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Version 12/2020
Alaska MARRIAGE 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:
Date of Marriage_________________________________
City/village of Marriage
_____________________________
FIRST, MIDDLE, LAST name of Bride, Groom or Spouse
FIRST, MIDDLE, LAST name (Maiden Name) of Bride or Spouse
APPLICANT NAME_____________________________________________
Contact Phone Number ________________________________________
Contact E-mail Address_________________________________________
Mailing Name ________________________________________________
Mailing Address:
Street/P.O. Box _______________________________________________
City, State, Zip_________________________________________________
Relation to the person of the record
__Bride __Groom __ Spouse
__ Legal Representative (with documentation)
Purpose of Request:
(Ex: 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 Marriage Certificates
_____
($30 for one copy plus $25 for each additional copy of the same record ordered at the same time)
_______
_____ _______
Marriage Certificate Correction Processing Fee ($30)
Apostille Fee ($12 for first copy, $2 for each additional copy)
_____
___________________________________________
_______
Apostille Country:
Number of Heirloom Certificates ($65 for f
irst copy, $60 for additional copies)
Choose one:
___
Rie Munoz (“Tenakee Wedding”)
___ D
ale DeArmound (“Raven In Love”)
B___
yron Birdsall (“McKinley Moonlight”
____ 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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