DEPARTMENT OF HEALTH SERVICES
Division of Public Health
F-05281 (Rev. 11/2016)
STATE OF WISCONSIN
Wis. Stat. § 69.21
Page 1 of 2
WISCONSIN MARRIAGE CERTIFICATE APPLICATION
(for Mail or In-Person Requests)
PENALTIES: Any person who illegally possesses any vital record with knowledge that the vital record has been illegally obtained is guilty of a Class I felony [a fine of not more than
$10,000 or imprisonment of not more than 3 years and 6 months, or both, per Wis. Stat. § 69.24(1)].
MAIL TO NAME - First (if different)
YOUR STREET ADDRESS (CANNOT be a P.O. Box address) Apt. No
MAIL TO ADDRESS (if different than street address) Apt. No.
DAYTIME TELEPHONE NUMBER
TYPE OF CURRENT VALID PHOTO ID
(See item 3 on page 2.)
II. APPLICANT’S RELATIONSHIP TO
PERSON(S) NAMED ON THE CERTIFICATE
Per Wis. Stat. § 69.20(1), a CERTIFIED copy of a marriage certificate is only available to those with a “direct and tangible interest." (A–E)
CHECK ONE box which indicates YOUR RELATIONSHIP to one of the PERSONS NAMED on the marriage certificate.
A. I am one of the persons named on the marriage certificate.
B. I am a member of the immediate family of one of the persons named on the marriage certificate.
Parent Child Brother / Sister
Maternal Grandparent Paternal Grandparent
C. I am the legal custodian or guardian of one of the persons named on the marriage certificate.
D. I am a representative authorized by any person in categories A - C, including an attorney.
Specify the person you represent: ____________________________________________________________________________________
E. I can demonstrate the marriage certificate is necessary for the determination or protection of a personal or property right.
Specify your interest ______________________________________________________________________________________________
F. None of the above. I am requesting an uncertified copy. (Copy will not be valid for identity or legal purposes.)
NOTE: Grandchildren, stepparents, stepchildren, stepbrothers / stepsisters may only obtain certified copies as categories C – E.
PURPOSE FOR WHICH CERTIFICATE IS REQUESTED:
First Copy Fee ………………………………………………..………………………………………………..……………... $ 20.00 ___20.00____
Additional copies of the same certificate issued at the same time as the first copy …...…__________________ X $ 3.00 ___________
Number of Additional Copies
Submit your application materials and fee to:
Be sure to include: completed form, acceptable identification, payment,
any additional proof or authorization required
GROOM / SPOUSE 1 BIRTH NAME – First
BRIDE / SPOUSE 2 BIRTH NAME – First
DATE OF MARRIAGE (MM/DD/YYYY)
LOCATION OF MARRIAGE - County
LOCATION OF MARRIAGE – City, Village, or Township
I hereby attest that the information provided on this application is correct to the best of my knowledge and belief and that I am entitled to copies of
the requested marriage certificate in accordance with the categories listed above.
Important: Signature and payment are required for processing.
Waukesha County Register of Deeds
FEE IS NOT REFUNDABLE IF NO RECORD IS FOUND. CANCELLATION REQUESTS ARE NOT ACCEPTED.
Waukesha County Register of Deeds, 515 W Moreland Blvd RM AC110, Waukesha WI 53188
and a self addressed, stamped, business-size envelope
Make Check or Money Order payable to: Waukesha County Register of Deeds