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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 . |
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Macomb County Clerk Carmella Sabaugh's Vital Records Certified Copy Order Form Complete and fax to the Macomb County Clerk Vital Records Office (586) 469-4751 Or mail to: Macomb County Clerk's Office, Attn: Vital Records, 40 North Main Street, Mount Clemens, MI 48043 REQUESTOR'S INFORMATION PRINT LEGIBLY Name: Mailing Address: Driver's license number: Daytime Phone Number: City, State, Zip: Signature (required): BIRTH RECORDS (Copy of picture ID MUST be included) Name of person on record Date of Birth Place of Birth Mother's full maiden name Father's full name Relationship to person: Self Parent Cost: Additional copies: TOTAL: BUSINESS REGISTRATION Name of Business: Cost: Additional copies: TOTAL: $15.00 x $5.00= $ $ DEATH RECORDS Other (document proof of relationship is required) Name of Deceased Date of Death: Place of Death: Cost: Additional copies: TOTAL: $15.00 x $5.00= $ $ $15.00 x $5.00= $ $ MARRIAGE LICENSES Bride's Full Maiden Name: Groom's Full Name: Date of Marriage: Cost: Additional copies: TOTAL: MILITARY DISCHARGE (Copy of picture ID MUST be included) Name $15.00 x $5.00= $ $ Date of Birth Social Security Number: ___ ___ ___ - ___ ___ - ___ ___ ___ ___ Cost: Number of copies: x $1.00= $ PAYMENT / MAIL INFORMATION COSTS (from above): $ SHIPPING: Overnight*: Regular mail: TOTAL COST: $ $24.00 FREE (optional) Type of credit card being used: (If mailing, check or money order can be enclosed) VISA MasterCard Discover American Express Credit Card Number: ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ Expiration Date: ___ ___ - ___ ___ Cardholder signature (REQUIRED) 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: (586) 469-5205 For additional forms: In Michigan (888) 99-CLERK Out-of-State (310) 575-5035 American LegalNet, Inc. www.FormsWorkFlow.com Fax-on-Demand Doc #3010 Rev. 10/09
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