Riverside County Recorder - Vital Records Marriage Print this form, complete it and fax it to 8883876984

Name of Party A ______________________________________________________________________   (first middle last name at birth)   Name of Party B ______________________________________________________________________   (first middle last name at birth) Date of Marriage ___________________________ City ____________________________ State_______ Relationship:   Spouse  Mother  Father  Other ________________________________ Reason for request _________________________________________ Number Of Copies _______ Ship Method: Express Courier (additional charges)  Regular Mail Ship To Name ______________________________________________________________________ Address ______________________________________________________________________ City __________________________________________ State ________ Zip _________ Phone Number __________________________________________ Credit Card: Visa   MasterCard    American Express   Discover Credit Card Number ______________________________________________ Expires ________ Cardholder's Signature ______________________________________________   Date ________ Applicant's Signature ______________________________________________   Date ________ Applicant's Email ______________________________________________ Credit Card Billing Address Name ______________________________________________ Address ____________________________________________ City _________________________ State ____ Zip ________