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 $13.00
IS THIS IS A CONFIDENTIAL MARRIAGE?________
NAME
OF GROOM
BRIDE'S
MAIDEN NAME
DATE
OF MARRIAGE
NOTE: MARRIAGE CERTIFICATES ARE REGISTERED IN THE
COUNTY WHERE THE LICENSE WAS ISSUED, NOT IN THE COUNTY WHERE THE MARRIAGE TOOK
PLACE
COUNTY USE ONLY
ENTRY NUMBER___________________________ BANKNOTE NUMBER_______________DATE__________
q PAYMENT CASH_$___________ NO RECORD___________
q PAYMENT CHECK #_________ DRIVER'S LICENSE NUMBER___________________EX_________