Vermont Department of Health Record of Divorce or Annulment Form
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MARRIAGE
DECREE
9/09 SML
DEPARTMENT OF HEALTH
VERMONT RECORD OF DIVORCE OR ANNULMENT
Docket #
1a. Name (First, Middle, Last)
2a. State of Residence
2b. City or Town of Residence
4a. Name (First, Middle, Last)
5a. State of Residence
5b. City or Town of Residence
7a. State or foreign country of this marriage
7b. City or Town of this marriage
7c. Date of this marriage
(month, day, year)
8b. Number of children under 18 in this household as of the date in item 8a.
10. I certify that this decree became absolute (final) on