Free Request for Authentication - Oregon

Phone: (503) 986-2593 Fax: (503) 986-2300 Secretary of State Corporation Division 255 Capitol St. NE, Suite 151 Salem, OR 97310-1327 FilingInOregon.com

Request for Authentication

Notary

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All Sections Must Be Completed

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Country documents will be used in: My documents were ordered from Oregon State Vital Records on: Authenticate my enclosed document(s). REQUESTER INFORMATION
Name of Requester: Mailing Address:

U.S. Area code and Phone Number: (This office cannot make international calls)

Email Address:

METHOD OF PAYMENT: Required $10.00 fee per document. Make check payable to "State of Oregon" or you may fax this request for Vital Records being mailed to our office from Oregon State. Do Not fax documents that require authentication ­ we can not Authenticate Faxed documents. VISA or MasterCard #: Expiration Date: Cardholder Name: Billing Address: City, State, Zip Code: Phone Number: Business Name: DELIVERY SERVICE:
If you would like us to return documents by express mail you must provide us with an account number or a pre-paid Air Bill. Otherwise documents will be returned by USPS mail.

USPS First Class Mail

Self-addressed, stamped envelope is provided.

DHL Account Number (International Delivery ONLY) FedEx Account Number UPS Account Number

516 (Rev. 05/09)