Fillable Printable Divorce Certificate Application Form - Wisconsin
Fillable Printable Divorce Certificate Application Form - Wisconsin
Divorce Certificate Application Form - Wisconsin
DEPARTMENT OF HEALTH SERVICES
Division of Public Health
F-05282 (Rev. 07/2015)
STATE OF WISCONSIN
Chapter 69.21 Wis.Stats
Page 1 of 2
WISCONSIN DIVORCE CERTIFICATE APPLICATION
(for Mail or In-Person Requests)
PENALTIES: Any person who willfully and knowingly makes a false application for a divorce certificate shall be fined not more than $1,000 or imprisoned not more than 90 days,
or both, per s. 69.24(2), Wis. Stats. Any person who willfully and knowingly obtains a divorce certificate for fraudulent purposes is guilty of a Class I felony [a fine of not more than
$10,000 or imprisonment of not more than 3 years and 6 months, or both, per s. 69.24(1), Wis. Stats.].
I. APPLICANT INFORMATION
YOUR CURRENT NAME - First
Middle
Last
YOUR STREET ADDRESS (CANNOT be a P.O. Box address) Apt. No.
MAIL TO ADDRESS (if different than street address) Apt. No.
City
State
ZIP Code
City
State
ZIP Code
YOUR DAYTIME TELEPHONE NUMBER
( )
EMAIL ADDRESS
TYPE OF CURRENT VALID PHOTO ID
(See item 3 on page 2.)
PHOTO ID NUMBER
STATE OF ISSUANCE
EXPIRATION DATE
II. APPLICANT’S RELATIONSHIP TO
PERSON(S) NAMED ON THE CERTIFICATE
According to Wisconsin Statute, a CERTIFIED copy of a divorce certificate is only available to those with a “direct and tangible interest."
(See item 1 on page 2.)
Check one box which indicates YOUR RELATIONSHIP to one of the PERSONS NAMED on the divorce certificate.
A. I am one of the persons named on the divorce certificate.
B. I am a member of the immediate family of one of the persons named on the divorce certificate. CHECK ONE of the following:
Parent Brother / Sister Grandparent Child
NOTE: Grandchildren, step-parents, step-children, step-brothers/step-sisters may only obtain certified copies as categories C – E.
C. I am the legal custodian or guardian of one of the persons named on the divorce certificate. (Legal proof is required.)
D. I am a representative, authorized in writing, by any of the aforementioned (categories A - C). (The written and notarized
authorization must accompany this application.)
Specify the person you represent: _______________________________________________________________________________
E. I can demonstrate that the information from the divorce certificate is necessary for the determination or protection of a personal or
property right for myself/my client/my agency. (Proof is required.)
Specify your interest: _________________________________________________________________________________________
F. None of the above. I am requesting an uncertified copy. (Copy will not be valid for legal purposes.)
PURPOSE FOR WHICH CERTIFICATE IS REQUESTED:
III. FEES
Required Search Fee (includes one copy, if found) ………………….………..…………………..……………... $ 20.00 ___20.00___
Additional copies of the same certificate issued at the same time as the first copy ___________________ X $ 3.00 ___________
Number of Additional Copies
FEE IS NOT REFUNDABLE IF NO RECORD IS FOUND. CANCELLATIONS NOT ACCEPTED. TOTAL ___________
Mail your application materials and fee to: STATE VITAL RECORDS OFFICE / PO BOX 309 / MADISON, WI 53701-0309
Be sure to include: completed form, acceptable identification, payment,
self-addressed, stamped business-size envelope, and any additional proof or authorization required
Make check or money order payable to: STATE OF WIS. VITAL RECORDS
IV. DIVORCE
INFORMATION
BIRTH NAME - First
Middle
BIRTH Last Name
BIRTH NAME - First
Middle
BIRTH Last Name
LOCATION OF DIVORCE - County COUNTY
DATE OF DIVORCE (MM/DD/YYYY)
I hereby attest that the information provided on this application is correct to the best of my knowledge and belief and that I am entitled to copies
of the requested divorce certificate in accordance with the categories listed above.
SIGNATURE (Applicant)
Date Signed (MM/DD/YYYY)
Important: Signature and payment are required for processing.
TYPE or PRINT.
WISCONSIN DIVORCE CERTIFICATE APPLICATION
F-05282 (Rev. 07/15)
Page 2 of 2
1. What is the difference between a “certified” and an “uncertified” copy of a divorce certificate?
A certified copy of a divorce certificate issued by the State Vital Records Office will have a raised seal, will show the signature of the
State Registrar, and will be printed on security paper. A certified copy may be required to change your last name or to marry.
State law restricts who may obtain a certified copy of a divorce certificate. A certified copy can only be issued to those people with a
“direct and tangible interest” (section II, categories A – E) which means the following people:
A person named on the divorce certificate (section II, category A).
An immediate family member defined as a parent (whose name is on one of the party’s birth certificates and whose parental rights
have not been terminated), brother, sister, grandparent, or child of the subject of the record (section II, category B).
NOTE: Grandchildren, step-parents, step-children, step-brothers and step-sisters can only obtain certified copies as section II,
categories C – E.
The legal custodian or guardian of a person named on the divorce certificate. Legal proof, e.g., a court order of custody or
guardianship, is required (section II, category C).
A person authorized in writing by one of the above. A written and notarized authorization must be attached to this application and
the authorization must clearly state the relationship of the authorizing party to the subject of the record (section II, category D).
A person who can demonstrate that the divorce certificate is required to determine or to protect a personal or property right (section
II, category E). Proof is required.
If you do not meet one of the above criteria, you cannot receive a certified copy of a divorce certificate.
An uncertified copy will contain the same information as a certified copy but it is not acceptable for legal purposes, such as remarriage.
(section II, category F)
2. How long will it take to process my request?
Copies of divorce certificates are available from the State Vital Records Office no less than 3 weeks from the date of the divorce.
Applying in Person
Requests for certified copies of divorce certificates are usually completed within 2 business hours of application, if the
divorce certificate is on file.
Requests for uncertified copies of divorce certificates are not completed on the same schedule as requests for
certified copies. In-person requests for uncertified copies may take up to 1 month to complete.
Applying by Mail
Requests for certified copies of divorce certificates may take up to 2 weeks plus mail time to complete.
Requests for uncertified copies of divorce certificates are not completed on the same schedule as certified copies. Mail
requests for uncertified copies may take up to 1 month plus mail time.
3. What identification is required when applying for a divorce certificate?
A photocopy of the applicant’s ID as listed below must be submitted with all mail applications. ID as listed below is required when
applying in-person.
At least one form of ID must show your name and address. Expired cards or documents will not be accepted.
Acceptable forms of identification are:
One of these:
OR
Two of these:
Wisconsin driver’s license
Wisconsin ID card
Out-of-state driver’s license or ID card
US government issued photo ID
Passport
Check book/bank statement
Health insurance card
Current, dated, signed lease
Utility bill or traffic ticket
Paycheck or earnings statement
If you have questions regarding this form, please call 608-266-1373
or visit our website at http://www.dhs.wisconsin.gov/vitalrecords
