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Request For Vital Records Via Fax Or Mail Order Form - Michigan

Request For Vital Records Via Fax Or Mail Order Form Form. This is a Michigan form and can be used in General Macomb Local County .
 Fillable pdf Last Modified 1/9/2014
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Macomb County Clerk Carmella Sabaugh's Vital Records Certified Copy Request Form 40 North Main Street, Mount Clemens, MI 48043 Fax: (877) 443-9505 E-mail: vitalstaff@macombgov.org Submit to the Macomb County Clerk Vital Records Office REQUESTOR'S INFORMATION PRINT LEGIBLY Name: Mailing Address: Driver's license number: Daytime Phone Number: City, State, Zip: E-mail address: (Copy of requestor's photo ID MUST be included) Name of person on record Date of Birth Mother's full maiden name Father's full name Place of Birth BIRTH RECORDS BUSINESS REGISTRATION Name of Business: Cost: Additional copies: TOTAL: x $5.00= $ $ $15.00 Self Parent Heir Legal Guardian Legal Representative Court of competent jurisdiction Relationship to person: Cost: Additional copies: TOTAL: x $5.00= $ $ $15.00 DEATH RECORDS Name of Deceased Date of Death: Place of Death: Cost: Additional copies: TOTAL: x $5.00= $ $ $15.00 (Copy of requestor's photo ID MUST be included) Name Date of Birth Social Security Number: ___ ___ ___ - `___ ___ - ___ ___ ___ ___ FREE Groom's Full Name: Date of Marriage: Cost: Number of copies: $ MILITARY DISCHARGE MARRIAGE LICENSES Bride's Full Maiden Name: $15.00 x $5.00= $ $ Additional copies: TOTAL: PAYMENT / SHIPPING INFORMATION COSTS (from above): $ SHIPPING: (will be mailed to requestor's address) Payment type: TOTAL COST: Overnight*: Regular mail: cash check made payable to Macomb County Clerk $24.00 $ FREE (optional) Credit Card Number: ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ Expiration Date: ___ ___ - ___ ___ Cardholder signature (REQUIRED) For additional forms call (888) 99-CLERK Fax-on-Demand Doc #3010 Rev. 01/12 American LegalNet, Inc. www.FormsWorkFlow.com Cardholder name (PRINT) *Delivery may take up to 2 days depending on the zip code and if request is not received before 1 pm. Rates are higher outside of the U.S. For help completing this form call: Phone: (586) 469-5205
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