Grimes County Clerk, Vanessa Burzynski
P. O. Box 209 101 S. Main Street
Anderson, Texas 77830
936-873-4408 office 936-873-3308 (fax)
MARRIAGE RECORD REQUEST
Date _____________________________
Name_______________________________________________________________
Address _____________________________________________________________
City___________________________ State___________ Zip Code _____________
Phone Number _______________________________________________________
Email Address ________________________________________________________
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Bride’s Maiden Name: __________________________________________________________
Groom’s Name: _______________________________________________________________
Marriage Date ___________________________________________________ (if known)
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Total Number of certified copies ________ @ $10.00 Each
Total Amount Due: $__________ Money Order Check Credit Card
(do not send cash)
Credit Card #_____________________________________________________
Expiration Date ______________________ 3-digit Security Code _________
____________________________________
Signature
Enclose Check or Money Order and send to PO Box 209, Anderson, Texas 77830
click to sign
signature
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