Office of William Britton Moore County Register of Deeds Vital Record Request

This is an official request for an aspect of the Moore County Register of Deeds Vital Record. The information contained in this request should be considered private. Please complete all information in full and then finalize the order process through payment of the 'order fee'.

The fee payment will be paid through Permitium Payments. The charge will show on your credit card statement as 'PermVitalRecs'. This is a secure and trusted provider of payment services.

Please Enter The First Applicant's Full Name:

Last Name: ^{(full name, no initials)}

First Name:

Middle Name:

Maiden Name:

Suffix:

Please Enter The Second Applicant's Full Name:

Last Name: ^{(full name, no initials)}

First Name:

Middle Name:

Maiden Name:

Suffix:

Please Enter The Marriage Location Information:

Date of Marriage:

Marriage Location City:

Marriage County:

Marriage State:

Please Enter The Requestor's Name:

Last Name: ^{(full name, no initials)}

First Name:

Middle Name:

Maiden Name:

Suffix:

Last 4 SSN:

Last 4 SSN: ^(confirm)

Requestor Date of Birth:

Requestor Current Age:

Requestor's Current Residence Address: ^{(this may be different than the mailing address)}

Address Line 1:

Address Line 2:

City:

State: ^(region)

Zip Code: ^{(postal code)}

Country:

^{Mailing Address Different:}

Yes No

Requestor's Current Mailing Address: ^{(if different from residence address)}

Address Line 1:

Address Line 2:

City:

State: ^(region)

Zip Code: ^{(postal code)}

Country:

Requestor's Contact Telephone Numbers: ^{(###-###-####)}

^Home:

^Work:

^{Cell Phone:}

^Fax:

Updates via Text Message?

Yes No

Requestor's Driver's License: ^{(or other State Issued ID)}

^{ID Number:}

^{Issuing State:}

Requestor's Email:

^Address:

^Confirm:

Please attach your photo identification

All general public certificate requests must provide a valid form of identification.

If you are a funeral director (or agent responsible for the disposition of the body) acting on behalf of the deceased's family you are required to upload a valid form of identification and proof of funeral home employment.

If you are an attorney please provide your BAR Association card.

If legal representative please provide ID and documentation for the reason
FAILURE TO UPLOAD THE REQUIRED DOCUMENTATION WILL RESULT IN A DENIAL WITH A LOSS OF PROCESSING FEES.

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Special Instructions :

Select Delivery Method:

These documents will be delivered via mail to the following address(es)

One of the applicants on the Marriage Certificate is:

Myself
My Spouse
My Brother / Sister
My Child / Step-child
My Parent / Step-Parent
My Grandparent / Grandchild
Authorized Agent, Attorney (proof required)
Legal Representative (proof required)

Select The Information Type(s) Requested:

Total Fee:

$0

AUTHORIZATION NOTIFICATION:

My initials below constitute an electronic signature and authorizes the Moore County Register of Deeds Department of Vital Records to release information and / or my vital record and confirms I have completed all sections accurately and truthfully, including information verifying my identity. I understand that the recipient of the record(s) will use the indicated documents(s) for legitimate interests only and that the information contained therein shall not be further transferred or communicated to any other party or agency without my expressed written consent except under authority of North Carolina General Statutes 130A-26A, and 130A-93.

I have enclosed the correct fees and understand that they are nonrefundable. I understand that an incomplete form will not be processed and will be considered closed after expiration of the 30 day notification window. I declare under penalty of perjury that the foregoing is true and correct.

Coupon Code:

Requestor's Initials:

Clear Form

Online Marriage Certificate Request

Please Enter The First Applicant's Full Name:

Please Enter The Second Applicant's Full Name:

Please Enter The Marriage Location Information:

Please Enter The Requestor's Name:

Requestor's Current Residence Address: ^{(this may be different than the mailing address)}

Requestor's Current Mailing Address: ^{(if different from residence address)}

Requestor's Contact Telephone Numbers: ^{(###-###-####)}

Requestor's Driver's License: ^{(or other State Issued ID)}

Requestor's Email:

Please attach your photo identification

Select Delivery Method:

Documents Will Be Delivered To: ^{please enter the delivery addresses}

One of the applicants on the Marriage Certificate is:

Select The Information Type(s) Requested:

Total Fee:

$0

Online Marriage Certificate Request

Add An Address

A Shipping Address Is Required!

Please Enter The First Applicant's Full Name:

Please Enter The Second Applicant's Full Name:

Please Enter The Marriage Location Information:

Please Enter The Requestor's Name:

Requestor's Current Residence Address: (this may be different than the mailing address)

Requestor's Current Mailing Address: (if different from residence address)

Requestor's Contact Telephone Numbers: (###-###-####)

Requestor's Driver's License: (or other State Issued ID)

Requestor's Email:

Please attach your photo identification

Select Delivery Method:

Documents Will Be Delivered To: please enter the delivery addresses

One of the applicants on the Marriage Certificate is:

Select The Information Type(s) Requested:

Total Fee:

$0

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Requestor's Current Residence Address: ^{(this may be different than the mailing address)}

Requestor's Current Mailing Address: ^{(if different from residence address)}

Requestor's Contact Telephone Numbers: ^{(###-###-####)}

Requestor's Driver's License: ^{(or other State Issued ID)}

Documents Will Be Delivered To: ^{please enter the delivery addresses}