Czech Marriage Certificate

Embassy of the Czech Republic

Address
3900 Spring of Freedom St.
Washington D.C. 20008

VISA Office Phone
(202) 363-6308

Phone
(202) 363-6315

E-Mail
177000.1723@compuserve.com

Fax
(202) 966-8540

Web site
http://www.mzv.cz/washington/

Application for Marriage Certificate

Zadost o oddaci list
Name of husband: /Jmeno manzela/:
Maiden name of wife: /Rodne jmeno manzelky/:
Date of marriage: Datum snatku/:
Place of marriage: /Misto snatku/:
District: /Okres/:
Date and place of birth of husband: /Datum a misto narozeni manzela/:
Date and place of birth of wife: /Datum a misto narozeni manzelky/::
Enclosures: consular fee $10 for the above certificate. – stamped self-addressed envelope for certified mail. – consular fee $14, for the translation /if requested/. – The consular fee is to be made in MONEY ORDER payable to the Embassy of the Czech Republic.
Name and address of applicant:
Date: