Form F-05281 Wisconsin Marriage Certificate Application - Wisconsin

Form F-05281 is a Wisconsin Department of Health Services form also known as the "Wisconsin Marriage Certificate Application". The latest edition of the form was released in November 1, 2016 and is available for digital filing.

Download an up-to-date fillable Form F-05281 in PDF-format down below or look it up on the Wisconsin Department of Health Services Forms website.

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DEPARTMENT OF HEALTH SERVICES
STATE OF WISCONSIN
Division of Public Health
Wis. Stat. § 69.21
F-05281 (Rev. 11/2016)
Page 1 of 2
WISCONSIN MARRIAGE CERTIFICATE APPLICATION
TYPE or PRINT.
(for Mail or In-Person Requests)
PENALTIES: Any person who illegally possesses any vital record with knowledge that the vital record has been illegally obtained is guilty of a Class I felony [a fine of not more than
$10,000 or imprisonment of not more than 3 years and 6 months, or both, per Wis. Stat. § 69.24(1)].
CURRENT NAME – First
MAIL TO NAME - First (if different)
Last
Last
YOUR STREET ADDRESS (CANNOT be a P.O. Box address) Apt. No
MAIL TO ADDRESS (if different than street address)
Apt. No.
City
State
ZIP Code
City
State
ZIP Code
DAYTIME TELEPHONE NUMBER
EMAIL ADDRESS
(
)
TYPE OF CURRENT VALID PHOTO ID
PHOTO ID NUMBER
STATE OF ISSUANCE
EXPIRATION DATE
(See item 3 on page 2.)
Per Wis. Stat. § 69.20(1), a CERTIFIED copy of a marriage certificate is only available to those with a “direct and tangible interest." (A–E)
CHECK ONE box which indicates YOUR RELATIONSHIP to one of the PERSONS NAMED on the marriage certificate.
I am one of the persons named on the marriage certificate.
A.
I am a member of the immediate family of one of the persons named on the marriage certificate.
B.
Parent
Child
Brother / Sister
Maternal Grandparent
Paternal Grandparent
I am the legal custodian or guardian of one of the persons named on the marriage certificate.
C.
I am a representative authorized by any person in categories A - C, including an attorney.
D.
Specify the person you represent: ____________________________________________________________________________________
I can demonstrate the marriage certificate is necessary for the determination or protection of a personal or property right.
E.
Specify your interest ______________________________________________________________________________________________
None of the above. I am requesting an uncertified copy. (Copy will not be valid for identity or legal purposes.)
F.
NOTE: Grandchildren, stepparents, stepchildren, stepbrothers / stepsisters may only obtain certified copies as categories C – E.
PURPOSE FOR WHICH CERTIFICATE IS REQUESTED:
First Copy Fee ………………………………………………..………………………………………………..……………... $ 20.00 ___20.00____
$ 0.00
Additional copies of the same certificate issued at the same time as the first copy …...…__________________ X $ 3.00 ___________
Number of Additional Copies
$ 20.00
FEE IS NOT REFUNDABLE IF NO RECORD IS FOUND. CANCELLATIONS ARE NOT ACCEPTED.
TOTAL
____________
Submit your application materials and fee to: STATE VITAL RECORDS OFFICE / PO BOX 309 / MADISON, WI 53701-0309
Be sure to include:
completed form,
acceptable identification,
payment,
self- addressed, stamped, business-size envelope, and
any additional proof or authorization required
Make check or money order payable to: STATE OF WIS. VITAL RECORDS
GROOM / SPOUSE 1 BIRTH NAME – First
Middle
BIRTH Last Name
BRIDE / SPOUSE 2 BIRTH NAME – First
Middle
BIRTH Last Name
LOCATION OF MARRIAGE – City, Village, or Township
DATE OF MARRIAGE (MM/DD/YYYY)
LOCATION OF MARRIAGE - County
I hereby attest that the information provided on this application is correct to the best of my knowledge and belief and that I am entitled to copies of
the requested marriage certificate in accordance with the categories listed above.
SIGNATURE (Applicant)
Date Signed (MM/DD/YYYY)
Important: Signature and payment are required for processing.
Clear / Reset Form
DEPARTMENT OF HEALTH SERVICES
STATE OF WISCONSIN
Division of Public Health
Wis. Stat. § 69.21
F-05281 (Rev. 11/2016)
Page 1 of 2
WISCONSIN MARRIAGE CERTIFICATE APPLICATION
TYPE or PRINT.
(for Mail or In-Person Requests)
PENALTIES: Any person who illegally possesses any vital record with knowledge that the vital record has been illegally obtained is guilty of a Class I felony [a fine of not more than
$10,000 or imprisonment of not more than 3 years and 6 months, or both, per Wis. Stat. § 69.24(1)].
CURRENT NAME – First
MAIL TO NAME - First (if different)
Last
Last
YOUR STREET ADDRESS (CANNOT be a P.O. Box address) Apt. No
MAIL TO ADDRESS (if different than street address)
Apt. No.
City
State
ZIP Code
City
State
ZIP Code
DAYTIME TELEPHONE NUMBER
EMAIL ADDRESS
(
)
TYPE OF CURRENT VALID PHOTO ID
PHOTO ID NUMBER
STATE OF ISSUANCE
EXPIRATION DATE
(See item 3 on page 2.)
Per Wis. Stat. § 69.20(1), a CERTIFIED copy of a marriage certificate is only available to those with a “direct and tangible interest." (A–E)
CHECK ONE box which indicates YOUR RELATIONSHIP to one of the PERSONS NAMED on the marriage certificate.
I am one of the persons named on the marriage certificate.
A.
I am a member of the immediate family of one of the persons named on the marriage certificate.
B.
Parent
Child
Brother / Sister
Maternal Grandparent
Paternal Grandparent
I am the legal custodian or guardian of one of the persons named on the marriage certificate.
C.
I am a representative authorized by any person in categories A - C, including an attorney.
D.
Specify the person you represent: ____________________________________________________________________________________
I can demonstrate the marriage certificate is necessary for the determination or protection of a personal or property right.
E.
Specify your interest ______________________________________________________________________________________________
None of the above. I am requesting an uncertified copy. (Copy will not be valid for identity or legal purposes.)
F.
NOTE: Grandchildren, stepparents, stepchildren, stepbrothers / stepsisters may only obtain certified copies as categories C – E.
PURPOSE FOR WHICH CERTIFICATE IS REQUESTED:
First Copy Fee ………………………………………………..………………………………………………..……………... $ 20.00 ___20.00____
$ 0.00
Additional copies of the same certificate issued at the same time as the first copy …...…__________________ X $ 3.00 ___________
Number of Additional Copies
$ 20.00
FEE IS NOT REFUNDABLE IF NO RECORD IS FOUND. CANCELLATIONS ARE NOT ACCEPTED.
TOTAL
____________
Submit your application materials and fee to: STATE VITAL RECORDS OFFICE / PO BOX 309 / MADISON, WI 53701-0309
Be sure to include:
completed form,
acceptable identification,
payment,
self- addressed, stamped, business-size envelope, and
any additional proof or authorization required
Make check or money order payable to: STATE OF WIS. VITAL RECORDS
GROOM / SPOUSE 1 BIRTH NAME – First
Middle
BIRTH Last Name
BRIDE / SPOUSE 2 BIRTH NAME – First
Middle
BIRTH Last Name
LOCATION OF MARRIAGE – City, Village, or Township
DATE OF MARRIAGE (MM/DD/YYYY)
LOCATION OF MARRIAGE - County
I hereby attest that the information provided on this application is correct to the best of my knowledge and belief and that I am entitled to copies of
the requested marriage certificate in accordance with the categories listed above.
SIGNATURE (Applicant)
Date Signed (MM/DD/YYYY)
Important: Signature and payment are required for processing.
Clear / Reset Form
WISCONSIN MARRIAGE CERTIFICATE APPLICATION
Page 2 of 2
F-05281 (Rev. 11/2016)
1. What is the difference between a “certified” and an “uncertified” copy of a marriage certificate?
A CERTIFIED COPY:
 Is printed on security paper, has a raised seal, and shows the signature of the State Registrar or Local Registrar.
 Can be used for legal purposes.
 Can only be obtained with a direct and tangible interest as defined in Wis. Stat. § 69.20(1).
AN UNCERTIFIED COPY:
 Is printed on plain paper and marked “uncertified.”
 Is for information purposes only and cannot be used for identity or legal purposes.
 Contains the same information as a certified copy.
2. How long will it take to process my request?
APPLYING IN PERSON
Requests for certified copies of marriage certificates are usually completed within 2 business hours of application, if the
marriage certificate is on file.
Requests for uncertified copies of marriage certificates are not completed on the same schedule as requests for certified
copies. In-person requests for uncertified copies may take up to 1 month to complete.
APPLYING BY MAIL
Requests for certified copies of marriage certificates may take up to 2 weeks plus mail time to complete.
Requests for uncertified copies of marriage certificates are not completed on the same schedule as certified copies. Mail
requests for uncertified copies may take up to 1 month plus mail time.
3. What identification is required when applying for a marriage certificate?
Requests for certified copies require proof of identification. Applicant’s original ID is required for in-person applications. A photocopy of
the applicant’s ID is required for mail applications.
At least one form of ID must show your name and address. Expired cards or documents will not be accepted.
Examples of acceptable forms of identification include:
One of these:
OR
Two of these:
 State issued driver’s license or ID card
 Bank/Earnings statement
 Current, dated, signed lease
US Government issued photo ID
 Health insurance card
 US or Foreign passport
 Utility bill or traffic ticket
 Tribal or Military ID card
 Vehicle registration/title
If you have questions regarding this form, please call 608-266-1373
or visit our website at http://www.dhs.wisconsin.gov/vitalrecords

Download Form F-05281 Wisconsin Marriage Certificate Application - Wisconsin

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