APPLICATION FOR CERTIFIED COPY OF BIRTH OR MARRIAGE CERTIFICATE

							APPLICATION FOR CERTIFIED COPY OF BIRTH OR MARRIAGE CERTIFICATE

Barbara W. Sasser
Register of Deeds
Post Office Box 974
Nashville, NC 27856

Fees: send cash or money order - NO PERSONAL CHECKS
Paper copy: $10.00
Wallet size: $12.00

Date Requested

Applicant is:

    A. Requesting OWN certificate, or:

        Spouse         Brother          Sister        Child

        Parent         Grandparent

    B. seeking information for legal determination or personal property rights; or

    C. authorized agent, attorney, or legal representative of the person listed in A or B above.

    (select )       BIRTH            DEATH           MARRIAGE

    FULL NAME (if marriage - both parties)

    _____________________________________________________________________

    DATE: BIRTH | MARRIAGE | DEATH ____________________________________

    FULL NAME OF FATHER ____________________________________________________

    FULL NAME OF MOTHER (maiden name) ______________________________________

    NUMBER OF CERTIFICATES NEEDED ____________

    SIGNATURE __________________________________________________

    ADDRESS _____________________________________

    _____________________________________

    _____________________________________

    _____________________________________

    * Need photocopy of Driver's License of party requesting certificate