Office of John F. Warren County Clerk Dallas County, Texas www.DallasCounty.org C ERTIFIED COPY OF MARRIAGE RECORD REQUEST (Copias de licencia de matrimonio ) FEES AND INFORMATION COSTO Y INFORMACION Certified Marriage Records are $10.00 per copy CASH, MONEY ORDER, or DEBIT /CREDIT in person ( A $3.95 charge will be added for Debit/Credit ) MONEY ORDER ONLY by mail N on - refundable fee of $10.00 for searched requests Copias Certificada son $10.00 por licencia EFFECTIVO , MONEY ORDER, Y CREDITO/DEBIT in persona . ($3.95 mas para Debit/Credito) SOLO MONEY ORDEN por correo No regresamos fondos por servicio *** MARRIAGE RECORD INFORMATION *** DALLAS COUNTY ONLY [ # ] Copies Requested D ate of Marriage : (Fecha de matrimonio) Month/Mes de matrimonio Day /Dia de matrimonio Year /A361o de matrimonio name : (Esposo ) First /Primer Nombre Middle /Segundo Last Name /Appellido name : (Esposa ) First /Primer Nombre Middle /Segundo Maiden Last Name /Appellido de Soltera Other Last Name/Apellido Anterior ***YOUR INFORMATION *** (Informacion de solicitante) Your relationship to above record [ ] Spouse [ ] Single Status [ ] Officiant [ ] Other Name: (Nombre) First/Primer nombre de solicitante Middle /Segundo Last Name/Appellido Home address: (Domicilio) # Street/Calle Apt # City/Ciudad State/Estado Zip /Codigo Phone #: (Telefono) ( ) E - mail (for Receipt) : [ ] SAME AS ABOVE Mailing address if different from above: (Residencia de domicilio es diferente ) First/Primer nombre Middle/Segundo Last/Apellido # Street/Calle Apt # City/Ciudad State/Estado Zip/ Codigo Would you like a paper receipt? YES NO (Must sign to process) Date Would you like a receipt emailed? YES NO Mail your form and money order to: ATTN: Marriage License 509 Main Street Suite #200 Dallas, TX 75202 (Please allow 2-4 weeks to process by mail) OFFICE USE ONLY Receipt Issuing Clerk Amount License # Year Volume Page Form revised 02/02/2015 DCCYAWOT American LegalNet, Inc. www.FormsWorkFlow.com