Fillable F05282 Wisconsin Divorce Certificate Application (Wisconsin.Gov)

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F05282 Wisconsin Divorce Certificate Application (Wisconsin.Gov)

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DEPARTMENT OF HEALTH SERVICES
Division of Public Health
F-05282 (Rev. 11/2016)
STATE OF WISCONSIN
Wis. Stat. § 69.21
Page 1 of 2
WISCONSIN DIVORCE CERTIFICATE APPLICATION
(for Mail or In-Person Requests)
PENALTIES: Any person who illegally possesses any vital record with knowledge that the vital record has been illegally obtained is guilty of a Class I felony [a fine of not more
than $10,000 or imprisonment of not more than 3 years and 6 months, or both, per Wis. Stat. § 69.24(1)].
I. APPLICANT INFORMATION
CURRENT NAME - First
Last
MAIL TO NAME - First (if different)
Last
MAIL TO ADDRESS (if different than street address) Apt. No.
City
State
ZIP Code
City
State
ZIP Code
DAYTIME TELEPHONE NUMBER
( )
EMAIL ADDRESS
TYPE OF CURRENT VALID PHOTO ID
(See item 3 on page 2.)
PHOTO ID NUMBER
STATE OF ISSUANCE
EXPIRATION DATE
II. APPLICANT’S RELATIONSHIP TO
PERSON(S) NAMED ON THE CERTIFICATE
Per Wis. Stat. § 69.20(1), a CERTIFIED copy of a divorce certificate is only available to those with a “direct and tangible interest." (A–E)
CHECK ONE box which indicates YOUR RELATIONSHIP to one of the PERSONS NAMED on the divorce certificate.
A. I am one of the persons named on the divorce certificate.
B. I am a member of the immediate family of one of the persons named on the divorce certificate.
Parent Child Brother / Sister
Maternal Grandparent Paternal Grandparent
C. I am the legal custodian or guardian of one of the persons named on the divorce certificate.
D. I am a representative authorized by any person in categories A - C, including an attorney.
Specify the person you represent: _________________________________________________________________________________
E. I can demonstrate the divorce certificate is necessary for the determination or protection of a personal or property right.
Specify your interest ___________________________________________________________________________________________
F. None of the above. I am requesting an uncertified copy. (Copy will not be valid for identity or legal purposes.)
NOTE: Grandchildren, stepparents, stepchildren, stepbrothers / stepsisters may only obtain certified copies as categories C – E.
PURPOSE FOR WHICH CERTIFICATE IS REQUESTED:
III. FEES
First Copy Fee ……………………………………………………………….………..…………………..……………... $ 20.00 ___20.00___
Additional copies of the same certificate issued at the same time as the first copy ___________________ X $ 3.00 ___________
Number of Additional Copies
FEE IS NOT REFUNDABLE IF NO RECORD IS FOUND. CANCELLATIONS NOT ACCEPTED. TOTAL ___________
Submit your application materials and fee to: STATE VITAL RECORDS OFFICE / PO BOX 309 / MADISON, WI 53701-0309
Be sure to include: completed form, acceptable identification, payment,
self-addressed, stamped business-size envelope, and any additional proof or authorization required
Make check or money order payable to: STATE OF WIS. VITAL RECORDS
IV. DIVORCE
INFORMATION
PARTY “A” BIRTH NAME - First
Middle
BIRTH Last Name
PARTY “B” BIRTH NAME - First
Middle
BIRTH Last Name
LOCATION OF DIVORCE - County COUNTY
DATE OF DIVORCE (MM/DD/YYYY)
I hereby attest that the information provided on this application is correct to the best of my knowledge and belief and that I am entitled to copies of
the requested divorce certificate in accordance with the categories listed above.
SIGNATURE (Applicant)
Date Signed (MM/DD/YYYY)
Important: Signature and payment are required for processing.
TYPE or PRINT.
$ 0.00
$ 20.00
Clear / Reset Form
WISCONSIN DIVORCE CERTIFICATE APPLICATION
F-05282 (Rev. 11/2016)
Page 2 of 2
1. What is the difference between a “certified” and an “uncertified” copy of a divorce certificate?
A CERTIFIED COPY:
Is printed on security paper, has a raised seal, and shows the signature of the State Registrar or Local Registrar.
Can be used for legal purposes.
Can only be obtained with a direct and tangible interest as defined in Wis. Stat. § 69.20(1).
AN UNCERTIFIED COPY:
Is printed on plain paper and marked “uncertified.”
Is for information purposes only and cannot be used for identity or legal purposes.
Contains the same information as a certified copy.
2. How long will it take to process my request?
APPLYING IN PERSON
Requests for certified copies of divorce certificates are usually completed within 2 business hours of application, if the divorce
certificate is on file.
Requests for uncertified copies of divorce certificates are not completed on the same schedule as requests for certified copies.
In-person requests for uncertified copies may take up to 1 month to complete.
APPLYING BY MAIL
Requests for certified copies of divorce certificates may take up to 2 weeks plus mail time to complete.
Requests for uncertified copies of divorce certificates are not completed on the same schedule as certified copies. Mail
requests for uncertified copies may take up to 1 month plus mail time.
3. What identification is required when applying for a divorce certificate?
Requests for certified copies require proof of identification. Applicant’s original ID is required for in-person applications. A photocopy of
the applicant’s ID is required for mail applications.
At least one form of ID must show your name and address. Expired cards or documents will not be accepted.
Examples of acceptable forms of identification include:
One of these:
OR
Two of these:
State issued driver’s license or ID card
US or Foreign passport
Tribal or Military ID card
Bank/Earnings statement
Current, dated, signed lease
Health insurance card
US Government issued photo ID
Utility bill or traffic ticket
Vehicle registration/title
If you have questions regarding this form, please call 608-266-1373
or visit our website at http://www.dhs.wisconsin.gov/vitalrecords
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Completed 10 September 2021

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