COUNTY OF SAN DIEGO ERNEST J. DRONENBURG, JR. ASSESSOR/RECORDER/COUNTY CLERK www.sdarcc.com APPLICATION FOR A MARRIAGE CERTIFICATE $14.00 FEE FOR MARRIAGE CERTIFICATE, LETTER CONFIRMING EXISTENCE OF MARRIAGE, OR LETTER OF NO RECORD NON-REFUNDABLE Effective January 1, 2010, California State Law, Health and Safety Code Section 103526c, permits only authorized persons as defined below to receive certified copies of marriage records. Those who are not authorized by law to receive a certified copy of a non-confidential marriage record will receive a certified copy marked “INFORMATIONAL, NOT A VALID DOCUMENT TO ESTABLISH IDENTITY.” Those who are not authorized by law to receive a confidential marriage record will receive a “Letter Confirming the Existence of a Marriage.” If we cannot find the record based on the information you provide, state law requires that we keep the fee and provide a “Letter of No Record.” Please wait 3 weeks from the date of event before submitting your request. Note: If the marriage license was not issued in the County of San Diego, then the San Diego Assessor/Recorder/County Clerk will not have the marriage certificate. Please order the marriage certificate from the Recorder or County Clerk of the county where the license was issued. … I would like a certified copy of a non-confidential marriage record. (you must indicate your relationship to the person named on the certificate by marking a box in the list to the right) I am: … A registrant (one of the two persons listed on the marriage certificate) … Entitled to the record as a result of a court order. The original COURT ORDER must be included with this request. … A parent or legal guardian of a registrant … A member of a law enforcement agency or a representative of another governmental agency, as provided by law, who is conducting official business. (Companies representing a government agency must provide authorization from the government agency.) … A child, grandparent, grandchild, sibling, spouse, or domestic partner of a registrant. … An attorney representing a registrant or a registrant’s estate, or any person or agency empowered by statute or appointed by a court to act on behalf of a registrant or a registrant’s estate. (If you are requesting a Certified Copy under a power of attorney, please include a copy of the power of attorney with this application form.) … I would like a certified copy of a confidential marriage record. (you must indicate your relationship to the person named on the certificate by marking a box in the list to the right) I am: … A registrant (one of the two persons listed on the marriage certificate) … Entitled to the record as a result of a court order. The original COURT ORDER must be included with this request. … I would like a certified informational copy of a non-confidential marriage OR a letter confirming the existence of a confidential marriage (A sworn statement is not required) PLEASE TYPE OR PRINT THE INFORMATION REQUESTED BELOW MARRIAGE CERTIFICATE: Complete First and Second Person Information Name of First Person – First Name Middle Name Current Last Name Birth Last Name Name of Second Person – First Name Middle Name Current Last Name Birth Last Name Date of Marriage – Month, Day, Year No. of Copies Note: The Sworn Statement must accompany this request in our office before a certificate can be issued with the exception of a certified informational copy. Requestor’s Name: ______________________________________________________________________________ PLEASE PRINT Vitals Form #V5M/6M (12/28/2010) 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com SWORN STATEMENT I, _________________________________, declare under penalty of perjury under the laws of the State of California, that I am an (print name) authorized person, as defined in California Health and Safety Code Section 103526 (c), and am eligible to receive a certified copy of the marriage record of the following individual(s): Number of Copies Names of Both Persons Listed on the Marriage Certificate Applicant’s Relationship to Person Listed on the Marriage Certificate Subscribed to this _______ day of ______________, 20___, at _________________________, ________________. (Day) (Month) (Yr) (City) (State) ______________________________________________________ (Applicant’s Signature) Note: If submitting your order by mail and requesting a Certified Copy (not an informational copy), you must have your sworn statement notarized using the Certificate of Acknowledgment below. The notary is only verifying the identity of the person requesting the copy not the relationship to the registrant. Only one notarization is required even though the requester may have different authorized relationships to each record being requested. (i.e. Mother on one request, Registrant on another request, etc.) CERTIFICATE OF ACKNOWLEDGMENT State of _______________________________________ County of ________________________________________________ On __________________, before me________________________________________________________________________, (Insert name and title of the officer) personally appeared _________________________________who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. ______________________________________________________ NOTARY SIGNATURE Mail Certificate to: Name Address City, State, Zip Please Mail this request along with your payment (check or Email money order made payable to SD County Recorder) to: Phone San Diego Recorder/County Clerk Vitals Form #V5M/6M (12/28/2010) x $14.00 = P.O. Box 121750 Total = Number of Copies San Diego, CA 92112-1750 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com