Marriage Certificate Order Form

Marriage certificates are available from the Department of Health or the State Archives and Records Administration, depending on how long ago the marriage occurred.

• Older records - More than five (5) years
  Contact the Vermont State Archives and Records Administration (VSARA)

• New records - Last five (5) years
  Order the marriage certificate from the Department of Health

For more information visit: Obtaining Vital Records Home

Department of Health Vital Records Order

• 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.

Send to:
Vermont Department of Health
Vital Records
P.O. Box 70
Burlington, VT 05402-0070

Application for a Certified Copy of a Marriage Certificate

For office use only ID# CPA# REC#

Number of Copies:
Amount Enclosed $
Date of Marriage:
Town where license was purchased :

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Bride Groom Spouse (Please check one)

Name:
Date of Birth:
Name of Father/Parent:
Name of Mother/Parent:

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Bride Groom Spouse (Please check one)

Name:
Date of Birth:
Name of Father/Parent:
Name of Mother/Parent:

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Your Name :
Address:
Town:
State:
Zip:
Phone Number:
Your relationship to couple on marriage certificate

Intended use of certificate

Proof of Marriage Family History Other: (specify)

Date: _____________________________

Signature: _____________________________________________________________________

Send to: Vermont Department of Health, Vital Records, PO Box 70, Burlington, VT 05402-0070 with check or money order payable to Vermont Department of Health.