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County Clerk Marriage Record Copy Request Form
***THIS FORM IS ONLY TO BE USED FOR MARRIAGE LICENSE COPY REQUESTS***
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CLERK USE ONLY
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7KLVIRUPDXWKRUL]HVWKHmerchant (VitalChek) to charge my account for services rendered by the County Clerk's office, plus a $2.50 service
fee. A base percentage of 4% will be charged on credit transactions over $50.00. Please see our website for additional fees. 3OHDVHOLVWGRFXPHQWVUHTXHVWHG
(Visit https://www.texaslandrecords.com/ to view and print plain copy marriage licenses for free.)
Name of Groom:
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Address to send documents:
_________________________________________
_________________________________________
_________________________________________
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Payment Information
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(Check which applies) 0DVWHU&DUG'LVFRYHUBBBB$PHULFDQ([SUHVVBBBB Visa ____
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**Note** The ZIP Code must match the cardholder’s billing address; if not, the transaction will be declined.
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