Form VS-39M "Request for a Certified Copy of Marriage Record From the Town/City Vital Records" - Connecticut

What Is Form VS-39M?

This is a legal form that was released by the Connecticut State Department of Public Health - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 10, 2009;
  • The latest edition provided by the Connecticut State Department of Public Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form VS-39M by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Public Health.

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Download Form VS-39M "Request for a Certified Copy of Marriage Record From the Town/City Vital Records" - Connecticut

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Marriage
Town/City
Request for a Certified Copy of
Record from the
Vital Records
VS-39M Revised: 9/10/2009
Mail this request to the Town Vital Records office. For the address and phone number of Town
Vital Record offices in Connecticut, please refer to our website at www.ct.gov/dph.com.
PLEASE PRINT
DO NOT MAIL CASH
Full Legal Name Before Marriage
First
Middle
Last
Groom/Spouse
Full Legal Name Before Marriage
Bride/Spouse
First
Middle
Last
Date of Marriage *
Town of Marriage
(Month/Day/Year))
PLEASE NOTE: In accordance with C.G.S. §7-51A, only the bride, groom or spouse listed on the marriage certificate or other persons
authorized by the Department of Public Health, shall be issued a certified copy of a marriage certificate containing the Social Security
numbers of the bride, groom or spouse.
All other requesters will receive a certified copy of the marriage certificate without the social
security numbers.
PERSON MAKING THIS REQUEST:
Name:
___________________________________________________________________________________________________________
First
Middle
Last Name
Address:
___________________________________________________________________________________________________________
Number
Street
Town/City: _________________________ State: _______________________ Zip Code: __________
Telephone No.: _______________________ E-Mail Address: (optional): ___________________________
Relation to Person Named in Certificate: _________________________________________________
Signature: ____________________________________________________________________________
The fee for a copy of Marriage Certificate at the State or Town is $20.00 per copy.
Number of Copies Requested:
Amount Enclosed: $_________________________
_________________
City/Town
FEE: $20.00 PER COPY. Remit a Postal Money Order made payable to the
(Personal Checks are not accepted)
Mail this request to the City/Town (for town contact information, refer to our website at
www.ct.gov/dph).
*
Note: Copies of death or marriage certificates for events that occurred less than 4 months prior to the date of the request
should be sent to the Vital Records office in the town of the event. Refer to our website at
www.ct.gov/dph
for town contact
information.
Marriage
Town/City
Request for a Certified Copy of
Record from the
Vital Records
VS-39M Revised: 9/10/2009
Mail this request to the Town Vital Records office. For the address and phone number of Town
Vital Record offices in Connecticut, please refer to our website at www.ct.gov/dph.com.
PLEASE PRINT
DO NOT MAIL CASH
Full Legal Name Before Marriage
First
Middle
Last
Groom/Spouse
Full Legal Name Before Marriage
Bride/Spouse
First
Middle
Last
Date of Marriage *
Town of Marriage
(Month/Day/Year))
PLEASE NOTE: In accordance with C.G.S. §7-51A, only the bride, groom or spouse listed on the marriage certificate or other persons
authorized by the Department of Public Health, shall be issued a certified copy of a marriage certificate containing the Social Security
numbers of the bride, groom or spouse.
All other requesters will receive a certified copy of the marriage certificate without the social
security numbers.
PERSON MAKING THIS REQUEST:
Name:
___________________________________________________________________________________________________________
First
Middle
Last Name
Address:
___________________________________________________________________________________________________________
Number
Street
Town/City: _________________________ State: _______________________ Zip Code: __________
Telephone No.: _______________________ E-Mail Address: (optional): ___________________________
Relation to Person Named in Certificate: _________________________________________________
Signature: ____________________________________________________________________________
The fee for a copy of Marriage Certificate at the State or Town is $20.00 per copy.
Number of Copies Requested:
Amount Enclosed: $_________________________
_________________
City/Town
FEE: $20.00 PER COPY. Remit a Postal Money Order made payable to the
(Personal Checks are not accepted)
Mail this request to the City/Town (for town contact information, refer to our website at
www.ct.gov/dph).
*
Note: Copies of death or marriage certificates for events that occurred less than 4 months prior to the date of the request
should be sent to the Vital Records office in the town of the event. Refer to our website at
www.ct.gov/dph
for town contact
information.