application for a copy of marriage certificate number of copies - Derby
City of Derby, Connecticut One Elizabeth Street - 06418
Marc J. Garofalo, MPA, CCTC Town / City Clerk
Email - [email protected] www.derbyct.gov
Telephone - 203.736.1462 FAX - 203.736.1479
APPLICATION FOR A COPY OF MARRIAGE CERTIFICATE NUMBER OF COPIES: DATE REQUESTED:
$20 (CASH ONLY) PER COPY $
FULL NAME OF GROOM: FULL NAME OF BRIDE:
First Name
Last Name
First Name
Last Name
TOTAL
DATE OF MARRIAGE: Month
PLACE OF MARRIAGE:
Town
NAME OF REQUESTER: ADDRESS OF REQUESTER: CITY, STATE & ZIP CODE: RELATIONSHIP: SIGNATURE OF REQUESTER:
Day
Year
Marc J. Garofalo, MPA, CCTC Town / City Clerk
Email - [email protected] www.derbyct.gov
Telephone - 203.736.1462 FAX - 203.736.1479
APPLICATION FOR A COPY OF MARRIAGE CERTIFICATE NUMBER OF COPIES: DATE REQUESTED:
$20 (CASH ONLY) PER COPY $
FULL NAME OF GROOM: FULL NAME OF BRIDE:
First Name
Last Name
First Name
Last Name
TOTAL
DATE OF MARRIAGE: Month
PLACE OF MARRIAGE:
Town
NAME OF REQUESTER: ADDRESS OF REQUESTER: CITY, STATE & ZIP CODE: RELATIONSHIP: SIGNATURE OF REQUESTER:
Day
Year
