www.michigan.gov/mdch MAIL OR COUNTER APPLICATION FOR A CERTIFIED COPY ____________________________ MICHIGAN MARRIAGE RECORD APPLICANT (PERSON REQUESTING RECORD) STATE FILE NUMBER PLEASE PRINT CLEARLY AND LEGIBLY DATE: / (If Known) / Applicant=s Name: Address: K City/State K APPLICANT=S SIGNATURE: = Zip: (Sign Here) _________________________________________________________________ Must be signed in order to process Daytime Phone: ( ) _________________________________ Other Phone: ( REQUESTED MARRIAGE INFO 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 A MICHIGAN MARRIAGE RECORD 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. PAYMENT MUST BE MADE IN U.S. FUNDS BY CHECK OR MONEY ORDER PAYABLE TO THE ASTATE OF MICHIGAN@ @ 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. PURPOSE FOR REQUESTING RECORD 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 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 - All search information is required in order to request expedited service. 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 marriage year is 1926 to the present. For a mail request, if marriage year is 1926 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 marriage year is prior to 1926, 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 marriage year is 1926 to the present, your request will be processed within 4 weeks of receipt in the vital records office. If the marriage year is prior to 1926, the processing time will be 1-3 months. DCH-0569-MX 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. IF REGULAR SEARCH MAIL TO: VITAL RECORDS REQUESTS PO Box 30721 Lansing MI 48909 QUESTIONS: (517) 335-8666 IF EXPEDITED SEARCH MAIL TO: VITAL RECORDS RUSH PO Box 30721 Lansing MI 48909 American LegalNet, Inc. www.FormsWorkflow.com