Groom or Spouse A: Bride or Spouse B:

Marriage Certificate Request Form

Jersey County Clerk

To obtain a certified copy of a marriage certificate, you must be one of the following:

 One of the spouses listed on the marriage certificate or their parents may obtain the full record.

 Any applicant may obtain a copy of the first page of the record.

 Any applicant with a genealogical interest may obtain the full record if the record is over 50 years old.

Please complete and sign this form and provide a copy of your current Photo ID

Groom or Spouse A: ______________________________________________________________

Bride or Spouse B: ________________________________________________________________

Date of Marriage: _________________________________________________________________

Mailing Address: __________________________________________________________________

________________________________________________________________________________

Your Relationship to the Person on Marriage Certificate:

[ ] Self

[ ] Parent

[ ] Guardian

[ ] Other ______________________________________________________

Signature: ______________________________________________________

Your daytime phone number (in case we have a question about your request): ____________________

Number of Certified Copies Requested: ____________________

Cost of a certified copy of marriage certificate:

- $10.00 for search, which includes one certified copy

- $5.00 for each additional copy of same certificate

(plus $2 fee if using credit/debit card)

Payment is accepted by check, money order, MasterCard, Visa, or Discover

Mail your request to:

Jersey County Clerk

P. O. Box 216

Jerseyville, IL 62052

Due to the confidential nature of vital records, your documents may not be faxed or emailed, but you may email your

completed request along with a copy of your photo ID to: countyclerk@jerseycounty-il.us