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2. INFORMATION OF PERSONS ON RECORD
   This section is for information on the two people who are listed on this marriage record.
4. First Name of PARTY A*
5. Middle Name of PARTY A
6. Last Name of PARTY A (BEFORE MARRIAGE)*
8. First Name of PARTY B*
9. Middle Name of PARTY B
10. Last Name of PARTY B (BEFORE MARRIAGE)*
12. Date of Marriage*
    Date of Marriage
13. Relationship to Name on Record*
    Please state how you are related to the the persons listed on this record (Examples: Party A, Party B. If related to either party list which party and the nature of the relationship.)
15. REQUESTOR'S CONTACT/MAILING INFORMATION
17. Mail-to Name*
18. Phone Number*
19. Email Address*
21. Mailing Address*
22. Mailing Address
24. Mailing Address City*
25. Mailing Address State*
26. Mailing Address Zip*
28. CONFIRMATION OF REQUESTOR'S IDENDITY
30. State, Federal, or School ID

    Scan or image of photo identification. We accept State, Federal, or School ID. We do not accept selfies!

31. Electronic Signature*
    By typing your full name above you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
35. Confirmation of Payment Requirements*

    1. Yes, I confirm I understand these requirements.

    By checking the box above you are confirming that you understand this request will not be processed until you pay for the records you are requesting via UNIPAY GOLD which will be linked on the confirmation page after you submit this form.
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field