J:\RECDOCS\New Clerk-Recorder Form Inventory\2015\Vitals & GB
APPLICATION FOR CERTIFIED COPY OF A CONFIDENTIAL MARRIAGE
CERTIFICATE - $17.00 PER COPY IN ALAMEDA COUNTY
Marriage Certificate Information Number of copies requested: ____________
Name of Party A: ________________________________________________________________________________________
Last (Before Marriage) First
Name of Party B: ________________________________________________________________________________________
Last (Before Marriage) First
Date of Marriage: ________________________ City Where License was Purchased:__________________________________
Month/Day/Year
Applicant Information (If ordered online) Confirmation #: _____________________
Last Name: ________________________________________ First Name: ________________________________________
Home Address: __________________________________________________________________________________________
(P.O. Box not acceptable) Number and Street (APT #) City State Zip Code
Shipping Address: _______________________________________________________________________________________
(If Different than home) Number and Street (APT #) City State Zip Code
Telephone Number: _(_____)___________________________Email Address: _______________________________________
Acknowledgment
State of ________________________
County of _______________________
On ____________ before me, __________________________________________________, personally appeared
(name and title of the officer)
____________________________ who proved to me on the basis of satisfactory evidence to be the person whose
name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her
authorized capacity, and that by his/her signature on the instrument the person, or the entity on behalf of which the
person acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true
and correct.
WITNESS my hand and official seal:
________________________________________
Signature of Notary Public (Notary Seal)
Certified copies of Confidential Marriage Certificates may be obtained only by a party to the marriage or by
court order. Requests made by any other person or agency will not be honored.
Authority to Request a Copy (Check One):
o Party to the Marriage (Groom/Bride or Party A / B)
o Court Order (Please include a copy of the court order)
I, ________________________________________________, swear under penalty of perjury that I am an authorized person, as
(Print Your Name)
defined in California Health and Safety Code Section 103526 (c), and am eligible to receive a certified copy of the marriage
record identified on this application form. Sworn this __________________ day of _________________________, 20________,
at ______________________________________________ Signature: ___________________________________________
(City and State)
A notary public or other officer completing this certificate verifies only the
identity of the individual who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or validity of that document.