Town of East Hartford
Registrar of Vital Statistics
740 Main Street
East Hartford, CT 06108
(860) 291-7230
APPLICATION FOR MARRIAGE CERTIFICATE
Fee: $20.00 cash or check made payable to “East Hartford Town Clerk.”
_________ # of Certified Copies
VALID GOVERNMENT-ISSUED PHOTO IDENTIFICATION OF APPLICANT IS REQUIRED
Photographic identification may be substituted by at least two of the following documents:
automobile registration, copy of utility bill showing name and address, checking account deposit slip stating
name and address or any other valid government-issued ID.
I AM APPLYING FOR THE MARRIAGE CERTIFICATE OF:
SPOUSE - Full name as it appears on the certificate:
first/middle/last)_________________________________________________________________________
SPOUSE - Full name as it appears on the certificate:
first/middle/last)_________________________________________________________________________
Place of Marriage: (town/state)_____________________________________________________________
Date of Marriage(mm/dd/yy)_______________________________________________________________
□ This is my own marriage certificate.
□ This is my child’s marriage certificate.
□ I am an immediate family member – spouse, child by blood or sibling.
□ I am a person authorized by the Dept. of Health & Chief Medical Examiner Rep. (Signed letter on letterhead required.)
□ an authorized CT genealogist. (Must produce a valid, signed card.)
□ Other. _________________________________________________________________________________
SIGNATURE of Applicant __________________________________ Phone # __________________
ADDRESS of Applicant (street/town/state)____________________________________________________
If requesting by mail, include: (1) Completed application form, (2) check or money order, (3) Self-addressed,
stamped envelope, (4) legible copy of photo ID. Mail to the address above.
FOR OFFICE USE ONLY:
Date certified copy issued: ___________________ Person issuing copy: ______________________________________
Form(s) of identification used: _________________________________________________________________________
