Please type in CAPITAL letters Fax to 916-745-4880
DIVORCE CERTIFICATE INFORMATION
Husband's Name
  First name Middle name Last name
Wife's's Name:
  First name Middle name Last name
Date of Divorce: State of Diovorce
Relationship:,,,, .Other:
County: City: File#
Reason for Request:
Other: .Number of Copies:
SHIPPING AND DELIVERY INFORMATION
Ship to:
  First name Middle name Last name
Shipping Address:
Apartment No:
City: State: Zip:
Daytime Tel:
E-mail:
Number of CopiesDelivery Method:
CREDIT CARD INFORMATION
Name on Credit Card
  First name Middle name Last name
Billing Address:
Apartment No:
City: State: Zip:
Credit Card Number: Expires

Card Holder Signature:_____________________________________ Date:
WARNING:
False application for a Birth Certificate is a punishible offense. For protection of the individual, certificates of vital events
are ONLY available to the indididual listed on the certificate or to a parent..

Requestor Signature:_____________________________________ Date: Needed by :


I authorize USA Birth Certificate Bureau or their representative to obtain divorce certificate for me.

Choose One:
*You must list a physical street address (no APO's, FPO's, or P.O. Boxes)

Fax to 916-745-4880
Rush Delivery*: Regular Delivery:
Our Fee: $45.00
State Fees: $25.00 - $35.00
Our Fee $25.00
State Fee: $8.00 - $10.00
*(includes FEDEX Overnight charges)
* You will receive three separate charges on your credit card
*You Must also fax a copy of your drivers license or state issued id.
Number of copies
All Sales Final, No Debit Cards Accepted.Process times may vary based on workload of state agencies.
I understand that USA Birth Certificate Bureau is not responsible for any service
performed by any overnight courier service.