Fillable State of Florida Department of Health - Office (Florida Department of Health)

Fill Online, Printable, Fillable, Blank State of Florida Department of Health - Office (Florida Department of Health) Form

Use Fill to complete blank online FLORIDA DEPARTMENT OF HEALTH (FL) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

State of Florida Department of Health - Office (Florida Department of Health)

On average this form takes 12 minutes to complete

The State of Florida Department of Health - Office (Florida Department of Health) form is 1 page long and contains:

  • 0 signatures
  • 1 check-box
  • 46 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Florida Department of Health

BROWSE FLORIDA DEPARTMENT OF HEALTH (FL) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
DH 261A (Apostille), 01/2015, Florida Administrative Code Rule 64V-1.0131 (Obsoletes Previous Editions)
State of Florida
Department of Health - Office of Vital Statistics
APPLICATION FOR A MARRIAGE RECORD FOR LICENSES ISSUED IN FLORIDA
(FOR APOSTILLE or EXEMPLIFIED CERTIFICATION)
The Office of Vital Statistics does not forward records to the Department of State (DOS) for the DOS Apostille/Exemplified Certification process. If an apostille or exemplified certification
from the DOS is needed, forward the record received from this application to the DOS. See the back of this application for DOS’s mailing, street and website addresses and telephone
number. Use this application when requesting certification from our office to ensure the correct certification needed for forwarding to the DOS for the apostille/exemplified certification
process.
SECTION A – REGISTRANT INFORMATION. Provide as much information as known. Asterisk (*) items are REQUIRED fields
*NAME OF SPOUSE
FIRST NAME MIDDLE NAME LAST NAME INCLUDING SUFFIX
MAIDEN, IF DIFFERENT
DATE OF BIRTH
(If known)
*NAME OF SPOUSE
FIRST NAME MIDDLE NAME LAST NAME INCLUDING SUFFIX
MAIDEN, IF DIFFERENT
DATE OF BIRTH
(If known)
*DATE OF EVENT
MONTH
DAY YEAR (4-DIGIT)
ADDITIONAL YEARS TO BE SEARCHED
LIST SPAN OF YEARS TO SEARCH (ONLY if you do not know the exact year of the event)
STATE FILE NO. (If known)
CITY/COUNTY WHERE MARRIAGE LICENSED ISSUED (See reverse side)
*COUNTRY WHERE CERTIFICATION TO BE USED (Required to ensure you receive the correct type of
certificate)
CORRECTED or
AMENDED
To your knowledge, has the Clerk of Court corrected/amended an item on this Marriage Record and forwarded the
newly corrected Record to the Office of Vital Statistics?
□ Yes
□ No
SECTION B – FEES & PAYMENT
1
st
Certification or Single Status Report (see reverse for explanation of Single Status Statement)
$5.00
X
1
=
$5.00
Additional Certification or Single Status. $4.00 Each
$4.00
X
No. Certs.
=
$
Additional Years to be Searched:
Required ONLY when the exact year of the marriage is not known and you wish more than one year searched. The maximum
additional year search fee is $ 50.00 regardless of the total number of years to be searched. (Be sure to indicate the range of
years to be searched in Section A above)
$2.00 X
No. of Yrs.
=
$
RUSH ORDERS (Optional): RUSH Fees are an additional $10.00.
If you desire RUSH service, mark the outside of your envelope “RUSH” (Processing time within our office for Rush
Service is 2-3 business days; routine processing time within our office is 4-6 business days.)
Check here for RUSH Order
$
TOTAL AMOUNT ENCLOSED: Check or Money Order Payable to: Vital Statistics. (DO NOT SEND CASH) International payments should be made
by Cashiers Check or Money Order in U. S. Dollars. Florida Law imposes an additional service charge of $15.00 for dishonored checks.
$
SECTION C – APPLICANT/MAILING INFORMATION
Any person who willfully and knowingly provides any false information on a certificate, record or report required by Chapter 382, Florida Statutes, or on any application
or affidavit, or who obtains confidential information from any Vital Record under false or fraudulent purposes, commits a felony of the third degree, punishable as
provided in Chapter 775, Florida Statutes.
Applicant’s Name
TYPE OR PRINT
FIRST MIDDLE LAST (INCLUDING ANY SUFFIX)
DELIVERY ADDRESS (INCLUDE APT. NO., IF APPLICABLE)
CITY STATE ZIP CODE
HOME PHONE NUMBER
( )
WORK PHONE NUMBER
( )
RELATIONSHIP TO REGISTRANT SIGNATURE OF APPLICANT
IF ATTORNEY, PROVIDE BAR/PROFESSIONAL LICENSE NO. IF ATTORNEY , PROVIDE NAME OF PERSON YOU REPRESENT AND THEIR RELATIONSHIP TO REGISTRANT
IF THE CERTIFICATION IS TO BE MAILED TO ANOTHER PERSON OR ADDRESS USE THE SPACES BELOW TO SPECIFY SHIP TO NAME AND ADDRESS.
SHIP TO NAME
TYPE OR PRINT
FIRST MIDDLE LAST (INCLUDING ANY SUFFIX)
HOME PHONE NUMBER
( )
SHIP TO STREET ADDRESS (AND APT. NO. IF APPLICABLE)
WORK PHONE NUMBER
( )
CITY STATE ZIP CODE
Print Form
Reset Form
DH 261A (Apostille), 01/2015, Florida Administrative Code Rule 64V-1.0131 (Obsoletes Previous Editions)
INFORMATION AND INSTRUCTIONS
APPLICATION FOR MARRIAGE RECORD FOR LICENSES ISSUED IN FLORIDA
(FOR APOSTILLE or EXEMPLIFIED CERTIFICATION)
An apostille is a certification provided under the Hague convention of 1961 for authenticating documents for use in foreign countries.
An exemplified certification covers those countries which did not sign the Hague Treaty. The sole function of the apostille or
exemplified certificate is to certify the authenticity of the signature on the document. In Florida, the apostille or exemplified certificate
contains the original signature of the State Registrar and the Secretary of State.
Once the certification is obtained, it should be forwarded to the Florida Department of State (DOS) for the Apostille/Exemplified
Certification of the signature of Florida’s State Registrar. The address for mailing to the DOS is: Department of State, Division of
Corporations, Apostille Certification, P.O. Box 6800, Tallahassee, FL 32314-6800; telephone (850) 245-6945. For walk-in service or
courier delivery, the address is Department of State, Division of Corporations, Apostille Certification, Clifton Building, 2661 Executive
Center Circle, Tallahassee, FL 32301. See the website at www.dos.state.fl.us/ for information regarding their requirements, processing
time, fees, etc. To access the correct area on the website, select Corporations, then Apostilles. Be sure to provide the name of the
country where the certification is needed.
SINGLE STATUS STATEMENT: If marrying in another country, proof of “single status” may be required by that country. This
request will generate a search of state of residence records (if Florida) to verify that a marriage record is not on file. An official “Not
Found” statement indicating this fact will be provided in lieu of a marriage record.
REGISTRATION OF MARRIAGE RECORDS: After a marriage has been recorded with the Clerk of Court, the Clerk sends the
original document to this office. If the marriage recently occurred, it generally takes up to 60 days for documents to be received,
registered and available for certification from our office.
MARRIAGE RECORDS: We ONLY have records for the period June 6, 1927 to the present. Any marriages prior to June 6, 1927
are obtainable from the Clerk of the Court in the County where the marriage license was issued.
MARRIAGE STATISTICAL PORTION/ELIGIBILITY: Except for the Social Security numbers (SSN) contained on a Marriage
Record, the record is a public record and may be released to anyone who has properly applied and paid the required fee(s). There is also
some statistical information that is available for certain years on marriage records and will be included on the certification, if available.
This information includes the number of previous marriages and date last marriage ended.
For Marriage prior to 1972, any statistical information would have been included on the Application to Marry and is only
available from the Clerk of Court in the county where the marriage license was issued. Visit their website at www.flclerks.com
For Marriage 1972 to present, the statistical portion is contained with the marriage record and, except for SSN, will
automatically be included on the certification.
SEARCH INFORMATION FOR MARRIAGE REQUESTS: Marriages are indexed by bride, groom or spouse. Provide as much
information as known.
PROCESSING TIME: Processing time can range from 4-6 business days, not including mailing time. A $10
Rush Fee will expedite
the request within our office. Certification(s) are mailed 1
st
Class Mail unless a prepaid self-addressed express envelope is included
with the request.
FEES ARE NONREFUNDABLE: If no record is found, a “Not Found” statement will be issued.
Fees are nonrefundable, except fees
paid for additional copies when no record is found. These are refunded on written request.
If you need assistance, you may call our Apostille Unit at (904) 359-6900, ext. 9006.
MAIL THIS APPLICATION WITH PAYMENT TO:
DEPARTMENT OF HEALTH
OFFICE OF VITAL STATISTICS
ATTN: APOSTILLE UNIT
P.O. BOX 210,
Jacksonville, FL 32231-0042
(Street Address: 1217 North Pearl Street, Jacksonville, Florida, 32202)
PLEASE VISIT OUR WEBSITE:
www.FloridaVitalStatisticsOnline.com
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

State of Florida Department of Health - Office (Florida Department of Health)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 21 July 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document