Scribd Logo
Upload

Welcome to Scribd!

  • 62 views

    Application For Certified Copy of Divorce Certificate

    Uploaded by

    Tiffany Weathersbee
    This document is an application for a certified copy of a dissolution of marriage certificate from Nebraska. It requests information about the applicant and those listed on the certificate, warns about penalties for deception, and provides instructions for submitting the application and payment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application For Certified Copy of Divorce Certificate

    Uploaded by

    Tiffany Weathersbee
    62 views1 page
    This document is an application for a certified copy of a dissolution of marriage certificate from Nebraska. It requests information about the applicant and those listed on the certificate, warns about penalties for deception, and provides instructions for submitting the application and payment.

    Original Title

    application-for-certified-copy-of-divorce-certificate

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document is an application for a certified copy of a dissolution of marriage certificate from Nebraska. It requests information about the applicant and those listed on the certificate, warns about penalties for deception, and provides instructions for submitting the application and payment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    62 views1 page

    Application For Certified Copy of Divorce Certificate

    Uploaded by

    Tiffany Weathersbee
    This document is an application for a certified copy of a dissolution of marriage certificate from Nebraska. It requests information about the applicant and those listed on the certificate, warns about penalties for deception, and provides instructions for submitting the application and payment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    APPLICATION FOR CERTIFIED COPY OF DISSOLUTION

    OF MARRIAGE (DIVORCE) CERTIFICATE

    This office has been registering dissolutions of marriage (divorces) occurring in Nebraska since 1909. For records occurring
    prior to 1909, or if you wish to obtain the divorce decree, contact the District Court in the county where the divorce was
    granted.)

    PLEASE TYPE OR PRINT LEGIBLY


    Full name of husband__________________________________________________________________________________

    Full name of wife______________________________________________________________________________________

    City or county where granted ____________________________________________________________________________

    Month, day, and year granted ____________________________________________________________________________

    For what purpose is this record to be used?_________________________________________________________________

    If this is not your divorce certificate, how are you related to the person listed on the record?___________________________

    WARNING: Section 71-649, Nebraska Revised Statutes: It is a felony to obtain, possess, use, sell, furnish, or
    attempt to obtain any vital record for purposes of deception.

    SIGNATURE ______________________________________________ FOR OFFICE USE ONLY

    Type or print name__________________________________________ q Check q MO q Cash

    Street Address_____________________________________________ Amount Received_________________________

    City, State, Zip ____________________________________________ Date Received___________________________

    Daytime Telephone Number __________________________________ By Whom Received_______________________

    Email Address ___________________________________________ PROOF OF IDENTIFICATION;

    Today’s Date ______________________________________________ DL STATE ID OTHER


    _______________________________________
    Please enclose a photocopy of your photo ID (i.e. current driver’s
    license) when mailing in this request.

    Fees are subject to change without notice. Please call our 24-hour
    recorded message at (402) 471-2871 to verify fees.

    Number of certified copies________ x $16.00 each = $________ Total


    (Please make checks payable to Vital Records)

    Mail to: Bring to:


    Vital Records Vital Records
    PO Box 95065 1033 O Street, Suite 130
    Lincoln, NE 68509-5065 Lincoln, NE 68508-3621
    (Please enclose a stamped,
    self-addressed business
    size envelope.)

    HHS-95 (55097) 6/14

    You might also like