Download Divorce Certificate Mail Order Form for Free

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Washington State Department of Health
Marriage / Divorce Certificate Mail Order Form
Complete payment and mailing information below:
Total number of certified certificates:
x $20.00 =
$
First Class Mail (allow 2-3 weeks for delivery)
no additional charge
*USPS Express Mail Delivery (street address or PO Box)
$
*Fed Ex to continental US (no PO Box)
$
*Fed Ex to AK/HI/Canada/Mexico (no PO Box)
$
TOTAL AMOUNT DUE
$
Instructions
Print clearly.
We issue certificates for marriages and divorces that took place in Washington State only.
For marriages and divorces before 1968, contact the local County Auditor for marriage or County Clerk for divorce.
We only accept checks or money orders for mail orders. Do not send cash or credit card information.
$20.00 per certificate.
Visit www.doh.wa.gov for more information and ordering options, or call 360-236-4300, Monday through Friday,
between 8:00 a.m. and 5:00 p.m. Pacific Time.
Contact
Information
Name of person ordering certificate(s):
Company Name (if applicable):
Address sending certificate(s) to:
(Street address required for FedEx Orders)
City:
State:
ZIP Code:
Daytime Phone: (______) ______________________
Email Address:
Complete Person A and Person B information below, to the best of your knowledge. Exact date or county information not required.
Marriage Certificate Request
Number of Certificates Ordering_________
Person
A
Legal Name Before Marriage:
(First) (Middle) (Last)
Birth Last Name (if different): Circle one: Bride, Groom, Spouse
Person
B
Legal Name Before Marriage:
(First) (Middle) (Last)
Birth Last Name (if different): Circle one: Bride, Groom, Spouse
Approximate Date of Marriage or 10-year
Search Range (after January 1, 1968):
Licensing County, if known:
Divorce Certificate Request
Number of Certificates Ordering_________
Spouse
A
Name Listed on Divorce Decree:
(First) (Middle) (Last)
Birth Last Name (if different): Circle one: Wife, Husband, Spouse
Spouse
B
Name Listed on Divorce Decree:
(First) (Middle) (Last)
Birth Last Name (if different): Circle one: Wife, Husband, Spouse
Approximate Date of Divorce or 10-year
Search Range (after January 1, 1968):
Filing County, if known:
Make checks or money orders
payable to DOH.
MAIL ORDERS TO:
Department of Health
PO Box 9709
Olympia WA
98507-9709
*Signature is required at time of delivery for USPS Express Mail and Federal Express Orders.
DOH 422-104 May 2013 *Additional charges for express delivery are per order mailed, not per certificate.
Divorce Certificate Mail Order Form
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