DOMESTIC PARTNERSHIP AGREEMENT CERTIFICATE APPLICATION


NOTE: We only have records of Domestic Partnership Agreements that were registered in Buffalo County.

This form may be printed and the information required may be completed by hand.  A signature is required before your application can be processed. Requestor must provide a copy of his/her drivers license.

Penalties:  Any person who willfully and knowingly makes false application for a marriage certificate shall be fined not more than $10,000 or imprisoned not more than 2 years or both.


Return form using one of the following methods:

MAIL TO:
Buffalo County
Register of Deeds
PO Box 28
Alma, WI  54610-0028

FAX TO:
Buffalo County
Register of Deeds
at
(608) 685-6213

IN PERSON AT:
Buffalo County
Register of Deeds Office
407 South Second Street
Alma, WI  54610

Charges:  First copy of each record $20.00 - additional copies of the same record are $3.00 each.

1. Number of Copies Wanted:  _______

2.  Requestor Name:  ________________________      3.  Daytime Phone Number:  _________________

4.  Requestor Signature:  ______________________________________

5.  How is the requestor related to the person on the record (Please circle one of the following):


SELF    SPOUSE    PARENT    LEGAL CUSTODIAN    CHILD    BROTHER    SISTER  GRANDPARENT


6. Mail Records to:

    Name:  ________________________________________________

    Address:  ______________________________________________

    City:  ___________________ State: ______  Zip: ______________




The Following Information Must Be Supplied By The Requestor:


7.  Date of Domestic Partnership Agreement:  _______________  8. County of Domestic Partnership Agreement:  ________________

9. Name of Partner A:  __________________________________  10.  Name of Partner B: __________________________________

 11. Copy of requestor's drivers license.