County Clerk Marriage Record Copy Request Form
***THIS
FORM
IS
ONLY
TO
BE
USED
FOR
MARRIAGE LICENSE
COPY
REQUESTS***
Date:
________
_
To:
Denton County Clerk, Juli Luke
FAX
Number: 940/349-2019
Department: Recording
From: Name:
________________
_
Fax:
(~_~)
____
_
Phone number:
(~_~)
__
CLERK USE ONLY
TOTAL CHARGES
$
------
Authorized Signature:
This form authorizes the merchant
(,,.V~ita~1=c~h~ek~)~to-c~h-a-rg_e_m_y_a_c_co-u-nt~£~0-r
s-e-rv~1c_e_s-re-n~de-r-ed~b~y~th~e~C-ou-n~ty-C=1~er~k~'s-o~fi~ic_e_,
p~lu_s_a~$=2~_5=0-s-er-vice
fee.
A base percentage
of
4% will be charged on credit transactions over $50.00. Please see our website for additional fees.
Please provide details about document requested:
Name
of
Groom:
Name
of
Bride:
Date
of
Marriage:
____________________
_
Address
to
send documents:
****************************************************************
Payment Information
Name as it appears
on
Card:
------------------
Credit Card Account Number:
~----
(Check which applies) MasterCard D Discover D American Express D Visa D
CVV#
______
(security code
on
back
of
card) Exp. Date:
__
/
__
Billing Address:
__________
City
_____
_
ZIP
**Note** The
ZIP
Code
must
match the cardholder's billing address;
if
not, the transaction will
be
declined.
• Certified copies
of
marriage records recorded after April
1,
2001 are $18.00 + $2.50 credit transaction fee.
• Certified copies
of
marriage records recorded prior to April
2,
2001 are $17.00 + $2.50 credit transaction fee.
********************************************************************
click to sign
signature
click to edit
![]()
