APPLICATION FOR A MARRIAGE CERTIFICATE
PLEASE READ THESE NOTES before completing this form.
Marriage Certificate
 Sandwell Register Office : 39/16/204
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 HEATH  SURNAME JACKSON ANY OTHER SURNAME USED BEFORE THIS MARRIAGE
 
FORENAME(S) Joseph  FORENAME(S) Ann M 
DATE OF MARRIAGE PLACE OF MARRIAGE
DAY
 
MONTH
 
YEAR
1897 
NAME OF BUILDING, CHURCH OR REGISTER OFFICE AND LOCALITY
Tipton, St Martin (Pepper Box) 
4 REQUIREMENTS Send this Application to:
MARRIAGE CERTIFICATE £11.00 Superintendent Registrar, Sandwell Register Office, Highfields, High Street, West Bromwich, West Midlands, B70 8RJ, 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 : Superintendent Registrar for £ 11.00
Overseas: applications should enclose a self addressed envelope and two IRCs, with payment by Bankers Sterling Draft payable to : Superintendent Registrar
The Fee for a certificate issued against this form 'as printed' will not be refunded.
You are strongly recommended to add any qualifying information you may have in order to help the registrar issue the correct certificate.