www.michigan.gov/mdch _________________________ MAIL OR COUNTER APPLICATION FOR A CERTIFIED COPY AUTHENTICATED MICHIGAN MARRIAGE RECORD STATE FILE NUMBER (If Known) INFORMATION ABOUT AUTHENTICATED CERTIFICATES Authenticated (exemplified or containing an Apostille) records are typically required by foreign governments for an adoption, work visas, marriage in a foreign country or establishing residency. You must specify which country requires the document. The processing of an authenticated certificate takes approximately 3 to 4 weeks after receipt in the Vital Records office. Please allow additional time for mailing and our Department=s receipting of your payment. APPLICANT (PERSON REQUESTING RECORD) PLEASE PRINT CLEARLY AND LEGIBLY DATE: Applicant=s Name: Address: K City/State APPLICANT=S SIGNATURE: = Daytime Phone: ( K Zip: (Sign Here) _________________________________________________________________ Must be signed in order to process ) Other Phone: ( ) K Please specify which FOREIGN COUNTRY requires the document REQUESTED MARRIAGE INFO (Cannot be U.S.) If the exact date of the marriage is unknown, please indicate which year you want us to search. If the record is not found in that year=s files, we will search the files for the = year before and the year after. If you want additional years searched, please see the payment box for additional information. DATE OF MARRIAGE _____________________________________ Month Day Year NAME OF GROOM: First Middle Last BRIDE=S NAME AT TIME OF APPLICATION = FOR MARRIAGE LICENSE: First Middle Last First Middle Last City County State BRIDE=S NAME BEFORE FIRST MARRIED = (IF DIFFERENT FROM ABOVE) LOCATION OF MARRIAGE: COUNTY WHERE LICENSE WAS OBTAINED: REQUESTING AN AUTHENTICATED MICHIGAN MARRIAGE RECORD PAYMENT MUST BE MADE IN U.S. FUNDS BY CHECK OR MONEY ORDER PAYABLE TO THE ASTATE OF MICHIGAN@ @ The Michigan Vital Records office has records of marriages that occurred in Michigan and were filed with the state since 1867. Some records were not filed with the state. Anyone is eligible to request a copy of a Michigan marriage record if the application is completed and signed and the required fee is paid. Search (Non-Refundable) Includes One Authenticated Copy $ 29.00 ______ Add=l Authenticated Copies ($15.00 for each add=l authenticated copy) $ 15.00 If requested, this office will conduct a search to determine that a marriage has not occurred in the State of Michigan for purposes of a forthcoming marriage in a foreign country. The applicant must specify exactly which years to search, usually from age 18 to the present, or the span of years that you resided in Michigan. EXPEDITED A RUSH@ SERVICE (Additional) @ $ 10.00 Additional Search When Exact Date is Unknown: $29.00 fee includes a 3-year search Each additional year is $12.00 per year No. Years PAYMENT - NO ORDER WILL BE PROCESSED WITHOUT PROPER FEE SUBMITTED WITH A SIGNED APPLICATION SEARCH FEES ARE NON-REFUNDABLE: Fees are established by state statute. A search fee covers the cost of the basic 3-year search and includes either one authenticated copy of the record or an official statement that the record is not filed with the state. A basic search includes the files for the year specified as the death year, as well as the year before and the year after. REFUNDABLE FEES: Payment for additional copies will be refunded if the search indicated that the record is not filed with the state. Extra years that are paid for but do not have to be searched to locate the record will be refunded. A refund check would be mailed to you by the Department of Treasury, usually within 3-4 weeks. RUSH SERVICE: Applies to processing time in Vital Records and not the Great Seal. DCH-0569-MXAUTH Rev 3/9/06 By Authority of MCL 333.2882(1)(2), MCL 333.2883(2) and MCL 333.2891(1-4) Specify Which Additional Years to be Searched: ______________________________ TOTAL ENCLOSED: $ $ __________ $12.00 each $ WE CANNOT PROCESS YOUR REQUEST WITHOUT PAYMENT. IF MAILING, PLEASE REMEMBER TO INCLUDE CHECK OR MONEY ORDER. Mail application with payment to: VITAL RECORDS REQUESTS PO Box 30721 Lansing MI 48909 QUESTIONS: (517) 335-8666 American LegalNet, Inc. www.FormsWorkflow.com