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

Marriage Certificate  Shrewsbury : C-S33/1/14

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 BEACALL			SURNAME COLLEY	ANY OTHER SURNAME USED BEFORE THIS MARRIAGE
FORENAME(S) Margaret			FORENAME(S) Solomon
DATE OF MARRIAGE			PLACE OF MARRIAGE
DAY	MONTH	YEAR 1850	NAME OF BUILDING, CHURCH OR REGISTER OFFICE AND LOCALITY Leighton, Shrewsbury

4 REQUIREMENTS	Send this Application to:
MARRIAGE CERTIFICATE £11.00	Superintendent Registrar, Shropshire Register Office,The Shirehall, Abbey Foregate, Shrewsbury, Shropshire, SY1 6ND, UK
I requireNUMBER marriage certificate(s)

5 REMITTANCE ENCLOSED  (POSTAL APPLICATIONS ONLY)
Payment of £11.00 + £1 handling by Credit Card only UK: applications should enclose an SAE. Overseas: applications should enclose a self addressed envelope and two IRCs.
If paying by Credit Card: Please debit my account by the amount: £		Type of card (e.g. Visa, Mastercard or Switch):
Name on Card:		Card Expiry Date (DD/MON/YYYY):
Enter both Card Number & Security Code. Card Number:                                       Security Code:
Signature:   Date:   Card Issue No. : (Switch only) Card Start Date (DD/MON/YYYY): (Switch only)
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.