Certified Copy Marriage Certificate / Civil Union
Request Form

Town of West Hartford
Town Clerk - Vital Statistics
50 South Main Street
West Hartford, CT 06107
(860) 561-7430

Dear Town Clerk:

Please provide me with a certified copy of a marriage certificate or civil union license. Enclosed is a (__ ) money order / (__ ) personal check for $10.00 each, (payable to the Town of West Hartford).

 

Bride's full (maiden) name or partner's name:

.

Groom's name or partner's name:

.

Place of marriage or civil union:

.

Date of marriage or civil union:

.

 

Please forward ____(#) certified copies of this marriage certificate or civil union license to the following address:

 

Name:     

Address:

City/State:

Phone:

 

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