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