Form 0682-ENG-DPH: South Carolina Report of Divorce or Annulment of Marriage

Enter the Plaintiff (First, Middle, Last, Suffix) in Box 1 and the Last Name on Birth Certificate (If Different) in Box 2.

Enter the Date of Birth (Month, Day, Year) in Box 3 and the Place of Birth (State or Foreign Country) in Box 4.

Enter the Residence (County, State/Country) in Box 5 and the Number of this Marriage - First, Second, etc. (Specify) in Box 6.

Enter the Defendant (First, Middle, Last, Suffix) in Box 7 and the Last Name on Birth Certificate (If Different) in Box 8.

Enter the Date of Birth (Month, Day, Year) in Box 9 and the Place of Birth (State or Foreign Country) in Box 10.

Enter the Residence (County, State/Country) in Box 11 and the Number of this Marriage - First, Second, etc. (Specify) in Box 12.

Enter the Place of this Marriage (County, State/Country) in Box 13 and the Date of Marriage (mm/dd/yyyy) in Box 14.

In Box 15, mark the Type of Decree: Absolute Divorce or Annulment.

Enter the County of Decree in Box 16 and the Docket Number in Box 17.

Box 18, Date Decree Filed (mm/dd/yyyy), is to be completed by Clerk of Court.

In Box 19, the Signature of Clerk of Court certifies the marriage of the above named persons was dissolved on the date decree filed, with the Date Signed (mm/dd/yyyy).

Confidential and statistical information will not appear on certified copies of the report.

Enter the Plaintiff - Social Security Number (Last 4 Digits) in Box 20, the Plaintiff - Race in Box 21 and the Plaintiff - Sex in Box 22.

Enter the Defendant - Social Security Number (Last 4 Digits) in Box 23, the Defendant - Race in Box 24 and the Defendant - Sex in Box 25.

Enter the Attorney for Plaintiff in Box 26 and the Attorney Bar Number in Box 27.

Enter the Legal Grounds in Box 28.