APPLICATION FOR CERTIFIED COPY OF STATISTICAL RECORD OF MARRIAGE

INFORMATION

1.  Marriage records have been kept by state and county officials since January 1, 1926. From July 1, 1938, to December 31, 1941, records were kept only by the circuit court clerk in the county in which the marriage license was issued.

2.  The fee for a search of the records and a certified copy is $10.00. Additional copies ordered at the same time are $2.00 each.

3.  A five year search of our records will be made. If the record is not on file, a search fee of $6.00 will be retained.

INSTRUCTIONS

1.  Complete the required sections of this form. PLEASE PRINT.

2.  The application must be signed.

3.  PAYMENT:

Out-of-state:  Remit a bank or postal money order or a bank cashier’s check in the correct amount made payable to Mississippi State Department of Health.

Mississippi Resident:  In addition to the above methods of payment, personal checks are acceptable if drawn on a Mississippi bank; make payable to Mississippi State Department of Health.

We accept no responsibility for cash sent through the mail. Request for adjustments or refunds will be honored only if received within six months of application.

4.  Send completed application, appropriate fee and self-addressed stamped legal size envelope to the address at the top of this form.