APPLICATION FOR CERTIFICATE OF MARRIAGE
KAREN S. COLE, CABELL COUNTY CLERK
VITAL STATISTICS DEPARTMENT
750 5th AVENUE - SUITE 108
HUNTINGTON, WV  25701
Note: A $5.00 search fee and self addressed
stamped envelope must accompany this
application. This fee includes one copy if
found. This fee is not refundable. Each
additional copy is $5.00 per copy. Check or
money order payable to CABELL COUNTY
CLERK.

QUANTITY

                      

FOR OFFICE USE ONLY

Cash
Check
M/O
No. Copies
AMOUNT
BRIDE NAME
 		 FIRST
 		   MIDDLE
 		   LAST
 
AGE (WHEN MARRIED)
 		   BIRTH-PLACE CITY

 		 COUNTY

 		 STATE

 
GROOM NAME FIRST
 		   MIDDLE
 		   LAST
 
AGE (WHEN MARRIED)   BIRTH-PLACE CITY
 		 COUNTY
 		 STATE
 
DATE OF MARRIAGE: MO.
 		 DAY
 		 YEAR
 		 PERFORMED BY:
WHAT IS YOUR RELATIONSHIP TO PERSON
NAMES ON CERTIFICATE?

                                                                                        

SIGNATURE OF APPLICANT


                                                                                    

Please Print - Do Not Write

PLEASE PRINT THIS FORM, COMPLETE AND SIGN AND RETURN TO OUR OFFICE.