Marriage Record Order Form
Please allow UP TO 2 WEEKS for your order to be complete
I would like to order a copy of the following marriage record
Your Name at time Marriage Application: (PLEASE PRINT CLEARLY)
Last: First: Middle:
Spouse’s name at time Marriage Application: (PLEASE PRINT CLEARLY)
Last: First: Middle:
Date of Marriage:
Type of Marriage Record Requested:
Plain - $2.00
Certified Record - $25.00
Exemplified Copy - $30.00
Enclosed is a check or money order made payable to: “Clerk of Orphans’ Court”
In the amount of: $
Military Service? YES NO
Please send the Marriage Record to:
(PLEASE PRINT CLEARLY)
Name:
Address:
City:
State, Zip:
Phone:
*Please provide a self-addressed stamped envelope. This will expedite processing time.
MAIL COMPLETED FROM TO:
Mary J. Walk, Esquire
Register of Wills Marriage Records Dept.
1
st
Floor Government Center
201 West Front Street Media, PA 19063
Phone 610 – 891 – 4414
*This fee will be waived for active or veteran members of the military when obtaining ONE
CERTIFIED COPY of their own marriage record. Please provide proof of military service.
