DEPARTMENT OF HEALTH SERVICES Division of Public Health F-05281 (Rev. 11/07)
STATE OF WISCONSIN Chapter 69.21 Wis.Stats. Page 1 of 2
WISCONSIN MARRIAGE CERTIFICATE APPLICATION
(for Mail or In-Person Requests)
TYPE or PRINT.
PENALTIES: Any person who willfully and knowingly makes a false application for a marriage certificate shall be fined not more than $1,000 or imprisoned not more than 90 days, or both, per s. 69.24(2), Wis. Stats. Any person who willfully and knowingly obtains a marriage certificate for fraudulent purposes is guilty of a Class I felony [a fine of not more than $10,000 or imprisonment of not more than 3 years and 6 months, or both, per s. 69.24(1), Wis. Stats.].
The information in Section I is about the person completing this application.
YOUR CURRENT NAME - First Middle Last YOUR DAYTIME TELEPHONE NUMBER ( YOUR STREET ADDRESS (CANNOT be a P.O. Box address) No. City, Village, or Township State Apt. MAIL TO ADDRESS (if different) No. City or Village State Zip Code ) Apt.
I. APPLICANT INFORMATION
TYPE OF CURRENT VALID PHOTO ID (See item 4 on page 2.)
PHOTO ID NUMBER
STATE OF ISSUANCE (Indicate country, if not issued in U.S.A.)
II. APPLICANT'S RELATIONSHIP TO PERSON(S) NAMED ON THE CERTIFICATE
According to Wisconsin Statute, a CERTIFIED copy of a marriage certificate is only available to those with a "direct and tangible interest" (categories A E below.) You may select to receive an uncertified copy if you just need a copy for informational purposes OR if you do not meet the criteria for categories A E. In that case, you may check category F below. (See item 1 on page 2 for more details.)
Check one box which indicates YOUR RELATIONSHIP to one of the PERSONS NAMED on the marriage certificate.
A. I am one of the PERSONS NAMED on the marriage certificate. B. I am a member of the immediate family of one of the PERSONS NAMED on the marriage certificate. (Only those listed below qualify as immediate family. NOTE: Grandchildren, step-parents, and step-children may only obtain certified copies as C E.) CHECK ONE. Parent (whose name is on the bride or groom's birth certificate and whose parental rights have not been terminated) Spouse Child Brother / Sister Grandparent
C. I am the legal custodian or guardian of one of the PERSONS NAMED on the marriage certificate. (Legal proof is required. See item 1 on page 2.) D. I am a representative authorized, in writing, by any of the aforementioned (categories A - C). (The written, NOTARIZED authorization must accompany this application. See item 1 on page 2.) Specify whom you represent. __________________________________________________________________________________ E. I can demonstrate that the information from the marriage certificate is necessary for the determination or protection of a personal or property right for myself/my client/my agency. (Proof is required.) Specify interest. ____________________________________________________________________________________________ F. Uncertified copy (information purposes only; not valid for legal purposes) Persons not in categories A E above OR who do not need a copy for legal purposes. (See item 1 on page 2.)
PURPOSE FOR WHICH CERTIFICATE IS REQUESTED (Specify. This information will assist us in processing your request.)
FEE IS NOT REFUNDABLE IF NO RECORD IS FOUND. CANCELLATION REQUESTS ARE NOT ACCEPTED. Search Fee (includes one copy, if found) ....................................................................................... $ 20.00 ___20.00____ Each additional copy of the same record, issued at the same time as the first copy .............. __________ X $ 3.00
Number of Copies
Make check or money order payable to: STATE OF WIS. VITAL RECORDS
Mail your application materials and fee to: STATE VITAL RECORDS OFFICE / PO BOX 309 / MADISON, WI 53701-0309
Be sure to include (1) completed form, (2) acceptable identification, (3) any additional proof or authorization required, (4) self-addressed, business-size envelope, and (5) check or money order.
Middle BIRTH Last Name (as it appears on his birth certificate)
IV. MARRIAGE INFORMATION
GROOM'S BIRTH NAME - First
BRIDE'S BIRTH NAME - First
BIRTH Last Name (as it appears on her birth certificate)
LOCATION OF MARRIAGE City, Village, or Township
LOCATION OF MARRIAGE - County
DATE OF MARRIAGE (Month/Day/Year)
I hereby attest that the information provided on this application is correct to the best of my knowledge and belief and that I am entitled to copies of the requested marriage certificate in accordance with the categories listed above.
SIGNATURE - Applicant
(Person Completing Application)
Date Signed (Month / Day / Year)
VITAL RECORDS OFFICE USE ONLY
Reset Fee Calculations
WISCONSIN MARRIAGE CERTIFICATE APPLICATION
F-05281 (Rev. 11/07)
Page 2 of 2
1. What is the difference between a "certified" and an "uncertified" copy of a marriage certificate?
A certified copy of a marriage certificate issued by the State Vital Records Office will have a raised seal, will show the signature of the State Registrar, and will be printed on security paper. A certified copy may be required to change your last name or to obtain benefits. State law restricts who may obtain a certified copy of a marriage certificate. A certified copy can only be issued to those people with a "direct and tangible interest" (section II, categories A E) which means the following people: The bride or groom named on the marriage certificate (section II, category A). An immediate family member, defined as spouse, child, parent (whose name is on the bride or groom's birth certificate and whose parental rights have not been terminated), brother/sister, or grandparent of a subject of the record (section II, category B). NOTE: Grandchildren, step-parents, and step-children can only obtain certified copies as C E. The legal custodian or guardian of the bride or groom named on the marriage certificate. Legal proof, e.g., a court order of custody or guardianship, is required. (section II, category C). A person authorized in writing by one of the above. Written authorization with NOTARIZED signatures must accompany the application and the authorization must clearly state the relationship of the authorizing party to the subject of the record (section II, category D). A person who can demonstrate that the marriage certificate is required to determine or to protect a personal or property right (section II, category E). Proof is required. If you do not meet one of the above criteria, you cannot receive a certified copy of a marriage certificate. An uncertified copy will contain the same information as a certified copy but it is not acceptable for legal purposes, such as claiming insurance benefits (section II, category F).
2. How long will it take to process my request?
Copies of marriage certificates are available from the State Vital Records Office no less than three weeks from the date of the marriage.
Applying in Person In-person requests for certified copies of marriage certificates are usually completed within two business hours of application, if the marriage certificate is on file. In-person requests for uncertified copies of marriage certificates are not completed on the same schedule as requests for certified copies. In-person requests for uncertified copies may take up to six months to complete.
Applying by Mail Requests for certified copies of marriage certificates may take up to one month to complete. Requests for uncertified copies of marriage certificates are not completed on the same schedule as certified copies. Mail requests for uncertified copies may take up to six months to complete.
3. How will the certificate be sent?
Marriage certificates are mailed in one of three ways: a self-addressed, stamped envelope provided by the applicant a pre-paid carrier envelope provided by the applicant (e.g., express carriers) first-class mail NOTE: It is illegal to FAX marriage certificates.
4. What identification is required when applying for a certified or uncertified copy of a marriage certificate?
A current valid photo ID (e.g., Wisconsin Driver's License, Wisconsin State Identification Card, passport, Military Identification Card) is required when applying in person.) A photocopy of the applicant's current valid photo ID must accompany all mail applications.
If you have questions regarding this form, please call 608-266-1373 or visit our website at www.dhfs.wisconsin.gov/vitalrecords.