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Application for Certified Copy of Kansas Divorce Certificate

This form signifies the validity of a divorce that was filed and approved in the State of Kansas. The Court provides divorced spouses with their respective copy of this form for records purposes.

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Address:	City/State:Zip:	
Self	Father Paternal Uncle	
Mother	Brother Maternal Uncle	
Sister	SonPaternal Aunt	
Current Spouse	Daughter	Maternal Aunt	
Last Name Prior to First Marriage (if different)	
Check one:    Husband             Wife                 Spouse	Date of Birth:	
                                              FIRST                                             MIDDLE                                             LAST	Last Name Prior to First Marriage (if different)	
 	
Check one:  Wife                     Husband           Spouse 	Date of Birth:	
$Total:
*Requirements-Read before turning in application	
1) This request form must	 be completed.	Type/ID #	
2) Enclose a copy of both front and back of a current legal photo ID
 (see back for list of acceptable ID's)
3) Enclose appropriate fees
4) Person requesting	 to receive a certificate must sign above	.	
5) If submitting by mail, enclose a self-addressed stamped envelope Amount given	$	Chg provided	$	
*Request will be returned if the above steps are not completed correctly.	
Form VS-238 rev  3/15	
County that granted Divorce:	
MO/DAY/YEAR	
COUNTY                                        STATE(MUST BE KANSAS)	
Phone:  785-296-1400	Topeka, KS 66612-2221	Monday-Friday	
Application for Certified Copy of Kansas Divorce Certificate 	
*
IF THE CERTIFICATE IS NOT LOCATED, A $15.00 FEE  	MUST BE RETAINED	 BY THIS DEPARTMENT FOR THE RECORD SEARCH	.                                                  
Make checks or money orders payable to Kansas Vital Statistics.  For your protection, do not send cash	
.	
Fees	
K.A.R. 28-17-6 requires the following fee(s).
The correct fee must be submitted with the request.  The fee for certified copies of divorce certificates is $15.00 for each certified copy. This fee allows a 5-	
year search of the records, including the year indicated plus two years before and two years after, or you may indicate the consecutive 5-year period you want  searched. You may specify more than one 5-year span, but each search will cost $15.00.	
Divorce Information  	
(person requesting the certificate)	
Name of Requestor:
Requestor's Signature:	
City that Divorce took place:	
$15 per Certified Copy	Number of Copies Ordered:
Party A                   
Name on Record:	
MO/DAY/YEAR
MO/DAY/YEAR
          FIRST                                              MIDDLE                                            LAST                                                                       	
Office hours:(live phones)	Kansas Office of Vital Statistics	
Mon-Fri 8:00a.m.-5:00 p.m.	
Walk-in Hours:
9:00a.m.-4:00 p.m.	1000 SW Jackson Suite 120	
Station/# of apps  __________________________   Exp    __________________
Payment  Type               CASH            CHECK          CCARD           MO	
OFFICE USE ONLY	
INITIAL	
Email:	
* PLEASE NOTE DIVORCE CERTIFICATES ARE ON FILE FROM July 1, 1951 TO PRESENT	
Date of Divorce:	
Paternal Grandparent	
Legal Guardian(submit custody order)	
*IMPORTANT:  
The person requesting the vital record  must submit a copy of  their identification .  See list on reverse side.	
Requestor's relationship to person on the Certificate? (Check one)	
Reason for Request (PLEASE BE SPECIFIC):	
Party B                  
Name of Record:	
Today's Date:	
Maternal Grandparent	
Other (specify)	
Phone Number:

◦  Bureau of Indian Affairs Tribal ID card of Requestor
◦  Valid health insurance card or policy of Requestor
◦  Parole document (book sheet) of Requestor	
By State law, vital records filed with this office are not open for public 
inspection and the requestor must meet eligibility requirements -- must be  named on the record, an immediate family member, or someone who can 
provide legal proof the record is necessary for the determination of personal or 	
property rights. [K.S.A. 65-2422d]                                                       	
◦  Parents	
Please make a copy of one of the following documents and  send with the application. All documents MUST	
 be signed, 	
current and valid.  All Identification must have both sides and 	
be able to be read.	
◦  Voter's registration card (Countries outside of the U.S.)	
◦  Aunts/Uncles	
◦  Photocopy of Government Issued Driver's License,  Military 
ID,  State ID card, Valid Passport and Visa's. (Not the 
credit/debit card)
◦  Permanent resident card
◦  Alien registration receipt card
◦  Employment authorization card
◦  Re-entry permit
◦  Inmate ID of Requestor(along with a memo completed and signed by a counselor or parole officer) 	
◦  Niece/Nephew	
Who's Eligible to Obtain Most	 Certificates: Must	 provide ID and proof of direct 
interest	
Requestor's current ID	 required To Get a Certificate:	
Eligibility	ONE	 form of Primary Documentation required from list below	
◦  Utility Bill with current address of Requestor and company letterhead with company name and address; not handwritten
◦  Current Pay Stub (must include your name, social security number plus name and address of business; not handwritten)
◦  Social Security card (must be signed by card holder)
◦  Bank Statement with Requestor's current address
◦  Car Registration or Title with Requestor's current address
* PLEASE NOTE MATRICULAS ARE NOT AN ACCEPTABLE FORM 
OF ID	
If legal guardianship has been established through the courts, please provide a  copy of the guardianship papers.	
◦  Resident Alien card	
◦  Siblings	◦  Refugee Travel Document
◦  Certificate of Naturalization (with intact photo)
◦  Concealed Carry handgun license	
◦  Must	 be age 18 or older	
◦  VA Card (with intact photo)
If you do not have a government issued photo ID, you must send photocopies of any two	 of the following:  *Photocopies must 	
be of the complete document, able to be read and be the Requestor's with current address	
◦  Temporary Driver's License
◦  Valid insurance card or policy of Requestor
1)  FEES EXPIRE 12 MONTHS FROM THE DATE OF THE REQUEST.
2)  MULTIPLE REQUESTS FOR DIFFERENT RECORDS MAY BE HANDLED AND MAILED SEPARATELY.	
WARNING: COPYING, ALTERING, or FRAUDULENT ACTIVITY PROHIBITED	
Except as authorized by the Uniform Vital Statistics Act, no person shall prepare or issue any certificate (vital record) which purports to be an 
original, certified copy or abstract or copy of a certificate [K.S.A. 65 ‑2422d.(g)].  Vital records identity theft related to obtaining certificates or 
making, counterfeiting, altering, amending any certified copy of a vital record with the intent to sell or obtain for any purpose of deception a  certified copy of a vital record is a severity level 8, nonperson felony. [K.S.A. 21-3830a (d) and K.S.A 21-3830a (e)].
◦  Letter from employer (with Requestor's current address)
◦  U.S. Voters registration card of Requestor
◦  Filed Income Tax of Requestor with current address 
◦  Letter to Requestor from Social Service Agency/Health Department or other government agency with current address
◦  Hospital or Health agency bill (with current address) of Requestor
◦  Court Documents of Requestor
◦  W-2 from Employer (with Requestor's current address)	
Read:  IMPORTANT MISCELLANEOUS INFORMATION	
◦  Current Spouse
◦  Adult Children
◦  Grandparents	
 Detailed Information	
Identification
Next: Appearance by Unrepresented Person in Civil Case Previous: Admission of Service of Summons and Petition for Dissolution of Marriage
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