Fillable Request for Marriage Certi cate (Collège Boréal)

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Request for Marriage Certi cate (Collège Boréal)

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11078E (2013/10)
Page RM of3
page 1 of 4
Request for Marriage Certifi cate
(For marriages which took place in Ontario only)
(THIS SPACE RESERVED FOR OFFICE USE ONLY)
1. What information are you requesting and how much will it cost?
Offi ce of the
Registrar General
$
The Offi ce of the Registrar General holds records for marriages that happened in Ontario during the past 80 years.
To obtain older records, contact:
Archives of Ontario
134 Ian Macdonald Boulevard
Toronto ON M7A 2C5
1 800 668-9933
416 327-1600
Marriage Certifi cate (File Size) NOTE: Section 4a must be completed
This contains basic information, such as names, date and place of marriage.
$15.00 each
Quantity
Quantity
$
Certifi ed Copy of Statement of Marriage (Long form) NOTE: Section 4b must be completed
This contains all information registered on the statement of marriage including signatures.
$22.00 each
$
Search
A search results in a letter that either confi rms the marriage registration exists or that there is no registration
(see Instruction #4). If you don’t know the exact date of the marriage event, choose a year based on
information you may have obtained for this purpose, and write it in the space provided for the date. We will
search that whole year plus two years before and after, for a total of fi ve years. You may also request a
search of additional years, in increments of fi ve years.
Range of years searched
to
Each 5 years searched ...............$15.00
Please PRINT clearly in blue or black ink.
In the context of this form, the word “Applicant” refers to the person completing this Request.
© Queen’s Printer for Ontario, 2013 Disponible en français
City
Street No.
Postal Code
Telephone Number (including area code)
Applicant Name
Organization / Firm (if applicable)
Last Name
First Name
Street Name
PO Box
Country
Province
Ext.
Mailing Address
Apt. No. Buzzer No.
If you have any questions, please contact the
Offi ce of the Registrar General
189 Red River Road
PO Box 4600
Thunder Bay ON P7B 6L8
Telephone: 1 800 461-2156 (outside of Toronto)
416 325-8305 (in Toronto)
416 325-3408 (TTY/Teletypewriter)
Fax: 807 343-7459
Clear Form
11078E (2013/10)
Page RM of3
page 2 of 4
2. Details of Brides/Grooms
Name of Bride/Groom
Any other last name used
OR, If date unknown, range of years to search
Day
Month
Date of Marriage
Place of Marriage
(City, Town or Village)
3. Details of Event
Place of Birth (Province/Country)
Year
TO
Is either bride/groom deceased?
YES
NO
Name of Bride/Groom Last name before marriage First Name Middle Name
Last name before marriage First Name Middle Name
Any other last name used
Place of Birth (Province/Country)
4. Details of the Applicant (Please indicate to which category of entitled individuals the applicant belongs)
4a. Applicants for a Marriage Certifi cate (File Size):
I am:
bride/groom
parent of either bride/groom
child of the marriage
Only the individuals above are entitled to apply for a Marriage Certifi cate (File Size).
If either or both bride(s)/groom(s) are deceased, the following additional Next of Kin
(see Instruction #1) are entitled to apply for a Marriage Certifi cate (File Size):
My relationship is:
sibling of either bride/groom
Authorized Representative of any entitled individual (see Instruction #2). Proof of authorization is required and must be attached to
this application
(see Instruction #3)
4b. Applicants for a Certifi ed Statement of Marriage (Long Form):
If either or both bride(s)/groom(s) are deceased, the Next of Kin are entitled
to apply
(see Instruction #1). My relationship is:
I am:
bride/groom. Only bride(s)/groom(s) are entitled to apply
Authorized Representative of any entitled individual
(see Instruction #2). Proof of authorization is required and must be attached to this
application
(see Instruction #3)
If either bride(s)/groom(s) is deceased, and the Next of Kin are also deceased,
the Extended Next of Kin (see Instruction #1) may apply. Please indicate the
applicant’s relationship to either
bride/groom
parent of either bride/groom mariage
child of the marriage
sibling of either bride/groom
either or both the bride(s)/groom(s) is deceased, and the Next of Kin
are also deceased, the Extended Next of Kin
(see Instruction #1) may
apply. Please indicate the applicant’s relationship to the bride/groom
In the case that the applicant is the Next of Kin
or the Extended Next of Kin, please complete the
following certifi cation:
I,
(name,
please print), am the
of
. I certify that I am the
Next of Kin, or all the Next of Kin are deceased,
and I am the Extended Next of Kin.
In the case that the applicant is the Next of Kin
or the Extended Next of Kin, please complete the
following certifi cation:
I, (name,
please print), am the
of
. I certify that I am the
Next of Kin, or the Next of Kin are deceased,
and I am the Extended Next of Kin.
11078E (2013/10)
Page RM of3
page 3 of 4
Instructions
Instruction #1
For the purposes of entitlement to a Marriage Certifi cate (File Size), Next of Kin to the Bride/Groom include: Parents of either the Bride/
Groom and Children of the marriage. If either (or both) of the Bride/Groom is deceased, Sibling(s) are entitled. Extended Next of Kin
(closest surviving relative) to the Bride/Groom include: Grandmother, Grandfather, Aunt, Uncle, First Cousin, Niece, Nephew, or Grandchild.
For the purpose of entitlement to a Certifi ed Copy of Statement of Marriage (Long Form), Next of Kin to the Bride/Groom include: Parents
of either the Bride/Groom, Children of the marriage, Sibling(s) of the Bride/Groom. Extended Next of Kin (closest surviving relative) to the
Bride/Groom include: Grandmother, Grandfather, Aunt, Uncle, First Cousin, Niece, Nephew, or Grandchild.
Instruction #2
Authorized Representative includes an estate trustee, an executor or administrator, a person with power of attorney or a person with legal
guardianship acting on behalf of the deceased or an entitled individual.
Instruction #3
Proof of Authorization includes a certifi cate of appointment of estate trustee, letters of administration, an order under the Declarations of
Death Act, 2002, a will, proof of power of attorney and proof of legal guardianship.
Instruction #4
A search may be requested by an individual getting married in another jurisdiction to demonstrate that he/she has not been married in
Ontario (sometimes referred to as a letter of non-impediment).
Mail the Completed Request to:
The Offi ce of the Registrar General
189 Red River Road
PO Box 4600
Thunder Bay ON P7B 6L8
Fax: 807 343-7459
If you require faster service than 6-8 weeks,
please apply online at www.ServiceOntario.ca
Personal information contained on this form is collected under the authority of the Vital Statistics Act, R.S.O. 1990, c.V.4 and will be used
to provide certifi ed copies, extracts, certifi cates, or search notices and to verify the information provided and your entitlement to the service
requested and for security and law enforcement purposes. It is an offence to wilfully make a false statement on this form. Questions about
this collection should be directed to: The Deputy Registrar General, Offi ce of the Registrar General, 189 Red River Road, PO Box 4600,
Thunder Bay ON P7B 6L8. Telephone outside Toronto 1 800 461-2156 or in Toronto 416 325-8305, TTY/Teletypewriter (for the hearing
impaired) 416 325-3408 or Fax: 807 343-7459.
5. Why are You Requesting this Information? (Select One)
pension benefi ts
insurance
divorce
estate settlement
immigration
other (specify)
I authorize the Offi ce of the Registrar General to issue the requested document/information, and consent to the Ministry of Government
Services collecting information about myself and the person(s) named on the record (if other than myself) from such other sources as may
be necessary to verify the information on this form and my entitlement to the service required, and the disclosure of such information to the
Ministry of Government Services. I am aware that it is an offence to wilfully make a false statement on this form.
Signature of Applicant
Date Signed
Year DayMonth
Daytime Telephone Number (including area code)
Ext.
11078E (2013/10)
Page RM of3
page 4 of 4
• If you’re sending your payment from anywhere other than Canada, you must pay with an international money order in Canadian funds
drawn on a Canadian clearing house, or by VISA, MasterCard or American Express.
• We will not accept post-dated cheques. An administration fee of $35.00 will be applied to any cheques returned by a Financial
Institution.
• We DO NOT accept cash as payment for any type of application.
• Please note that fees are subject to change without notice. You may send your request by mail, and pay by cheque or money order,
made payable to Minister of Finance, or by VISA, MasterCard or American Express.
Your Payment Options
Cheque or Money Order. Please make payable to: “Minister of Finance”.
Print Name of Cardholder (as it appears on the credit card)
Signature of Cardholder
Credit card payment. Please complete Credit Card Information below. ▼
You must pay by credit card if you are faxing your request to us.
Our fax number is: 807 343-7459.
American Express
VISA MasterCard
Applicant’s Last Name
Applicant’s Information
Applicant’s First Name
Payment Method and Credit Card Authorization
Name of Credit Card Company
Credit Card Number (print clearly) Expiration Date
MM YY
Credit Card Information
X
Date
Year DayMonth
Persons Named on the Marriage Certifi cate
Name of Bride/Groom Last name before marriage First Name Middle Name
Name of Bride/Groom Last name before marriage First Name Middle Name
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Request for Marriage Certi cate (Collge Boral)

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Completed 8 March 2022

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