Civil Union Dissolution Form
To order a civil union dissolution certificate from the Department of Health:
- Complete and print the application below.
- Sign and date the application.
- Make check or money order payable to "Vermont Department of Health".
- The fee for certified copies is $10.00 per copy.
- Return the application with your check or money order to the address below. Do NOT mail cash.
Vermont Department of Health
P.O. Box 70
Burlington, VT 05402-0070
For more information visit: Obtaining Vital Records