone
who
can
provide
legal proof the
record
is necessary for the determination
of
personal or propcrty
rights.
[K.S.A.
65-2422dJ
WEBSITE
Eos
additional
infos~nation,
please
access
the
web
site at:
http://www.Iidhe.state.ks.us/vital
WARNING:
COPYING
013
ALTEKlNG
PROHTBITED
Except
as
authorized
by
the Uniform Vital Slatistics
Act,
no
person
shall
prepare
or
issue
any
certificate (vital record)
which
purports
to
be
an
original,
certified
copy
or copy
of
a
certificate
[K.S.A.
65-2422d.(g)].
Any
person
who willfully
makes
or alters
any
certificate
or
certified
copy,
except
as
authorized
by
the
Uniform
Vital Statistics Act, shall
be
fined
or
imprisoned, or
both.
[K.S.A.
65-2434.(1)1.
