Office of Vanessa Burzynski County Clerk
Grimes County, Texas
www.grimescountytexas.gov
CERTIFIED COPY OF MARRIAGE RECORD REQUEST
(Copias de licencia de matrimonio)
FEES AND INFORMATION
COSTO Y INFORMACION
Certified Marriage Records are $10.00 per copy
CASH, MONEY ORDER, or DEBIT/CREDIT in person
(A $3.95 charge will be added for Debit/Credit)
MONEY ORDER ONLY by mail
Non-refundable fee of $10.00 for searched requests
Copias Certificada son $10.00 por licencia
EFFECTIVO, MONEY ORDER, Y CREDITO/DEBIT in
persona. ($3.95 mas para Debit/Credito)
SOLO MONEY ORDEN por correo
No regresamos fondos por servicio
***MARRIAGE RECORD INFORMATION***
GRIMES COUNTY ONLY
[ # ]
Copies Requested
Date of
Marriage:
(Fecha de matrimonio)
Month/Mes de matrimonio
Day/Dia de matrimonio
Marriage
Applicant 1
(Aplicante 1)
First/Primer Nombre
Middle/Segundo
Marriage
Applicant 2
(Aplicante 2)
First/Primer Nombre
Middle/Segundo
***YOUR INFORMATION***
(Informacion de solicitante)
Your relationship to
above record
[ ] Spouse
[ ] Single Status
[ ] Officiant
[ ] Other
Name:
(Nombre)
First/Primer nombre de solicitante
Middle/Segundo
Last Name/Appellido
Home
address:
(Domicilio)
# Street/Calle
Apt #
City/Ciudad
State/Estado
Zip/Codigo
Phone #:
(Telefono)
( )
E-mail
(for Receipt):
[ ] SAME AS ABOVE
Mailing address if different from above:
(Residencia de domicilio es diferente)
nombre First/Primer
Middle/Segundo
Last/Apellido
# Street/Calle
Apt #
City/Ciudad
State/Estado
Zip/Codigo
Would you like a paper receipt? YES NO
(Must sign to process) Date
Would you like a receipt emailed? YES NO
Mail your form and money order to:
Grimes County Clerk’s Office
ATTN: Marriage License
PO Box 209
Anderson, Texas 77830
OFFICE USE ONLY
Receipt
Issuing
Clerk
Amount
License #
Year
Volume
Page
Form revised 02/02/2015 DCCYAWOT