Request For Certified Copy of Divorce Record - Hawaii
STATE OF HAWAII, DEPARTMENT OF HEALTH
OFFICE OF HEALTH STATUS MONITORING
REQUEST FOR CERTIFIED COPY OF
DIVORCE
RECORD
IMPORTANT! THIS OFFICE ONLY HAS DIVORCE RECORDS FROM July 1951 TO December 2002
ALL OTHER DIVORCE RECORDS ARE KEPT IN THE COURT WHERE THE DIVORCE TOOK PLACE.
1
FIRST CERTIFIED COPY = $ 10.00
ADDITIONAL COPIES AT $4.00 EACH = $
OTHER:_______________________
= $
TOTAL COPIES
TOTAL AMOUNT DUE
FIRST MIDDLE LAST
HUSBAND'S
NAME:
FIRST MIDDLE MAIDEN
WIFE'S
NAME:
MONTH DAY YEAR
DATE OF
DIVORCE:
CITY OR TOWN ISLAND
PLACE OF
DIVORCE:
RELATIONSHIP OF REQUESTOR TO
PERSON NAMED ON CERTIFICATE
REASON FOR THIS REQUEST
SIGNATURE OF
REQUESTOR:
PRINT NAME OF REQUESTOR:
TELEPHONE NUMBERS
RES:
BUS:
ADDRESS OF REQUESTOR: NO. AND STREET OR P.O. BOX
CITY STATE ZIP
IF MAILING TO A
LOCATION OTHER
THAN ABOVE,
PLEASE FILL THIS
SECTION.
IF THE INFORMATION GIVEN
IS INCORRECT, THE
CERTIFICATE WILL FAIL TO
REACH THE DESTINATION.
NAME OF PERSON TO RECEIVE CERTIFICATE
AGENCY OR ORGANIZATION
NUMBER AND STREET OR P.O. BOX
CITY
STATE ZIP
FOR OFFICE USE ONLY
NR FILE
PENDING:
INDEX SEARCHED
FROM TO
VOLUMES SEARCHED
FROM TO
DATE COPY PREPARED
YEAR VOLUME CERTIFICATE RECEIPT NUMBER
OHSM 138 (Rev. 9/13/05)
* Be sure to sign the "Signature of Requestor" Box before submitting this form.
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