Fillable Printable certificate of divorce and dissolution of marriage or annulment
Fillable Printable certificate of divorce and dissolution of marriage or annulment
certificate of divorce and dissolution of marriage or annulment
STATE OF UTAH - DEPARTMENT OF HEALTH
CERTIFICATE OF DIVORCE, DISSOLUTION
OF MARRIAGE, OR ANNULMENT
1. HUSBAND'S NAME (First, Middle, Last)
2a. RESIDENCE - CITY, TOWN OR LOCATION 2b. COUNTY
3. BIRTHPLACE (State or Foreign Country) 4. DATE OF BIRTH (Month, Day, Year)2c. STATE
5. NUMBER OF THIS
MARRIAGE -
First, Second, etc.
(Specify below)
7. RACE: White, Black,
Amer. Indian, etc.
(Specify below)
6. IF NOT FIRST MARRIAGE, LAST MARRIAGE ENDED:
By Death, Divorce, Dissolution,
or Annulment (Specify Below)
Date (Mo., Day, Yr.)
8. EDUCATION: (Specify only
highest grade completed)
Elementary/Secondary
(0 - 12)
College
(13-16 or 17+)
HUSBAND
9a. WIFE'S NAME (First, Middle, Last)
10a. RESIDENCE - CITY, TOWN OR LOCATION 10b. COUNTY
11. BIRTHPLACE (State or Foreign Country) 12. DATE OF BIRTH (Month, Day, Year)10c. STATE
13. NUMBER OF THIS
MARRIAGE -
First, Second, etc.
(Specify below)
15. RACE: White, Black,
Amer. Indian, etc.
(Specify below)
14. IF NOT FIRST MARRIAGE, LAST MARRIAGE ENDED:
By Death, Divorce, Dissolution,
or Annulment (Specify Below)
Date (Mo., Day, Yr.)
16. EDUCATION: (Specify only
highest grade completed)
Elementary/Secondary
(0 - 12)
College
(13-16 or 17+)
WIFE
9b. MAIDEN LAST NAME
17a. PLACE OF THIS MARRIAGE - CITY,
TOWN, OR LOCATION
17b. COUNTY 17c. STATE OR FOREIGN COUNTRY18. DATE OF THIS MARRIAGE
(Month, Day, Year)
19. DATE COUPLE LAST RESIDED IN
SAME HOUSEHOLD (Month, Day, Year)
20. NUMBER OF CHILDREN UNDER 18 IN THIS
HOUSEHOLD AS OF THE DATE IN ITEM 19.
Number ___________ None
21. PETITIONER
Husband Wife Both
Other, Specify _________________
`
MARRIAGE
`
22a. NAME OF PETITIONER'S ATTORNEY (Type/Print) 22b. ADDRESS (Street and Number or Rural Route Number, City or Town, State Zip Code)
ATTORNEY
DECREE
23. I CERTIFY THAT THE MARRIAGE OF THE ABOVE
NAMED PERSONS WAS DISSOLVED ON
(Month, Day, Year)
24. TYPE OF DECREE, Divorce, Dissolution,
or Annulment (Specify)
25. DATE RECORDED (Month, Day, Year)
`
28. TITLE OF COURT27. COUNTY OF DECREE
26. NUMBER OF CHILDREN UNDER 18 WHOSE PHYSICAL CUSTODY
WAS AWARDED TO:
Husband ______________________ Wife ______________________
Joint _________________________ Other _____________________
No Children Not Determined Yet
29. SIGNATURE OF CERTIFYING OFFICIAL 30. TITLE OF CERTIFYING OFFICIAL 31. DATE SIGNED
(Month, Day, Year)
UDOH OVRS Form 14 Rev 12/03
