Fill - Free fillable ALAMEDA COUNTY CLERK-RECORDER CERTIFIED COPY REQUEST PDF form

Rev. 01/19/18

J:J:\RECDOCS\New Clerk-Recorder Form Inventory\2018\VTLS Marriage Certificate Copy Index Request Form rev 01-19-18.doc

ALAMEDA COUNTY CLERK-RECORDER

MARRIAGE CERTIFICATE COPY REQUEST FORM

NUMBER OF COPIES REQUESTED: _____ DATE OF MARRIAGE (WITHIN 90 DAYS)______________________

TYPE OF MARRIAGE LICENSE BEING PURCHASED? (CIRCLE ONE) PUBLIC CONFIDENTIAL

CITY OF MARRIAGE (MUST BE WITHIN CALIFORNIA) _________________________________________________

NAME OF ‘PARTY A’: ____________________________________________________________________________

NAME OF ‘PARTY B’: ____________________________________________________________________________

STREET ADDRESS (REQUIRED): __________________________________________________________________

CITY, STATE, ZIP: _____________________________________________ TELEPHONE: ____________________

INITIAL BELOW:

______ _____ I/we have read the Changing Your Name on Your Marriage License (on the back of this form). I/we

understand that the name(s) I/we indicated on the marriage license that I/we plan to use after marriage and

cannot be changed or amended after the license has been issued.

I, ___________________________________________________________, SWEAR (OR AFFIRM) UNDER PENALTY

(PRINT YOUR NAME HERE)

OF PERJURY THAT I AM AN “AUTHORIZED PERSON,” AS DEFINED IN HEALTH AND SAFETYCODE 103526(c).

“AUTHORIZED PERSON” MEANS:

1. The person named on the record (The “Certificate Holder”).

2. A parent or legal guardian of the certificate holder. (Legal guardian must provide documentation.)

3. A person entitled to receive the record as the result of a court order.

4. A member of a law enforcement agency or a representative of another governmental agency, as

provided by law, who is conducting official business. (Photo identification or request on Agency’s

letterhead)

5. A child, grandparent, grandchild, sibling, spouse or domestic partner of the certificate holder.

6. An attorney representing the certificate holder or the certificate holder’s estate, or any person or agency

empowered by statute or appointed by a court to act on behalf of the certificate holder or the certificate

holder’s estate. (Include a copy of the power of attorney; documentation identifying you as the executor

or supporting documentation)

________________________________________________________________________________________________

(SIGNATURE OF REQUESTER) (DATE)

FOR OFFICE USE ONLY

ID PRESENTED-PARTY A____________________ ID PRESENTED-PARTY B_______________________

RECORDING CLERK’S INITIALS__________________ LOCAL REGISTRATION NUMBER____________________________

TOTAL COPIES REQUESTED____________________ BANKNOTE NUMBER(S) USED______________________________

RECEIPT NUMBER FOR COPIES_________________ ACCOUNTING USE ONLY__________________________________

DEPUTY MARRIAGE COMMISSIONER’S CHECKLIST

COMMISSIONER’S NAME: __________________________________________________________

TYPE OF LICENSE--CIRCLE ONE: PUBLIC CONFIDENTIAL

RECEIPT NUMBER FOR CEREMONY: ____________________________________

LICENSE ISSUED OUT OF COUNTY? Y N LICENSE NUMBER ____________________________________

Rev. 01/19/18

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IMPORTANT: Couples must read and initial on the other side of this application.

Disclaimer: CHANGING YOUR NAME ON YOUR MARRIAGE LICENSE

The Name Equality Act of 2007 gives specific options to the parties to be married, at the time they apply

for a California marriage license, to choose and list on the license the new name(s) each party will use

after marriage. (The new law applies only to marriage licenses issued on or after January 1, 2009. It does

not apply to any marriage license issued before that date.)

Parties are NOT required to have the same name; nor are they required to change their names at all.

If the parties to be married choose to have their new name(s) shown on the marriage license, then the

new name must be entered on the marriage license application. The parties may choose any of the

following middle or last names as the name(s) they wish to use after marriage {Family Code, Section

306.5(b)(1),(2), and (3)}.

The parties to the marriage may adopt any of the following last names:

 Current last name of the other spouse or last name of either of the spouse

give at birth

 A name combining into a single last name all or a segment of the current

last name or the last name of either spouse given at birth.

 A combination of the last names.

The parties to the marriage may adopt any of the following middle names:

 Current last name of either spouse or the last name of either spouse given at

birth.

 A combination of the current middle name and the current last name of the

person or spouse.

 A combination of the current middle name and the last name given at birth

of the person or spouse.

Note: You may not change your first name using this process.

IMPORTANT! You may not amend the marriage license AFTER it has been issued in order to add or to

change the name you wish to use after marriage. The name you indicate on the application will be the name

that is put on the marriage license and certificate; it cannot be changed by the County Clerk.

A certified copy of the marriage certificate constitutes proof that the use of the new name, or retention of

the former name, is lawful [Family Code Section 306.5(b)(3)(a)].

For purposes of establishing relationship and/or name, the marriage certificate is used by multiple local,

state, federal and private agencies including, but not limited to, insurance companies, departments of

motor vehicles, the Social Security Administration, the Passport Office, etc. These agencies have

conflicting rules and regulations regarding what documents they will accept as proof of a name change

due to marriage. You are strongly encouraged to contact these agencies directly to verify their

requirements before applying for a marriage license.

It is unlawful for our employees to answer questions of a legal nature; County Clerk staff cannot advise

you how to complete the marriage license application as it relates to your entry of a new name, or

retention of your former name on the marriage license application. For your protection, if you have any

questions as to whether you should or should not list your new name on the marriage license; or

questions as to how the Name Equality Act of 2007 may affect you, please consult an attorney before

applying for a marriage license.

New names (if any) after marriage: (optional)

Party A: First________________Middle___________________Last____________________________

Party B: First________________Middle___________________Last____________________________

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