application for certified copy or search of vital records

Riverside County Recorder
APPLICATION FOR CERTIFIED COPY OR SEARCH OF VITAL RECORDS
Birth, Death or Marriage MUST have occurred in Riverside County
1. Fill out appropriate section(s) of this request form.
3. Make checks payable to: RIVERSIDE COUNTY RECORDER
2. Print YOUR NAME and MAILING ADDRESS in the
Purchased by section below.
$ 10.00 each Death Certificate or Search
$ 15.00 each Birth Certificate or Search
$ 12.00 each Marriage Certificate or Search
$ 2.00 Indio Fax Fee, if applicable
We charge for searches even if NO record is found
(Se cobrabra por buscar aunque no aye nada)
BIRTH RECORD
Ctf. # ___________________
PLEASE PRINT (FAVOR DE PASAR A MANO E MACHINA)
Name Given at Birth _______________________________________________________________________________________________________
(Nombre de nacimiento)
First (Primer)
Middle (Segundo)
Last (Apellido)
Date of Birth _____________________________________
(Fecha de Nacimiento)
City of Birth _______________________________________________________
(Ciudad de Nacimiento)
Name of Father ___________________________________________________________________________________________________________
(Nombre del Padre)
First (Primer)
Middle (Segundo)
Last (Apellido)
Mother’s Maiden Name (Nombre de soltera de la madre) __________________________________________________________________________
Is child adopted or had a legal name change? Y/N
Number of Copies (Numero de Copias) ________________________
DEATH RECORD
Ctf. # ___________________
PLEASE PRINT (FAVOR DE PASAR A MANO E MACHINA)
Name of Deceased ________________________________________________________________________________________________________
(Nombre de fallecido)
First (Primer)
Middle (Segundo)
Last (Apellido)
Date of Death ______________________________________
(Fecha de fallecimiento)
Date of Birth _____________________________________________
(Fecha de Nacimiento)
City of Death __________________________________
(Ciudad de fallecimiento)
Number of Copies (Numero de Copias)________________________
MARRIAGE RECORD or
CERTIFICATE OF NO RECORD
Ctf. # ___________________
PLEASE PRINT (FAVOR DE PASAR A MANO E MACHINA)
Public (Publico) _____________
Confidential (Confidencial) ___________
Years to be searched ________ to _________
Name of Groom ___________________________________________________________________________________________________________
(Nombre del Novio)
First (Primer)
Middle (Segundo)
Last (Apellido)
Name of Bride ____________________________________________________________________________________________________________
(Nombre de la Novia)
First (Primer)
Middle (Segundo)
Last (Apellido)
Date of Marriage ________________________________
(Fecha de Matrimonio)
Number of Copies (Numero de Copias) ________________________
Confidential Marriages require a picture I.D. if requested in person or a notarized signature if requested by mail.
Purchased by (Pedido por):
_______________________________________________
Name (Nombre)
_______________________________________________
Street address (Domicilio)
_______________________________________________
City (Ciudad)
State (Estado) Zip (Zona postal)
FORM 320 (Rev 1/99)
For Office Use Only:
Ctf.# ___________ Yr.______
Rect. # _____________________ Cash ___________ Check __________
Total $___________________ Govt. Agency ________________________
Ck.# _______________ Amt. $ _______________ Long $ _____________
Clerk ________________________________________________________