VITAL RECORDS ORDER FORM

 

Type of Record:   _____  Birth     _____  Marriage     _____  Death

(Select only one)

 

_____  photocopy (.15/pg.)          _______ certified copy ($2.00)

 

Name of Individual Sought:

 

First:__________________  Middle: ______________ Last:_______________

 

Date of Birth/Marriage/Death: _______________________________________

 

Place of event:  _____________________________________________________

 

Parents' Names:  _________________________________________________

 

Spouse:  ________________________________________________________

 

Your Name:  ___________________________

 

Address:  ______________________________

 

          _____________________________

 

Kenneth S. Carlson

Reference Archivist

Office of the Secretary of State Matthew A. Brown

State Archives Division

337 Westminster Street

Providence, RI  02903

Tel. 401 222 - 2353

Fax. 401 222 - 3199

TTY:  711

Email:  reference@sec.state.ri.us

Website:  www.sec.state.ri.us/archives