VSCRA-35
Rev. 11/2018

Vermont State Archives and Records Administration

1078 US RTE 2, Middlesex . Montpelier , VT 05633-7701 . Tel: (802) 828-3700 . Fax: (802) 828-3710

Requests may be made in person or mailed . Please print or type this form and include it with your documents.

Required field appear in red and are marked with an *

* Country document(s) will be used in

Document(s) to be Authenticated/apostilled:

(please check one and list documents)

Vermont Cetified Public Record

Vermont Notarized Document

Total number of documents:

* Requestor's Name:

Name of Firm/Organization (if applicable)

Address:

Daytime telephone number:

Email address:

Document(s) will be sent to the address provided above unless other specified here:

Send apostilled/authenticated document(s) to:

Address in the United States (no additional charge)

Address outside the United States

USPS First-Class Mail (no additional charge)

Customer-provided USPS International Priority or Express envelope with postage

Customer-provided ccarrier label (FedEx,UPS,DHL)

Number of documents:

x$10.00 fee per document

= Total due

Payment: Checks/money orders must be drawn on a U.S. financial and made payble to Vermont State Archives .

Please send to the attention of: Authentication Services

A document issued and signed by the state of Vermont