MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES P.O. BOX 570
BUREAU OF VITAL RECORDS JEFFERSON CITY, MISSOURI 65102-0570
APPLICATION FOR COPY OF MARRIAGE AND DIVORCE STATEMENTS
Missouri law requires a $15.00 fee to search the files. One certified statement of the event will be issued if
found. If no report is found, the fee is retained for the search, and a “No Report Statement” will be issued.
**Certified statements are computer generated and are valid for legal purposes.
FEE MUST ACCOMPANY APPLICATION
Check or money order payable to: Missouri Department of Health and Senior Services
Statewide recording of marriage and divorce reports began July 1, 1948.
TYPE OR PRINT ALL ITEMS EXCEPT SIGNATURES
MARRIAGE ________ (Quantity) DIVORCE ________ (Quantity)
A $15.00 fee is required for search of the files for a certified A $15.00 fee is required for search of the files for a certified
statement of Marriage. Additional statements are $15.00 each. statement of Divorce. Additional statements are $15.00 each.
FULL NAME OF GROOM (FIRST) (MIDDLE) (LAST) FULL NAME OF HUSBAND (FIRST) (MIDDLE) (LAST)
FULL NAME OF BRIDE (FIRST) (MIDDLE) (MAIDEN) FULL NAME OF WIFE (FIRST) (MIDDLE) (MAIDEN)
PREVIOUS MARRIED NAME PREVIOUS MARRIED NAME
LICENSE ISSUED (CITY) (COUNTY) DECREE ISSUED (CITY) (COUNTY)
DATE OF MARRIAGE (MONTH) (DAY) (YEAR) DATE DECREE ISSUED (MONTH) (DAY) (YEAR)
For marriage license prior to July 1, 1948, contact the Recorder For divorce decree of marriage prior to July 1, 1948, contact the
of Deeds in the county where the license was issued. Circuit Clerk’s Office in the county where the decree was
Please enclose a Self Addressed Stamped Envelope with your Request
YOUR SIGNATURE DATE OF APPLICATION DAYTIME PHONE
ADDRESS (STREET OR RURAL ROUTE) (CITY) (STATE) (ZIP)
PURPOSE FOR WHICH CERTIFIED STATEMENT IS TO BE USED
YOUR RELATIONSHIP TO PERSON NAMED ON STATEMENT (IF LEGAL GUARDIAN, MUST PROVIDE GUARDIANSHIP PAPERS)
IF LEGAL REPRESENTATIVE – INDICATE LEGAL RELATIONSHIP
WARNING: False application for a certified copy of a valid record is a crime.
MO 580-0641 (07-04) VS-151