Vsa 430M Form – Fill Out and Use This PDF

APPLICATION FOR MARRIAGE CERTIFICATE

OR REGISTRATION PHOTOCOPY

Did you know that you can save yourself time and effort by ordering your certiicate using our on-line electronic ordering system? This service is secure and easy to use and does not cost anything additional. Click here or type https://www.vs.gov.bc.ca/ecos/ into your Internet Browser.

APPLICANT AND MAILING ADDRESS INFORMATION

SuRname		given nameS
maiLing addReSS
City, PROvinCe/State, COuntRy				POStaL COde
hOme teLePhOne numbeR (inCLude aRea COde)	WORK teLePhOne numbeR (inCLude aRea COde)		if COmPany, attentiOn

e-maiL addReSS fOR CORReSPOndenCe (PLEASE PRINT CLEARLY)

DATE AND PLACE OF MARRIAGE

PARTY 1 DETAILS

biRthPLaCe (City, PROv/State, COuntRy)

PARTY 2 DETAILS

biRthPLaCe (City, PROv/State, COuntRy)

NUMBER OF SERVICES REQUIRED (see reverse for fee information and limits on number of certiicates)

*NOTE: All services, other than courier services, will be mailed. Courier service requests are produced the next business day. Delivery time is dependent on shipping destination. Fee includes the cost of the search of our records. A certiicate will be generated upon conirmation of a record held. If no record of the event is found, the fee will be applied to the search process. Courier Service will not be attempted at the following residence types: post ofice box, apartment complex, homes that utilize Super Box mailboxes and

Basement suites. Instead, a delivery notice with instructions will be left at those residences and the package delivered to the nearest postal outlet. ID and signature will be required upon pick up.

YOUR RELATIONSHIP TO MARRIAGE: Self

*Other

(*requires written authorization from an eligible applicant)

Reason Certiicate Required:

YOUR SIGNATURE (written) :

PAYMENT METHODS

Cheque *

money Order

visa

masterCard

american express

* Postdated cheques not accepted

interac/Cash payment may be made

AMOUNT

in person at one of our three ofices.

Card holder signature

Cheque or money order made

ENCLOSED $

payable to the minister of finance.

PRINT Card holder name as shown on Credit Card

Credit Card #

expiry date

VSA 430M 2013/10/15

PLEASE READ NOTES ON REVERSE OF THIS FORM

IMPORTANT INFORMATION

TO AVOID DELAY

*Complete all sections in full (all requests with incomplete information must be accompanied by a signed, written explanation for the omission and include two pieces of identiication, including one picture id, and written veriication of identity on oficial letterhead from a Physician, Lawyer, notary Public, or Religious Representative who has known you for at least two years.)

*be sure you are authorized to make the request (see Section 3 below).

*it is against postal regulations to send cash through the mail. Payment in Canadian funds should be forwarded by cheque, bank draft or money order made payable to the Minister of Finance. Postdated cheques not accepted. Credit card payments are accepted, please complete the Credit Card portion on the front of this form.

1)FEES

fees as noted for each requested copy on the front of this form. the following conditions apply: where a certiicate or registration photocopy cannot be issued because no record exists or the applicant has not supplied suficient or correct information, a $27.00 search fee will be assessed. *All fees subject to change. If ordering after April 1, 2014, contact our ofice for current fees.

2)INFORMATION PROVIDED

Certiicates contain the following information:

marriage Small - name of each party, date, place, registration date, and registration number marriage Large - same as small plus birthdates and places of birth of each party

Photocopies

a)Registration photocopies are rarely needed by citizens, are not required for court purposes, and are not suitable for identiication purposes.

b)Registration photocopies contain all the information about the event as recorded at the time, and are rarely needed for reasons other than personal records.

c)Should you believe that you require a certiied photocopy of a marriage event registration, please visit our web site at: www.vs.gov.bc.ca or contact our customer enquiry line at 250 952-2681 (victoria & Outside bC) or toll free at 1-888-876-1633 (within bC) for eligibility information.

3)WHO QUALIFIES TO APPLY FOR A MARRIAGE CERTIFICATE marriage certiicates may be released to:

a)either party of the marriage

b) a person who has written authorization of either party to the marriage

OTHER SERVICE - For Records held in British Columbia only

Genealogy Registration Photocopy

to obtain an application for this service, please visit our web site or contact one of our ofices by telephone or in person.

			OR VISIT ONE OF OUR OFFICES
	MAILING ADDRESS
	vital Statistics agency
	PO box 9657 Stn PROv gOvt	VICTORIA:	VANCOUVER:	KELOWNA:
	victoria bC v8W 9P3
		818 fort Street	250 - 605 Robson Street	305 - 478 bernard avenue
	ENQUIRIES & CREDIT CARD ORDERS	victoria bC	vancouver bC	Kelowna bC
	telephone: 250 952-2681 (victoria & Outside bC)
	toll free: 1 888 876-1633 (within bC)	Check our Web Site at: http://www.vs.gov.bc.ca

the information on this form is collected under the authority of the Vital Statistics Act (RSbC 1996, c.479, Sec. 37). the information provided will be used to fulill the requirements of the Vital Statistics Act for the release of marriage information. if you have any questions about the collection or use of this information, please contact a vital Statistics Client Service Representative at 250-952-2681, or write to the mailing address given above.

VSA 430M 2013/10/15