Division
Docket No.
The Commonwealth of Massachusetts Department of Public Health Registry of Vital Records and Statistics CERTIFICATE OF ABSOLUTE DIVORCE OR ANNULMENT
(G.L. Chap. 208, Sec. 46) R-408
Husband-Name First 1. HUSBAND Usual Residence-Street Address 2a. County 2c. Wife-Name 5a. WIFE Usual Residence-Street Address 6a. County 6c. State 6d. 6b. First State 2d. Middle 2b.
Middle City, Town, or Location Date of Birth (mo., day, yr.) 3. Last 5b. City, Town, or Location Date of Birth (mo., day, yr.) 7.
Last
Number of this Marriage (1st, 2nd, specify) 4. Maiden Name
Number of this Marriage (1st, 2nd, specify) 8.
Date of this Marriage (mo., day, yr.)
Number of Children Born Alive of this Marriage
Number of Children under Age 18 in this Family
9.
10a.
10b.
FOR COURT USE ONLY County of Judgment 11. JUDGMENT Date of Judgment Nisi
(mo., day, yr.)
Title of Court 11a. Type of Judgment 13. Name of Plaintiff 16.
Divorce or Annulment
Date of Judgment Absolute
(mo., day, yr.)
12. Docket Number 15.
14. Cause for which Granted 17. Title of Official 18b.
Signature of Certifying Official 18a.