APPLICATION FOR CERTIFIED COPY OF

DAKOTA COUNTY RECORD

PLEASE TYPE OR PRINT LEGIBLY

Full name of owner of record:

Full name of groom

Identify record:
	Month, day and year of record:
	For what purpose is this record to be used? (Use reverse side if more room is needed)

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Certified copies will only be issued to the person named in the document, their immediate family, legal guardians, or legal representatives & Government Officials. Legal guardians and legal representatives must provide a copy of the document authorizing guardianship or representation. Government Officials should show some proof how they are affiliated with government. Applicant must provide photo identification. By signing this application, applicant attests that the recipient of this record has legal direct, tangible entitlement.

Please print the Name and address of person below to receive the certified copy and whether they will pick up

The document in person or by mail. (check one) Pick up ___ Mail ___

Please provide photo identification. If receiving by mail please send copy of Driver’s License.

Please print clearly on the lines below.

NAME: _________________________________________________

STREET ADDRESS: _________________________________________________

CITY, STATE & ZIP: _________________________________________________