DEPARTMENT OF HEALTH SERVICES
Division of Public Health
F-05282 (Rev.03/12)
WISCONSIN DIVORCE CERTIFICATE APPLICATION
(for Mail or In-Person Requests)
STATE OF WISCONSIN
Chapter 69.21 Wis.Stats
Page 1 of 2
TYPE or PRINT.
PENALTIES: Any person who willfully and knowingly makes a false application for a divorce certificate shall be fined not more than $1,000 or imprisoned not more than 90 days, or both, per s. 69.24(2), Wis. Stats. Any person who willfully and knowingly obtains a divorce certificate for fraudulent purposes is guilty of a Class I felony [a fine of not more than $10,000 or imprisonment of not more than 3 years and 6 months, or both, per s. 69.24(1), Wis. Stats.].
The information in Section I is about the person completing this application.
YOUR CURRENT NAME - First |
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Last |
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YOUR DAYTIME TELEPHONE NUMBER |
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YOUR STREET ADDRESS (CANNOT be a P.O. Box address) |
Apt. No. |
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MAIL TO ADDRESS (if different tban street address) |
Apt. No. |
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City, Village, or Township |
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State |
ZIP Code |
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City |
State |
ZIP Code |
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TYPE OF CURRENT VALID PHOTO ID |
PHOTO ID NUMBER |
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STATE OF ISSUANCE |
EXPIRATION DATE |
(See item 3 on page 2.) |
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II. APPLICANT’S RELATIONSHIP TO
PERSON(S) NAMED ON THE CERTIFICATE
According to Wisconsin Statute, a CERTIFIED copy of a divorce certificate is only available to those with a “direct and tangible interest" (categories A – E below.) You may select to receive an uncertified copy if you just need a copy for informational purposes OR if you do not meet the criteria for categories A-E. In that case, you may check category F below. (See item 1 on page 2 for more details.)
Check one box which indicates YOUR RELATIONSHIP to one of the PERSONS NAMED on the divorce certificate.
A. I am one of the persons named on the divorce certificate.
B. I am a member of the immediate family of one of the persons named on the divorce certificate. (Only those listed below qualify as immediate family.) NOTE: Grandchildren, step-parents, step-children, step-brothers/step-sisters may only obtain certified copies as section II, categories C – E.
CHECK ONE. Parent (whose name is on the husband or wife’s birth certificate and whose parental rights have not been terminated)
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Brother / Sister |
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Grandparent |
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Child |
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C. I am the legal custodian or guardian of one of the person named on the divorce certificate. (Legal proof is required. See item 1 on page 2.) D. I am a representative, authorized in writing, by any of the above checkboxes (categories A - C). (The written and notarized authorization must
be attached to this application. See item 1 on page 2.)
Specify the person you represent: _____________________________________________________________________________________
E. I can demonstrate that the information from the divorce certificate is necessary for the determination or protection of a personal or property right for myself/my client/my agency. (Proof is required.)
Specify your interest: _________________________________________________________________________________________________
F. None of the above. I am requesting an uncertified copy. Copy will not be valid for legal identity or benefit purposes. See Item 1 and 2 on page 2.
PURPOSE FOR WHICH CERTIFICATE IS REQUESTED (Specify. This information will assist us in processing your request.)
FEE IS NOT REFUNDABLE IF NO RECORD IS FOUND. CANCELLATIONS NOT ACCEPTED. |
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Search Fee (includes one copy, if found) ………………….………………………………………..……………... $ 20.00 |
___20.00___ |
Additional copies of the same certificate issued at the same time as the first copy ___________________ X $ 3.00 |
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Number of Additional Copies |
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TOTAL |
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Make check or money order payable to:
STATE OF WIS. VITAL RECORDS
Be sure to include (1) completed form, (2) acceptable identification, (3) any additional proof or authorization required, (4) self-addressed, stamped business-size envelope, and (5) check or money order.
Mail your application materials and fee to: STATE VITAL RECORDS OFFICE / PO BOX 309 / MADISON, WI 53701-0309
HUSBAND’S BIRTH NAME - First
WIFE’S BIRTH NAME - First
LOCATION OF DIVORCE - County
Middle |
BIRTH Last Name |
Middle |
BIRTH Last Name |
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DATE OF DIVORCE (Month/Day/Year) |
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I hereby attest that the information provided on this application is correct to the best of my knowledge and belief and that I am entitled to copies of the requested divorce certificate in accordance with the categories listed above.
SIGNATURE - Applicant (person named in section I, who is completing this application)
Date Signed (Month / Day / Year)
Important: If you do not sign and date this form above , your request cannot be processed.
VITAL RECORDS OFFICE USE ONLY
WISCONSIN DIVORCE CERTIFICATE APPLICATION |
Page 2 of 2 |
F-05282 (Rev. 03/12) |
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1.What is the difference between a “certified” and an “uncertified” copy of a divorce certificate?
A certified copy of a divorce certificate issued by the State Vital Records Office will have a raised seal, will show the signature of the State Registrar, and will be printed on security paper. A certified copy may be required to change your last name or to marry.
State law restricts who may obtain a certified copy of a divorce certificate. A certified copy can only be issued to those people with a “direct and tangible interest” (section II, categories A – E) which means the following people:
The husband or wife named on the divorce certificate (section II, category A).
An immediate family member defined as a parent (whose name is on the husband or wife’s birth certificate and whose parental rights have not been terminated), brother, sister, grandparent, or child of the subject of the record (section II, category B).
NOTE: Grandchildren, step-parents, step-children, step-brothers and step-sisters can only obtain certified copies as section II, categories C – E.
The legal custodian or guardian of the husband or wife named on the divorce certificate. Legal proof, e.g., a court order of custody or guardianship, is required (section II, category C).
A person authorized in writing by one of the above. A written and notarized authorization must be attached to this application and the authorization must clearly state the relationship of the authorizing party to the subject of the record (section II, category D).
A person who can demonstrate that the divorce certificate is required to determine or to protect a personal or property right (section II, category E). Proof is required.
If you do not meet one of the above criteria, you cannot receive a certified copy of a divorce certificate.
An uncertified copy will contain the same information as a certified copy but it is not acceptable for legal purposes, such as remarriage. (section II, category F)
2.How long will it take to process my request?
Copies of divorce certificates are available from the State Vital Records Office no less than 3 weeks from the date of the divorce.
Applying in Person
Requests for certified copies of divorce certificates are usually completed within 2 business hours of application, if the divorce certificate is on file.
Requests for uncertified copies of divorce certificates are not completed on the same schedule as requests for certified copies. In-person requests for uncertified copies may take up to 1 month to complete.
Applying by Mail
Requests for certified copies of divorce certificates may take up to 2 weeks plus mail time to complete.
Requests for uncertified copies of divorce certificates are not completed on the same schedule as certified copies. Mail requests for uncertified copies may take up to 1 month plus mail time.
3.What identification is required when applying for a certified or uncertified copy of a divorce certificate?
A photocopy of the applicant’s current ID as listed below must be submitted with all mail applications. A current ID as listed below is required when applying in-person.
At least one form of ID must show your current name and current address. Expired cards or documents will not be accepted.
The acceptable forms of identification are:
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One of these: |
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Two of these: |
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Wisconsin driver’s license |
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Government-issued employee |
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Major Credit Card |
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Wisconsin photo ID |
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ID card or badge with photo |
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Health Insurance Card |
Out-of-state driver’s license or |
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US Passport |
Recent dated, signed lease |
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photo ID card |
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Check or bank book |
Recent utility bill or traffic ticket |
If you have questions regarding this form, please call 608-266-1373 or visit our website at http://www.dhs.wisconsin.gov/vitalrecords
