Fillable Printable Application for Divorce Certificate - Kentucky

Application for Divorce Certificate - Kentucky

COMMONWEALTH OF KENTUCKY

DEPARTMENT FOR HEALTH SERVICES

State Registrar of Vital Statistics

VS-230

(Rev. 5/92)

APPLICATION FOR MARRIAGE/DIVORCE CERTIFICATE

Please Print or Type All Information Requested on This Form.

Please Circle Type of Record Requested.

Full Name of Husband

Maiden Name of Wife

County In Which (Marriage License) (Divorce Decree) Granted

(Circle One)

Date of (Marriage) (Divorce)

(Circle One)

Name of Applicant

Address

A $6.00 fee must accompany this application. The fee cannot be returned. If the certificate is on file you will receive one copy. Additional

copies are $6.00 each. Make check or money order payable to “Kentucky State Treasurer.” When complete, mail the entire form to Vital

Statistics, 275 East Main Street, Frankfort, Kentucky 40621.

Print Name and Mailing Address of Person to Receive the Certificate.

This Portion is a Mailing Insert and Will be Used to Mail the Copy you

Have Requested.

Office Use Only

Vol.

Cert.

Year

Date

Initials

The Information I Am Requesting Concerns

(Marriage) (Divorce)

(Circle One)

Please Indicate Quantity Desired ______________

(Mo.) (Day) (Year)

Name

Street Number & Name

City-State-Zip Code