APPLICATION FOR A MARRIAGE CERTIFICATE PLEASE READ THESE NOTES before completing this form.

Marriage Certificate  Liverpool : 3001/13/35

1 TO BE COMPLETED BY THE APPLICANT Name of applicant Mr Mrs Miss/Ms (STATE NAME IN FULL) Full postal address   Post Code: Telephone no: e-mail address:

2 Are you applying for your own marriage certificate? Yes/No If not please state your relationship to the person to whom the certificate relates:

3 DETAILS OF MARRIAGE CERTIFICATE REQUIRED
SPOUSE			PARTNER
SURNAME BURTON			SURNAME HOWARTH	ANY OTHER SURNAME USED BEFORE THIS MARRIAGE
FORENAME(S) William H			FORENAME(S) Annie
DATE OF MARRIAGE			PLACE OF MARRIAGE
DAY	MONTH	YEAR 1936	NAME OF BUILDING, CHURCH OR REGISTER OFFICE AND LOCALITY Liverpool, St. Francis Xavier

4 REQUIREMENTS	Send this Application to:
MARRIAGE CERTIFICATE £11.00	Superintendent Registrar, Liverpool Register Office, St George's Hall, Heritage Entrance, St George's Place, Liverpool, L1 1JJ
I requireNUMBER marriage certificate(s)

5 REMITTANCE ENCLOSED  (POSTAL APPLICATIONS ONLY)
UK: applications should enclose an SAE. Postal order or cheque made payable to : Liverpool City Council for £ 11.00 Overseas: applications should enclose a self addressed envelope and two IRCs, with payment by Bankers Sterling Draft payable to : Liverpool City Council Please note: Liverpool RO Certificates can be ordered online via http://www.liverpool.gov.uk/births-marriage-deaths/copies-of-certificates/
If paying by Credit Card: Please debit my account by the amount: £		Type of card (e.g. Visa, Mastercard or Switch):
Name on Card:		Card Expiry Date (DD/MON/YYYY):
Enter both Card Number & Security Code. Card Number:                                       Security Code:
Signature:   Date:   Card Issue No. : (Switch only) Card Start Date (DD/MON/YYYY): (Switch only)
The Fee for a certificate issued against this form 'as printed' will not be refunded. You are strongly recommended to add any qualifying information you may have in order to help the registrar issue the correct certificate.