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Get Indiana Form 54764

APPLICATION FOR SEARCH OF MARRIAGE INDEX State Form 54764 7-11 INDIANA STATE DEPARTMENT OF HEALTH Approved by State Board of Accounts 2011 Marriage Index records are maintained by the State Vital Records Office. Marriage and Divorce records are maintained by the Clerk of Courts in the county where the record was filed* THE INDIANA STATE VITAL RECORDS OFFICE DOES NOT HOUSE DIVORCE RECORDS FEES ARE ESTABLISHED BY LAW IC 16-37-1-11 AND IC 16-37-1-11. 5. Each Marriage Index search costs 8. 00. This fee is non-refundable. A letter of findings will be mailed to the requestor within 10-15 business days. A certified copy of the marriage certificate will NOT be provided* Please contact the clerk s office in the county where the marriage was filed for a certified copy. IDENTIFICATION IS REQUIRED. Requests for information sent without proper identification will be returned to the requestor without processing* Please complete as much of the information requested below to ensure the greatest chance of our office finding the record you are requesting. If no record is found a letter will be sent indicating no record found. Groom s Name First Middle Last Bride s Name Maiden Date of Marriage month day year County of Marriage City of Marriage if known Signature of applicant Mailing address number and street city state and ZIP code MAILING ADDRESS MUST MATCH IDENTIFICATION ADDRESS Daytime telephone number including area code Today s date month day year Send this application check or money order payable to the Indiana State Department of Health and a copy of your identification to Vital Records Indiana State Department of Health PO Box 7125 Indianapolis IN 46206-7125 The following individuals are eligible to receive marriage information under IC 16-37-1-10 1. Bride 2. Groom 3. Individual with direct interest in the record must provide documentation to confirm they meet the criteria. 4. Individual demonstrating the information is necessary for the determination of personal or property rights must provide documentation to confirm they meet the criteria. of federal documentation to confirm they meet the criteria. Period Checked FOR OFFICE USE ONLY Marriage Date month day year County Occurred Initials of verifier. Marriage and Divorce records are maintained by the Clerk of Courts in the county where the record was filed* THE INDIANA STATE VITAL RECORDS OFFICE DOES NOT HOUSE DIVORCE RECORDS FEES ARE ESTABLISHED BY LAW IC 16-37-1-11 AND IC 16-37-1-11. 5. Each Marriage Index search costs 8. 00. This fee is non-refundable. A letter of findings will be mailed to the requestor within 10-15 business days. 5. Each Marriage Index search costs 8. 00. This fee is non-refundable. A letter of findings will be mailed to the requestor within 10-15 business days. A certified copy of the marriage certificate will NOT be provided* Please contact the clerk s office in the county where the marriage was filed for a certified copy. A certified copy of the marriage certificate will NOT be provided* Please contact the clerk s office in the county where the marriage was filed for a certified copy. IDENTIFICATION IS REQUIRED. Requests for information sent without proper identification will be returned to the requestor without processing* Please complete as much of the information requested below to ensure the greatest chance of our office finding the record you are requesting.

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