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Kentucky Verification Request Marriage and Divorce Form


Kentucky Verification Request Marriage and Divorce Form
Kentucky Verification Request Marriage and Divorce Form
DPP-117 Commonwealth of Kentucky
(R. 11//05) Department for Community Based Services
Division of Protection and Permanency
VERIFICATION REQUEST MARRIAGE & DIVORCE
To: District Court Circuit Court Family Court
Case Name: _________________________________________________________________
Case Number: _________________________________
Date: ___________________
MARRIAGE: _____________________________ and _____________________________
(Name of Man) (Name of Woman)
Date: _______________ Place: _____________________________, ______________________
(City State) (County Recording Marriage)
DIVORCE: ______________________________ and _______________________________
(Name of Man) (Name of Woman)
Date: _______________ Place: _____________________________, ______________________
(City State) (County Recording Marriage)
Please complete the information below to verify or the Department for Community Based
Services (DCBS) authentic information.
___________________________________________
(DCBS Staff)
___________________________________________
(Address)
MARRIAGE: _____________________________ and ______________________________
(Name of Man) (Name of Woman)
Date: _______________ Place: _____________________________, ______________________
(City State) (County Recording Marriage)
Recorded in Book No.:________________________________ Page No.: __________________________________
DIVORCE: ______________________________ and _______________________________
(Name of Man) (Name of Woman)
Date: _______________
SIGNED: ____________________________________
TITLE: ______________________________________
DATE: ______________________________________
(Please return original form to sender)
Kentucky Verification Request Marriage and Divorce Form