Application for No Record of Marriage Certification
To obtain a "No Record of Marriage Certification" which is the New York State Vital Records equivalent
of a "Single Status Report" or "Certificate of Non-Impediment" the following information is required:
Name of Person Seeking the No Record
The Applicant (first middle last): _____________________________________________________
Birth name of Applicant (maiden name, if applicable): _______________________________________
Date of Birth: ___________________ Place of Birth: ___________________Gender: ________
Number of copies requested: ________Phone Number of Applicant: ___________________________
Address of Applicant: _________________________________________________________________
Mailing Address for Certification: ___________________________________________
___________________________________________
Dates of all previous dissolution of marriages (divorce, annulment, etc.):
Dates of all previous marriages: _____________________________________
Length of search required depends on country requesting the No Record of Marriage. In New York State
the earliest age at which a marriage may legally occur is fourteen, you may need to search from the year
in which you turned 14 until the present.
Search From Date (mm/dd/yyyy): _____________ Search To Date (mm/dd/yyyy): _____________
Number of years searched: ______Year(s)
(Each portion of a year is considered 1 year. A search from 6/1/2005 - 6/1/2007
is considered a three (3) year search 2005, 2006 & 2007)
Length of search Fee per copy.
Up to 3 years $45.00, 4 to 10 years $65.00, 11 to 20 years $85.00
21 to 30 years $105.00, 31 to 40 years $125.00
Fee (number of copies x fee for length of search): __________
Applicant Statement:
By my signature I do signify that I was not married during the period to be covered by the search herein
requested.
Applicant signature: _________________________________________
Date signed (mm/dd/yyyy): ___________________
Send the above information along with a check or money order for the proper fee amount (made
payable to the New York State Department of Health) and a copy of ID (see ID requirements below).
Application for No Record of Marriage Certification
Identification Requirements:
Application must be submitted with copies of either A or B:
A. One (1) of the following forms of valid photo-ID:
• Driver license
• Non-driver photo-ID (state issued)
• Passport
• U.S. Military issued photo-ID
OR
B. Two (2) of the following showing the applicant's name and address:
• Utility bill or telephone bill
• Letter from a government agency dated within the last six (6) months
Note: Copy of Passport required (along with ID from either A or B above) if request is made from a
foreign country that requires a U.S. Passport for travel.
For fastest processing we suggest that requests be submitted by overnight carrier to the following
address:
New York State Department of Health
Vital Records Certification Unit
800 N. Pearl St.
Albany, NY 12204
For fastest return, you may include a prepaid return mailer, otherwise your record will be returned by
regular mail.
__________________________
The New York State Department of Health does not file and cannot record marriages which occur
outside of New York State. This does not mean that such a marriage is not recognized by New York
State. Generally, marriages which occur in accordance with the laws and regulations of another state or
country are recognized under New York State law. However, for information about the acceptability of a
marriage license obtained outside of New York State for specific purposes (such as changing your name
on a driver license or social security card) you should contact the appropriate agency.
__________________________
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