GENESEE COUNTY CLERK APPLICATION FOR DIVORCE RECORD (Please Print) APPLICANT INFORMATION (Person Requesting Record) Applicant's Name: _____________________________________________________________________ Address: ____________________________________________________________________________ City/State/Zip: ________________________________________________________________________ Daytime phone number to contact you if there is a problem: ( APPLICANT'S SIGNATURE: ________________________________________________________ Must be Signed in Order to Process REQUESTED DIVORCE INFORMATION (Divorce Must Have Been Granted in Genesee County) ) ____________________________ Name of Husband: ___________________________________________________________________ First Middle Last Name of Wife: _______________________________________________________________________ First Middle Last Year Divorce Proceedings Started: _________________ Year The fee is $10.00 for the first copy, and $5.00 for EACH ADDITIONAL COPY of the same record when ordered at the same time as the first copy. Number of Copies Requested: ____________ Mail this application with a self addressed stamped envelope and a MONEY ORDER payable to: Genesee County Clerk Divorce Records 900 S. Saginaw St. Flint, MI 48502 For additional information call (810) 257-3220 American LegalNet, Inc. www.USCourtForms.com