Card Number: Exp. Date: /
PRINT name and address of person to whom the verification
is to be mailed to or issued to over the counter:
Name
Address
City/State/Zip
COLORADO DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT
VITAL RECORDS SECTION/HSVRD-VR-A1
4300 Cherry Creek Drive South
Denver, Colorado 80246-1530
303-692-2200
www.cdphe.state.co.us/certs
marigver.PMD (03/09)
Application for Certified Verification of a Marriage Record
INFORMATION ABOUT PERSONS WHOSE MARRIAGE RECORD IS REQUESTED -- please type or print
This office has indices for 1900 to 1939 and 1975 to present.
PLEASE COMPLETE THIS AREA
VISA
MasterCard
Discover
American Express
Card Type:
Cardholder name:
Credit card orders:
Make check or money order payable to to Vital Records. Please do not send cash.
First
Middle Last
First
Middle Last
County Where License Was Issued
Date of Marriage
Today's Date
Name of Wife
Name of Husband
This office will not have a record of the marriage if the county did not forward the information for the State Index. Verifications for the years 1940-1974 are not
available from this office and must be obtained from the county where the license was obtained. You may need to contact each of the counties if you do not know
where the license was obtained. County clerk offices are located in the county seat. A list of counties, county seats, and ZIP codes is provided on the reverse
side of this form.
● Apply in person for same day service. Office hours are from 8:30 a.m. to 4:30 p.m., Monday-Friday.
● Order verifications online** at http://www.cdphe.state.co.us/certs.Verification(s) mailed next work day upon receipt of all required
documentation.
● Fax your application with credit card information**: within contin