Application for a marriage certificate DCC Logo

Please print application form and complete.
Please read notes before completing
1. Applicant
Name of applicant: Mr/Mrs/Miss/Ms
(State name in full)
Full postal address:
Post Code: Telephone No:
Are you applying for your own marriage certificate? YES / NO
If no please state your relationship to the person to whom the certificate relates:  
It would help us if you would state the purpose for which the certificate is required:  
4. Details of marriage certificate required
Man Woman
Surname Surname before marriage Any other surname used before this marriage
Forename(s) Forename(s)

Date of marriage Place of marriage (Name of building, church or register office and locality)
Day Month Year  
5. Requirements
I require   (number) marriage certificate(s)
6. Remittance enclosed
I enclose a cheque/postal order made payable to Durham County Council, in sterling drawn on a British Bank Sorting Code, for £
Signature: Date:
Register No. - Entry No. - District
Certificate No.
Date of issue: