https://upload.wikimedia.org/wikipedia/commons/thumb/e/e0/Map_of_Nebraska_highlighting_York_County.svg/800px-Map_of_Nebraska_highlighting_York_County.svg.png                                                                     York County Clerk

Kelly Turner

510 Lincoln Avenue

York, NE 68467

P:   (402) 362-7759

F:   (402) 362-7558

E-mail: clerk@york.nacone.org

 

 

REQUEST FOR CERTIFIED COPY OF MARRIAGE LICENSE

 

 

Date of Request:___________________________

 

I hereby request a certified copy of the marriage license issued to:

 

Groom:________________________________ Bride: (maiden name)_____________________________

 

Month, day, year of marriage:_____________________________________________________________

 

 

______________________________________________________(Signature of Requestor)

**Print & Sign**

                                   

 

 

 

 

AUTHORIZATION FOR AGENT:

 

**I, Requestor, hereby authorize__________________________to act as my agent in obtaining this copy.

 

______________________________________________________(Signature of Requestor)

**Print & Sign**

 

 

 

Agent Signature______________________________________Date:__________________

 

INCLUDED WITH REQUEST MUST BE $9.00 AND A SELF-ADDRESSED STAMPED ENVELOPE.

 

(Office Use Only)

_____Check  _____Cash  _____Payport