Kentucky Birth, Marriage and Death Records (1852-1910)

Microfilm Order Form

* indicates a required field

Shipping/Billing Information

First Name *

Last Name *

Institution

Address

City

State *

Country

Zip Code

Telephone *

Email *

Tax Exempt

Include a copy of certificate with payment

Records Requested

View a listing containing County/Roll Numbers.

Order #1

Roll Number *

Description *

Roll Size *

Order #2

Roll Number

Description

Roll Size

Order #3

Roll Number

Description

Roll Size

Subtotal	Tax	Total
$18.00	$1.08	$19.08
$36.00	$2.16	$38.16
$54.00	$3.24	$57.24

Payment Information

Subtotal:

Kentucky residents must add 6% sales tax to their Subtotal.
If you do not reside in Kentucky, please transfer your Subtotal to the Total Purchase Amount field without adding tax.

Total Purchase Amount:

Receipt of payment through the mail is required before purchases will be filled.

Payment Addressee: Kentucky State Treasurer
Payment Mailing Address:
Michele Howard, Public Records Division,
KDLA,
P.O. Box 537,
Frankfort, Kentucky 40602-0537

Please print a copy of this form for your records.

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