THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) REQUEST FOR CERTIFIED COPY OF DIVORCE DECREE OR VITAL STATISTICS Please send a certified copy of my Divorce Decree ($40.00) and all accompanying paperwork to me at the address below. The Vital Statistics Form is required in order to remarry and/or to return to your maiden name after divorce. The document may also be required for other purposes. I have enclosed a $40.00 payment (for Divorce Decree which covers the cost of the Vital Statistics form as well). Please send a certified copy of my Vital Statistics Form ($10.00) to me at the address below. I have enclosed a $10.00 payment (for Vital Statistics Form). Enclosed is a copy of my driver's license or, if none, other photo identification. I understand that this is needed to obtain a copy of the Vital Statistics form. Please send a certified copy of the address below Name: Street Address: Mailing Address: City & State: Telephone: (name of document) to me at Date Signature For Court use only: Certified copy given to party on Request to be processed and mailed NHJB-2205-F (11/25/2013) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com