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Version 12/2020
Alaska DIVORCE Certificate Request Form
Please read the instructions on the first page. Incomplete or inaccurate requests that do not include a copy of a government issued ID will not
be processed.
Submit this form WITH PAYMENT in person (Cash, check, money order or credit card), by mail (check, money order, or credit card), or by fax
(credit card only). Office locations and contact information are on the instruction page.
Please make Checks/Money Orders payable to: ALASKA VITAL RECORDS OFFICE.
There will be a $30 nonsufficient funds fee for returned checks.
Information needed to locate the record:
FIRST MIDDLE LAST Name of Spouse A:
LAST/FAMILY Name of Spouse A: (Other names used, if any)
FIRST MIDDLE LAST Name of Spouse B:
LAST/FAMILY Name of Spouse B: (Other names used, if any)
Date of Divorce:
Date of Marriage: ______________________________________________
City/Village of Divorce: _________________________________________
APPLICANT NAME:
Contact Phone Number _____________________________________
Contact E-mail Address
__________________________________________________ Mailing Name
Mailing Address:
Street/P.O. Box ___________________________________________________________
City, State, Zip
Relationship to the Persons Named on the record
____Spouse ____Legal Rep (with documentation)
____Other (Please specify) _______________________________________
Purpose of Request (Personal records, legal purposes, Government benefits,
etc…) _________________________________________________________
Signature of Person Requesting the Record (Electronic/Typed
Signature NOT Accepted)
What would you like to order?
Number of Certified Divorce Certificates
Fee:
($30 for one copy plus $25 for each additional copy of the same record ordered at the same time)
DivorceCertificate CorrectionProcessing Fee ($30) _______
_______ Apostille Fee ($12 for first copy, $2 each additional copy)
_______
Apostille Country: ___________________________________________
______*Expedited/Rush Service (Fax/Email orders) ($11)
*Please note: If marriage is not registered, it cannot be rushed
How would you like it shipped?
Please note: Alaska Vital Records assumes no responsibility for items after they have been shipped. If documents are lost or
stolen you will need to resubmit your order with ID and payment. Vital Record certificates are legal documents that should be
in your control only. Lost certificates may end up in the hands of criminals who could use the certificate to steal your identity.
HAVRS strongly recommends you choose a method of shipping that requires a signature upon receipt. Call
907-465-3391 for more information on International Shipping.
Choose one:
_ Regular Mail (No fee, NO tracking available!)
_____ Priority Mail ($9.00. Includes tracking. No signature required).
_ Priority Mail ($12.00. Includes tracking and signature).
_____ FedEx Alaska (No P.O. Boxes; $25.00. Includes tracking and signature).
Do you want a signature?
Yes
No
_____ FedEx USA (No P.O. Boxes; $30.00. Includes tracking and signature).
Do you want a signature?
Yes
No
Total for all Items
Credit Card Information
(We accept: Visa, MasterCard, Discover, and American Express)
Name on Credit Card _________________________________________
Credit Card Number __________________________________________
Expiration date ______________________________________________
Zip Code ___________________________________________________
Cardholder Signature (REQUIRED; ELECTRONIC/TYPED SIGNATURE NOT
ACCEPTED) _______________________________________________
Click to Clear Form ______
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