CITY
PLACE OF APPLICATION
BRIDE’S MAIDEN NAME
(FIRST-MIDDLE-LAST)
GROOM’S NAME
(FIRST-MIDDLE-LAST)
DATE OF MARRIAGE
COUNTY STATE
Application for Certified Marriage Certificate
Vital Registration Office
Room 165
350 Capitol Street
Charleston WV, 2530
1-3701
(
304) 558-2931
www.wvdhhr.org
AMOUNT
MONEY ORDER
WHEN STAMPED PAID
THIS IS YOUR RECEIPT
For Office Use Only
CASH
CHECK
NO. COPIES
MONTH/DAY/YEAR
City, State, Zip
Mail Certificate to
Mailing Address
Suite or Apartment Number
What is Your Relationship to the Bride or the Groom ?
I understand that intentionally making a false statement on this application or obtaining,
possessing, or using a vital record other than is allowed by law or using the vital record of
another with an intent to deceive is a
FELONY under the law of the State of West Virginia
(WV Code §16-5-38).
Signature Required
Note: A $12.00 nonrefundable search fee
must accompany this application. This fee
includes one copy, if found. Each additional
copy is $12 . Cashis sent at sender’s risk.
Make check or money order payable to
“VITAL REGISTRATION”
1
12
WV
Marriage records are confidential and not open to the general public, except for those that are at least 50 years
old.
Who is entitled to obtain records:
● The parties that are listed on the marriage certificate;
● Adult children that were a product of the marriage; and
● Legal representatives (proof of legal representation also required).
Proof of relationship may also be required.
All requests must be accompanied by a valid ID as listed below. The acceptable documents listed may change without
prior notice. For mail requests, a photocopy of the document is sufficient, please do not send the original.
Submit one (1) document from the primary list OR two (2) documents from the secondary list.
Primary Documents
● DMV-issued driver's license unexpired or expired for not more than five years;
● DMV-issued learner's/instruction permit unexpired or expired for not more than five years;
● DMV-issued photo identification card (excluding child ID cards) unexpired or expired for not more than one year;
● Current Photo ID card, (school and employment). Check Cashing Cards are not acceptable;
● Unexpired U.S. military ID card of an active duty or retired member (ID cards of military dependents are not
acceptable as primary identity documents);
● U.S. Passport unexpired or expired for not more than five years;
● West Virginia Criminal Justice Agency Offender Information Form; or
● United States Probation Offender Information Form
Secondary Documents (Require two of below selections)
● Social Security Card
● A utility bill (phone, electric, gas, water, etc.) with your name and current address;
● Automobile registration with your name and current address;
● Automobile insurance card with your name and current address;
● Voter’s Registration Card with your name and current address;
● Checking account deposit slip or bank statement stating name and current address;
● Paycheck stub or a W-2 form with your name and current address;
● U.S. Selective Service Card;
● U.S. military discharge papers (form DD214);
● Health care insurance card;
● Unexpired welfare/social services identification card with photo, issued by a municipality;
● Unexpired weapons or gun permit issued by federal, state or municipal government; or
● Veterans’ Universal Access Identification Card.
WV Vital Registration
350 Capitol St. Rm. 165, Charleston, West Virginia, 25301-3701
Information Line: (304) 558-2931
