DEPARTMENT OF HEALTH SERVICES
Division of Public Health
F-05281 (12/2023)
STATE OF WISCONSIN
Wis. Stat. § 69.21
Page 1 of 2
WISCONSIN MARRIAGE CERTIFICATE APPLICATION
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)].
I. APPLICANT INFORMATION
CURRENT NAME – First
Last
MAIL TO NAME - First (if different)
Last
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
(See item 3 on page 2.)
PHOTO ID NUMBER
STATE OF ISSUANCE
EXPIRATION DATE
II. APPLICANT’S RELATIONSHIP TO
PERSON(S) NAMED ON THE CERTIFICATE
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.
A. I am one of the persons named on the marriage certificate.
B. I am a member of the immediate family of one of the persons named on the marriage certificate.
Parent Child Brother / Sister
Maternal Grandparent Paternal Grandparent
C. I am the legal custodian or guardian of one of the persons named on the marriage certificate.
D. I am a representative authorized by any person in categories A - C, including an attorney.
Specify the person you represent: ____________________________________________________________________________________
E. I can demonstrate the marriage certificate is necessary for the determination or protection of a personal or property right.
Specify your interest: ______________________________________________________________________________________________
F. None of the above. I am requesting an uncertified copy. (Copy will not be valid for identity or legal purposes.)
NOTE: Grandchildren, stepparents, stepchildren, stepbrothers / stepsisters may only obtain certified copies as categories C – E.
PURPOSE FOR WHICH CERTIFICATE IS REQUESTED:
III.
FEES
First Copy Fee ………………………………………………..………………………………………………..……………... $ 20.00 ___________
Additional copies of the same certificate issued at the same time as the first copy …...…__________________ X $ 3.00 ___________
Number of Additional Copies
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
IV. MARRIAGE
INFORMATION
GROOM / SPOUSE 1 BIRTH NAME – First
Middle
BIRTH Last Name
BRIDE / SPOUSE 2 BIRTH NAME – First
Middle
BIRTH Last Name
DATE OF MARRIAGE (MM/DD/YYYY)
LOCATION OF MARRIAGE - County
LOCATION OF MARRIAGE – City, Village, or Township
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.
$ 20.00
$ 0.00
$ 20.00
Clear / Reset Form
WISCONSIN MARRIAGE CERTIFICATE APPLICATION
F-05281 (12/2023)
Page 2 of 2
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?
Requests for certified and uncertified copies of marriage certificates may take up to 2 weeks plus mail time to complete.
3. What identification is required when applying for a marriage certificate?
Requests for certified copies require proof of identification. A photocopy of the applicant’s ID is required.
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
• US Government issued photo ID
• US or Foreign passport
• Tribal or Military ID card
• Bank/Earnings statement
• Current, dated, signed lease
• Health insurance card
• Utility bill or traffic ticket
• 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