www.michigan.gov/mdch __________________________ MAIL OR COUNTER APPLICATION FOR A CERTIFIED COPY MICHIGAN DIVORCE OR ANNULMENT RECORD APPLICANT (PERSON REQUESTING RECORD) STATE FILE NUMBER PLEASE PRINT CLEARLY AND LEGIBLY DATE: / (If Known) / Applicant=s Name: Address: K City/State/Zip: APPLICANT=S SIGNATURE: = K (Sign Here) _____________________________________________________________ Must be signed in order to process Daytime Phone: ( ) _______________________________ Home Phone: ( REQUESTED DIVORCE OR ANNULMENT INFO If the exact date of the divorce or annulment 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 DIVORCE OR ANNULMENT _____________________________________ Month Day Year NAME OF HUSBAND: First Middle Last First Middle Last WIFE=S NAME AT TIME = OF DIVORCE OR ANNULMENT: COUNTY WHERE DIVORCE OR ANNULMENT WAS GRANTED: REQUESTING A MICHIGAN DIVORCE OR ANNULMENT 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 divorces that occurred in Michigan and were filed with the state since 1897. Some records were not filed with the state. We have no divorce records for Detroit for 1973 and 1974. Fees are established by state statute. A search fee covers the cost of the basic search and includes either one copy of the record or an official statement that the record could not be located in the state files. Payment for additional copies will be refunded if the record cannot be located. A refund check would be mailed to you by the Department of Treasury, usually within 3-4 weeks. Anyone is eligible to request a copy of a Michigan divorce or annulment record if the application is completed and signed and the required fee is paid. PURPOSE FOR REQUESTING RECORD __________________________________________________________ __________________________________________________________ TURN-AROUND TIME - For regular and expedited mail requests, please allow additional time for mailing and our department=s receipting of your payment. * EXPEDITED SEARCH - If you pay the expedited search fee (in addition to the regular search fee), a counter request will be processed in 1-3 hours if divorce year is 1925 to the present. For a mail request, if divorce year is 1925 to the present, your request will be processed within 2 weeks of receipt in the vital records office. For a counter or mail request, if divorce year is prior to 1925, the processing time will be 3 weeks. * EXPEDITED SERVICE - Applies to standard three-year searches. Not available for extra year searches. REGULAR SEARCH - If the divorce year is 1925 to the present, your request will be processed within 4 weeks of receipt in the vital records office. If the divorce year is prior to 1925, the processing time will be 1-3 months. DCH-0569-DIV Rev 3/9/06 By Authority of MCL 333.2882(1)(d), MCL 333.2883(2) and MCL 333.2891(1-4) Search (Non-Refundable) Includes One Certified Copy $ 26.00 $ _______ Additional Copies (Each) $ 12.00 $ * EXPEDITED SEARCH (Non-Refundable) (In addition to the regular search fee) $ 10.00 Additional $ * Additional Search When Exact Date is Unknown: $26.00 fee includes a 3-year search Each additional year is $12.00 per year No. Years 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. IF REGULAR SEARCH MAIL TO: VITAL RECORDS REQUESTS PO Box 30721 Lansing MI 48909 IF EXPEDITED SEARCH MAIL TO: VITAL RECORDS RUSH PO Box 30721 Lansing MI 48909 QUESTIONS: (517) 335-8666 American LegalNet, Inc. www.FormsWorkflow.com