Center for Health Statistics
P.O. Box 9709
Olympia, WA 98507
360
-236-4300
To request this document in another format, call 1-800-525-0127.
Deaf or hard of hearing customers, please call 711 (Washington Relay) or email [email protected]
DOH 422-104 February 2021
I
nstructions for Marriage and Divorce Certificate Order Form
Carefully read these instructions before completing and submitting the Marriage and Divorce Certificate Order Form. Chapter
70.58A RCW and Chapter 246-491 WAC requires applicants to provide required information to order marriage and divorce
certificates. Our office has marriage and divorce records from 1968 to present that occurred in the state of Washington.
Checklist for completing the Marriage and Divorce Certificate Order Form:
C
omplete all fields on the Marriage and Divorce Certificate order form
Check or money order made payable to DOH
Send the order form and nonrefundable payment to:
D
epartment of Health
Center for Health Statistics
PO Box 9709
Olympia, WA 98507
W
hat information is required for marriage and divorce records?
The following information is required as it appears on the record:
• First and last name of one of the parties on the record
• Approximate date the event occurred (month and year)
• City or county where the event was filed
W
hat address do I put on the order form?
The address you provide on the order form must be the address you are REGISTERED to receive mail at. If that is not an option, put
the name of the individual registered at the address and then put “in care of” before your name (Ex. John Doe C/O Jane Doe, 101
Israel Rd SE, Tumwater, WA 98502). If filling in the form by hand, please print clearly to avoid delay in processing.
W
hat form of payment is accepted?
We accept checks or money orders for requests mailed to DOH. Make sure your check or money order is made payable to DOH.
Important note: no refunds will be given if a record could not be located.
H
elpful tip: To confirm that DOH has received your order over the phone, we need:
• For Checks: Check number, date it was cashed (check with your banking institution before calling DOH), and name on the
check
• For Money Orders: Money order number and date it was cashed (to find this date call the number provided on your mone
y
o
rder receipt)
For more information about vital records, please visit our website at
https://www.doh.wa.gov/LicensesPermitsandCertificates/BirthDeathMarriageandDivorce.
To request this document in another format, call 1-800-525-0127.
Deaf or hard of hearing customers, please call 711 (Washington Relay) or email [email protected]
DOH 422-104 February 2021
MARRIAGE/DIVORCE
CERTIFICATE
MAIL ORDER FORM
REGISTER
VALIDATION SPOT
MAIL ORDERS TO:
Department of Health
PO BOX 9709
OLYMPIA WA 98507-9709
DO NOT USE ANY UNAPPROVED THIRD PARTY VENDOR TO
OBTAIN THIS FORM. DO NOT PAY A FEE FOR THIS FORM
MAKE CHECKS & MONEY ORDERS
PAYABLE TO: DOH
NO REFUNDS
FEES: Check the box to select order type then enter the quantity.
☐ Total number of CERTIFIED certificates
x =
☐
APOSTILLE:
(Indicate country requesting document here)
x =
SHIPPING: (expedited shipping does NOT mean expedited processing)
☐
First Class Mail: (No additional charge)
x =
☐
*USPS Express Mail Delivery:
(street address or PO Box)
x =
☐ **FedEx to continental US: (no PO Box)
x =
☐ FedEx to AK/HI/Canada/Mexico: (no PO Box)
x =
TOTAL AMOUNT DUE
(ADD THE FEE AMOUNT + SHIPPING FOR TOTAL DUE)
F
☐ NM
☐ NI
☐ NR
☐ SIE
☐ MD
☐ MR
☐ NQ
☐ IA
☐
CALLED
DATE:
INITIALS:
☐EMAILED
DATE: INITIALS:
☐LETTER SENT
DATE: INITIALS:
OTHER:
☐ VERIFIED
DATE: INITIALS:
☐ SENT TO SOS
DATE: INITIALS:
☐
NOTATED IN WHALES
FEE#
COUNTRY:
APPLICANT INFORMATION
NAME OF PERSON/COMPANY ORDERING CERTIFICATE (S):
ADDRESS SENDING CERTIFICATE (S) TO: (STREET ADDRESS REQUIRED FOR FEDEX ORDERS)
CITY: STATE:
ZIP CODE:
COUNTRY
:
DAYTIME TELEPHONE NUMBER:
EMAIL ADDRESS:
COMPLETE PERSON A AND PERSON B INFORMATION BELOW, TO THE BEST OF YOUR KNOWLEDGE.
EXACT DATE OR COUNTY INFORMATION NOT REQUIRED.
*MARRIAGE & DIVORCE CERTIFICATES ARE NOT AVAILABLE FOR ISSUANCE UNTIL 3 MONTHS AFTER THE EVENT WAS FINALIZED WITH THE COUNTY*.
MARRIAGE RECORD DETAILS
PERSON
A
FIRST NAME(S):
FULL MIDDLE NAME(S):
LAST NAME(S):
LAST NAME PRIOR TO FIRST MARRIAGE: (IF DIFFERENT)
CIRCLE ONE: BRIDE, GROOM, SPOUSE
PERSON
B
FIRST NAME(S):
FULL MIDDLE NAME(S):
LAST NAME(S):
LAST NAME PRIOR TO FIRST MARRIAGE: (IF DIFFERENT)
CIRCLE ONE: BRIDE, GROOM, SPOUSE
APPROXIMATE DATE OF MARRIAGE: (MONTH & YEAR - 1968 to present only)
LICENSING COUNTY:
TOTAL NUMBER OF MARRIAGE CERTIFICATES ORDERING: [ ]
DIVORCE RECORD DETAILS
PERSON
A
FIRST NAME(S):
FULL MIDDLE NAME(S):
LAST NAME(S):
LAST NAME PRIOR TO FIRST MARRIAGE: (IF DIFFERENT)
CIRCLE ONE: BRIDE, GROOM, SPOUSE
PERSON
B
FIRST NAME(S):
FULL MIDDLE NAME(S):
LAST NAME(S):
LAST NAME PRIOR TO FIRST MARRIAGE: (IF DIFFERENT)
CIRCLE ONE: BRIDE, GROOM, SPOUSE
APPROXIMATE DATE OF DIVORCE: (MONTH & YEAR - 1968 to present only)
FILING COUNTY:
TOTAL NUMBER OF DIVORCE CERTIFICATES ORDERING: [ ]
$25
$15
$15
$25
$0
$26.35
CLEAR FORM