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

Marriage Certificate  Flintshire (Mold) : HOL/60/119

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 DODD			SURNAME MATTHEWS	ANY OTHER SURNAME USED BEFORE THIS MARRIAGE
FORENAME(S) John Desmond			FORENAME(S) Eileen Alice
DATE OF MARRIAGE			PLACE OF MARRIAGE
DAY	MONTH	YEAR 1939	NAME OF BUILDING, CHURCH OR REGISTER OFFICE AND LOCALITY Holywell, Civil Marriage

4 REQUIREMENTS	Send this Application to:
MARRIAGE CERTIFICATE £11.00	Superintendent Registrar, Flintshire Register Office, Llwynegrin Hall, Mold, Flintshire. CH7 6NR. UK
I requireNUMBER marriage certificate(s)

5 REMITTANCE ENCLOSED  (POSTAL APPLICATIONS ONLY)

UK: applications should enclose an SAE. Postal order or cheque made payable to : Flintshire County Council for £ 11.00 Overseas: applications should enclose a self addressed envelope and two IRCs, with payment by Bankers Sterling Draft payable to : Flintshire County Council