Fillable Printable Correct a Colorado Marrige, Dissolution or Civil Union Verification
Fillable Printable Correct a Colorado Marrige, Dissolution or Civil Union Verification
Correct a Colorado Marrige, Dissolution or Civil Union Verification
FORM TO CORRECT A COLORADO MARRIAGE, DISSOLUTION OR CIVIL UNION VERIFICATION
Please
Note
This process will only correct the Marriage, Dissolution or Civil Union Verification filed in the State Vital Records Office.
This process will not correct the actual copy of the Marriage, Dissolution or Civil Union filed in the County or District Court of the applicable jurisdiction
Record Type ►(check box
) Marriage Dissolution (Divorce) Civil Union
Please select the type of service requested ►(check box) correction of a verification registration of a missing verification
(complete 1a to 6a only)
INFORMATION AS IT CURRENTLY APPEARS ON THE MARRIAGE,
DISSOLUTION OR CIVIL UNION VERIFICATION
CORRECT INFORMATION AS IT SHOULD APPEAR ON THE MARRIAGE,
DISSOLUTION OR CIVIL UNION VERIFICATION
1. GROOM - PETITIONER’S NAME - PARTY ONE 1a. GROOM - PETITIONER’S NAME - PARTY ONE
FirstMiddleLast(s)FirstMiddleLast(s)
2. BRIDE - RESPONDENT’S NAME - PARTY TWO 2a. BRIDE - RESPONDENT’S NAME - PARTY TWO
FirstMiddleLast(s)FirstMiddleLast(s)
3. COUNTY OF MARRIAGE, DISSOLUTION OR CIVIL UNION 3a. COUNTY OF MARRIAGE, DISSOLUTION OR CIVIL UNION
4. DATE OF MARRIAGE, DISSOLUTION OR CIVIL UNION: (month/day/year)4a. DATE OF MARRIAGE, DISSOLUTION OR CIVIL UNION: (month/day/year)
5. DOCKET NUMBER (dissolution only)5a. DOCKET NUMBER (dissolution only)
6. Dissolution Type: Divorce
Separation Invalidation
Annulment Civil Union
6a. Dissolution Type: Divorce
Separation Invalidation
Annulment Civil Union
The penalties for obtaining a record under false pretenses include a fine of not more than $1,000 or imprisonment in the county jail for not more than one year
or both such fine and imprisonment (CRS 25-2-118). By signing below, I have read and understood that there are penalties for obtaining a record under false
pretenses. The information above is true to the best of my knowledge and I/we request that the marriage, Dissolution or Civil Union verification to be changed
accordingly.
Your relationship to requestor (check box
)
______________________________________ ___________ Groom Bride Legal Representative (must provide proof)
Signature of requestor Date Petitioner Respondent Party One
*see ID Policy
Your relationship to requestor (check box
)
______________________________________ ___________ Groom Bride Legal Representative (must provide proof)
Signature of requestor Date Petitioner Respondent Party Two
*see ID Policy
____________________________________________________________________________________________________________
Address City/State Zip code
________________________________________ _______________________________________________________________
Daytime phone number Email (Print Clearly)
OUR RETURN MAILING ADDRESS ► Vital Records, Marriage/Dissolution Correction Specialist, 4300 Cherry Creek Drive South, Denver, Colorado 80246-1530
OUR WEBSITE ►
www.colorado.gov/cdphe
CONTACT INFORMATION ►Name:Jake J. Salazar Phone: 303-692-2226 Email: jake.salazar@state.co.us
*ID POLICY ► Effective 11-01-2003, Return your request with a copy of your driver’s license, state ID, passport or other acceptable identification.
***EXCHANGE POLICY ►
Effective 7/1/2011 previously issued certified copies of the verification may be exchanged at any time after a correction or change
has been made to verification at $10.00 each. You must return the verification(s) to utilize this service or it must be presented to us
before any transaction is requested.
METHODS OF PAYMENT ►
We accept Checks (no-temporary), Money Orders (payable to Vital Records) and Credit Cards.
Not responsible for cash sent through the mail.
**CREDIT CARD ORDERS ► (check box
) Visa MasterCard Discover Convenience Charge will apply (see fee schedule above)
Cardholder Name
Cardholder Signature
Credit Card Number
Expiration Date
Total Charges ($)
CHECKLIST ►
TO AVOID DELAY ENCLOSE ALL NECESSARY DOCUMENTATION (PLEASE SEND THE FOLLOWING)
1) Form to Correct a Marriage, Dissolution or Civil Union Verification
3) *Identification
2) Certified Marriage Certificate, Dissolution Decree or Civil Union Certificate 4) Fees ($)
SERVICES AND FEES
(Fees are non-refundable)QUANTITY
FEES ($)
1
st
certified copy of the Marriage, Dissolution or Civil Union Verification - (if applicable, see exchange policy)
x 17.00
=
$
***Additional copies of the same certificate ordered at the same time or exchanges
x 10.00
=
$
Heirloom Certificate (Excludes dissolutions) (to view image of Heirloom Certificate visit our website)
x 35.00
=
$
**Credit Card Convenience Charge (Walk-Ins excluded)
10.00
=
$
Total Number of Verifications Requested: Total:
$
Cross outs and/or white-out is not acceptable
Complete this form in ink
INSTRUCTIONS FOR CORRECTING A COLORADO MARRIAGE, DISSOLUTION OR CIVIL UNION VERIFICATION
Please Note:Photocopies of the Marriage, Dissolution, or Civil Union are not acceptable. Court order or Documents will be returned to you
MARRIAGE
Years that can be corrected: 1975 to present
Eligible Parties: Only the bride, groom or their legal representative (must provide proof) are eligible to apply.
Items Needed:Form to Correct a Colorado Marriage, Dissolution or Civil Union Verification.
Certified copy of the marriage certificate from the county Clerk and Recorder’s office where the marriage license
was issued.
DISSOLUTION
Years that can be corrected: 1968 to present
Eligible Parties: Only the petitioner, the respondent or their legal representative
(must provide proof)
are eligible to apply.
Items Needed:Form to Correct a Colorado Marriage, Dissolution or Civil Union Verification.
Certified copy of the dissolution decree from the County District Court where the dissolution, separation,
invalidity, or annulment was granted.
CIVIL UNION
Years that can be corrected: May 1, 2013 to present
Eligible Parties: Only party one, party two or their legal representative
(must provide proof)
are eligible to apply.
Items Needed:Form to Correct a Colorado Marriage, Dissolution or Civil Union Verification.
Certified copy of the civil union from the county Clerk and Recorder’s office where the civil union license was
issued.
Link to the Colorado courts website - //www.courts.state.co.us
*REQUIRED IDENTIFICATION DOCUMENTS
PRIMARY LIST
At least 1 of the following:
(No expired documents accepted)
•
Alien Registration Receipt/Permanent Resident Card
•
Certificate of U.S. Citizenship
•
Colorado Department of Corrections ID card
•
CO Temporary Driver’s License Form (with hole-punched
Driver’s License)
•
Employment Authorization Card (I-766)
•
Foreign Passport
•
Photo Driver’s License
•
Photo ID Card (DMV)
•
School, University or College ID Card (must be current)
•
Temporary Resident Card
•
U.S. B1/B2 Visa card with I-94
•
U.S. Certificate of Naturalization
•
U.S. Citizenship ID Card (I-197)
•
U.S. Military ID Card
•
U.S. Passport
We are sorry, but we cannot accept:
•
Matricula Consular Card
•
Novelty ID Card
•
Non-expiring Identification Cards
•
City or County Prison/Jail ID
•
Souvenir birth certificates
•
Temporary Driver’s license or Temporary State ID
SECONDARY LIST
at least 2 of the following:
(Any document expired more than six months will not be accepted)
•
Acknowledgment of Paternity document
•
Birth Certificate of Applicant (U.S. only)
•
Court order of adoption or name change
•
Craft or trade license (Colorado only)
•
DD-214
•
Divorce Decree (U.S. only)
•
Hospital birth worksheet (for infants under 6 months)
•
Hunting or Fishing License (must be current-Colorado only)
•
IRS-TIN card
•
Marriage license (U.S. only)
•
Medicare Card
•
Merchant mariner card
•
Mexican voter registration card
•
Motor vehicle registration or title (U.S. only)
•
Pilot license
•
Selective Service Card (U.S. only)
•
Social Security Card
•
Social Services Card (Medicaid, WIC)
•
State or federal prison or corrections card
•
Tribal ID Card
•
Weapon or gun permit (U.S. only)
•
Work ID, Paycheck Stub (within 3 months), or W-2
•
Any Expired document from the “Primary” List (cannot be
expired more than 6 months)
marriage_divorce_civil union changeapp_ Enlish_September 2013.docx
