Please fill out form in capital letters.Fax to 916-745-4880
MARRIAGE CERTIFICATE INFORMATION

We are unable to process Marriage License for PA. The contact number is 724-656-3100

Husband's Name
  First name Middle name Last name
Wife's Name:
  First name Middle name Last name
Date of Marriage: State of Marriage:
Relationship:,,,, .Other:
County: City:
Reason for Request: Other:
SHIPPING AND DELIVERY INFORMATION
Ship to:
  First name Middle name Last name
Shipping Address*
City: State: Zip:
Daytime Tel:
E-mail:
 

Requestor Signature:_____________________________________ Date: Needed by :

*You Must also fax a copy of your drivers license or state issued id.

CREDIT CARD INFORMATION

Name on Credit Card
  First name Middle name Last name
Billing Address:
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..

 I authorize USA Birth Certificate Bureau or their representative to obtain my marriage certificate for me.
*You must list a physical street address (no APO's, FPO's, or P.O. Boxes)

Fax to 916-745-4880

Our Fee: $49.00

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.