Correct a Colorado Marrige, Dissolution or Civil Union Verification
FORM TO CORRECT A COLORADO MARRIAGE, DISSOLUTION OR CIVIL UNION VERIFICATION
Please
Note
This process will only correct the Marriage, Dissolution or Civil Union Verification filed in the State Vital Records Office.
This process will not correct the actual copy of the Marriage, Dissolution or Civil Union filed in the County or District Court of the applicable jurisdiction
Record Type ► (check box
) Marriage Dissolution (Divorce) Civil Union
Please select the type of service requested ► (check box) correction of a verification registration of a missing verification
(complete 1a to 6a only)
INFORMATION AS IT CURRENTLY APPEARS ON THE MARRIAGE,
DISSOLUTION OR CIVIL UNION VERIFICATION
CORRECT INFORMATION AS IT SHOULD APPEAR ON THE MARRIAGE,
DISSOLUTION OR CIVIL UNION VERIFICATION
1. GROOM - PETITIONER’S NAME - PARTY ONE 1a. GROOM - PETITIONER’S NAME - PARTY ONE
First Middle Last(s) First Middle Last(s)
2. BRIDE - RESPONDENT’S NAME - PARTY TWO 2a. BRIDE - RESPONDENT’S NAME - PARTY TWO
First Middle Last(s) First Middle Last(s)
3. COUNTY OF MARRIAGE, DISSOLUTION OR CIVIL UNION 3a. COUNTY OF MARRIAGE, DISSOLUTION OR CIVIL UNION
4. DATE OF MARRIAGE, DISSOLUTION OR CIVIL UNION: (month/day/year) 4a. DATE OF MARRIAGE, DISSOLUTION OR CIVIL UNION: (month/day/year)
5. DOCKET NUMBER (dissolution only) 5a. DOCKET NUMBER (dissolution only)
6. Dissolution Type: Divorce
Separation Invalidation
Annulment Civil Union
6a. Dissolution Type: Divorce
Separation Invalidation
Annulment Civil Union
The penalties for obtaining a record under false pretenses include a fine of not more than $1,000 or imprisonment in the county jail for not more than one year
or both such fine and imprisonment (CRS 25-2-118). By signing below, I have read and understood that there are penalties for obtaining a record under false
pretenses. The information above is true to the best of my knowledge and I/we request that the marriage, Dissolution or Civil Union verification to be changed
accordingly.
Your relationship to requestor (check box
)
______________________________________ ___________ Groom Bride Legal Representative (must provide proof)
Signature of requestor Date Petitioner Respondent Party One
*see ID Policy
Your relationship to requestor (check box
)
______________________________________ ___________ Groom Bride Legal Representative (must provide proof)
Signature of requestor Date Petitioner Respondent Party Two
*see ID Policy
____________________________________________________________________________________________________________
Address City/State Zip code
________________________________________ _______________________________________________________________
Daytime phone number Email (Print Clearly)
OUR RETURN MAILING ADDRESS ► Vital Records, Marriage/Dissolution Correction Specialist, 4300 Cherry Creek Drive South, Denver, Colorado 80246-1530
OUR WEBSITE ►
www.colorado.gov/cdphe
CONTACT INFORMATION ► Name: Jake J. Salazar Phone: 303-692-2226 Email: jake[email protected]co.us
*ID POLICY ► Effective 11-01-2003, Return your request with a copy of your driver’s license, state ID, passport or other acceptable identification.
***EXCHANGE POLICY ►
Effective 7/1/2011 previously issued certified copies of the verification may be exchanged at any time after a correction or change
has been made to verification at $10.00 each. You must return the verification(s) to utilize this service or it must be presented to us
before any transaction is requested.
METHODS OF PAYMENT ►
We accept Checks (no-temporary), Money Orders (payable to Vital Records) and Credit Cards.
Not responsible for cash sent through the mail.
**CREDIT CARD ORDERS ► (check box
) Visa MasterCard Discover Convenience Charge will apply (see fee schedule above)
Cardholder Name
Cardholder Signature
Credit Card Number
Expiration Date
Total Charges ($)
CHECKLIST ►
TO AVOID DELAY ENCLOSE ALL NECESSARY DOCUMENTATION (PLEASE SEND THE FOLLOWING)
1) Form to Correct a Marriage, Dissolution or Civil Union Verification
3) *Identification
2) Certified Marriage Certificate, Dissolution Decree or Civil Union Certificate 4) Fees ($)
SERVICES AND FEES
(Fees are non-refundable) QUANTITY
FEES ($)
1
st
certified copy of the Marriage, Dissolution or Civil Union Verification - (if applicable, see exchange policy)
x 17.00
=
$
***Additional copies of the same certificate ordered at the same time or exchanges
x 10.00
=
$
Heirloom Certificate (Excludes dissolutions) (to view image of Heirloom Certificate visit our website)
x 35.00
=
$
**Credit Card Convenience Charge (Walk-Ins excluded)
10.00
=
$
Total Number of Verifications Requested: Total:
$
Cross outs and/or white-out is not acceptable
Complete this form in ink
Page 1/2
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