Kentucky Application for a Certified Copy of Marriage/Divorce Certificate Form
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COMMONWEALTH OF KENTUCKY
STATE REGISTRAR OF VITAL STATISTICS
APPLICATION FOR A CERTIFIED COPY OF MARRIAGE/DIVORCE CERTIFICATE
Please Print or Type All Information Required On This Form
MARRIAGE/DIVORCE CERTIFICATE INFORMATION
1. Full Name of
Husband
First
Middle
Last
2. Maiden Name of Wife
First
Middle
Last
3. County in Which
Marriage License
Issued
Kentucky County
4. Date of Marriage
Month
Day
Year
5. County in Which
Divorce Decree
Granted
Kentucky County
6. Date of Divorce
Month
Day
Year
Signature and telephone number of the person requesting this certificate: