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_________