SISKIYOU COUNTY RECORDER
VITAL RECORDS
CERTIFIED COPY REQUEST
P.O. BOX 8
YREKA, CA 96097
If the record you have requested is not on file, a
"Certificate of No Record Found" will be issued to you. By law
we will retain the full fee for conducting the search for this record.
NAME OF PERSON REQUESTING CERTIFICATE______________________________________________________
ADDRESS
__________________________________________________________________________________________
REASON FOR NEEDING
CERTIFICATE_________________________________________________________
BIRTH CERTIFICATE - $13.00
WAS CHILD BORN IN SISKIYOU COUNTY_________ WAS CHILD ADOPTED?________
NAME OF CHILD
DATE OF BIRTH
MOTHER'S MAIDEN NAME
FATHER'S NAME______________________________________________________________
______________________________________________________________________
DEATH CERTIFICATE-$11.00
NAME OF DECEDENT__________________________________________________________
DATE OF DEATH
PLACE OF DEATH
______
MARRIAGE CERTIFICATE $13.00
IS THIS IS A CONFIDENTIAL
MARRIAGE?________
NAME OF GROOM
BRIDE'S MAIDEN NAME
DATE OF MARRIAGE
NOTE: MARRIAGE CERTIFICATES ARE REGISTERED IN THE COUNTY
WHERE THE LICENSE WAS ISSUED, NOT IN THE COUNTY WHERE THE MARRIAGE TOOK PLACE
COUNTY USE ONLY
ENTRY NUMBER___________________________ BANKNOTE
NUMBER_______________DATE__________
PAYMENT CASH_$___________ NO RECORD___________
PAYMENT CHECK #_________ DRIVER'S LICENSE NUMBER___________________EX_________