The Certificate of Dissolution (DOH 422-027) is the Washington State Department of Health (DOH) vital records form that reports a court decree ending or altering a marriage: a dissolution of marriage, a legal separation or a declaration of invalidity. The court clerk completes items 1-5, and the petitioner's attorney or the petitioner pro se completes items 6a-16. On FillingPDF you can fill out the form online and download or print the completed PDF; the form itself is published by the DOH at the official source link on this page.
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What is DOH 422-027?
The Certificate of Dissolution (DOH 422-027) is the Washington State Department of Health vital records form on which a court decree of dissolution of marriage, legal separation or declaration of invalidity of marriage is reported to the State Registrar of Vital Statistics.
The printed title reads "Certificate of Dissolution, Declaration of Invalidity of Marriage or Legal Separation." In item 2 the Clerk of the Court marks which kind of decree was entered: Legal Separation, Dissolution of Marriage or Declaration of Invalidity. The Clerk also records the court file number, the state file number, the date and county of the decree and signs as Superior Court Clerk.
The second half is completed by the petitioner's attorney or by the petitioner pro se. It records both spouses (name, birth last name if different, date of birth, birth state or country, current residence and Social Security number), the county, state and date of the marriage, the number of children born alive of the marriage, who the petitioner is, and the name and address of the petitioner's attorney.
The form says that complete information for each item is required for registering and locating certificates and for providing facts for legal matters and statistical purposes. It cites RCW 26.09.150, under which the Clerk forwards each certificate to the State Registrar.
The DOH lists a separate Certificate of Dissolution of Domestic Partnership (422-055) for domestic partnerships, so this form is the one for marriages. The revision printed on the form is March 2015.
Who needs to file DOH 422-027?
The form involves two groups, and each completes its own items.
- Clerk of the Court: completes items 1-5 (court file number, state file number, type of decree, date and county of decree, and the Superior Court Clerk's signature).
- Petitioner's attorney or the petitioner pro se: completes items 6a-16, covering both spouses, the marriage, the number of children, the petitioner and the attorney's details.
The form is used when a decree of dissolution of marriage, legal separation or declaration of invalidity of marriage has been ordered. The form's instructions say all items must be completed. The citation printed on the form, RCW 26.09.150, refers to decrees of divorce, dissolution of marriage, annulment or separate maintenance.
This form is for marriages. The DOH lists dissolutions of domestic partnership on a different form, 422-055. The form does not describe any other person who may complete it on a petitioner's behalf.
When to file DOH 422-027
The certificate is prepared once a decree of dissolution, legal separation or declaration of invalidity has been ordered, since item 3 asks for the date of the decree. The form's instructions set the clerk's deadline: on or before the tenth day of each month, the Clerk of the Court forwards to the State Registrar of Vital Statistics the certificate of each decree granted during the preceding month (RCW 26.09.150).
The form prints no separate due date for the petitioner or the attorney. Because the Clerk's monthly forwarding depends on the certificate being complete, items 6a-16 should be ready when the decree is entered. The instructions require that all items be completed.
How to fill out DOH 422-027
Let the clerk complete items 1-5
Item 1 holds the Court File Number and State File Number. Item 2 is the type of decree, item 3 the Date of Decree, item 4 the County of Decree and item 5 the Superior Court Clerk's signature; these are the Clerk's items.
Enter Spouse A's name and birth details
In items 6a-6d, enter the name (first, middle, last), the birth last name if different, the date of birth as MM/DD/YYYY and the birth state; if not USA, give the country.
Enter Spouse A's residence and SSN
In items 6e-6h, enter the current residence (number and street), city, county and state. Item 15 is Spouse A's Social Security Number.
Enter Spouse B's details
Items 7a-7h repeat the same fields for Spouse B: name, birth last name if different, date of birth, birth state or country, and current residence, city, county and state. Item 16 is Spouse B's Social Security Number.
Describe the marriage
Item 8 is the county where the marriage took place and item 9 the state, or the country if not USA. Item 10 is the date of the marriage as MM/DD/YYYY.
Enter the number of children
In item 11, enter the number of children born alive of this marriage.
Identify the petitioner
In item 12, mark Spouse A, Spouse B, Both or Other (Specify). In item 13, enter the name of the petitioner's attorney, or mark PRO SE.
Enter the attorney's address
In item 14, enter the petitioner's attorney's address.
Review and download the completed PDF
Check that every item is complete, that dates use MM/DD/YYYY and that the clerk's items 1-5 are filled. Download or print the completed PDF from FillingPDF and deliver it as described under How to submit.
How to submit DOH 422-027
The form names one route: the Clerk of the Court forwards the certificate to the State Registrar of Vital Statistics. It prints no mailing address, portal or fee, and it gives no separate channel for the petitioner.
- Court clerk: items 1-5 are the Clerk's, so the completed certificate goes through the clerk of the court that entered the decree.
- Monthly forwarding: on or before the tenth day of each month, the Clerk forwards the certificate of each decree granted during the preceding month to the State Registrar of Vital Statistics (RCW 26.09.150).
- Format: the form asks you to type or print in permanent black ink.
For questions about the form or other Washington vital records forms, the Department of Health publishes its list at https://doh.wa.gov/licenses-permits-and-certificates/vital-records/forms-vital-records. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Leaving items blank; the instructions state that all items must be completed.
- Having the petitioner or attorney fill in items 1-5, which are completed by the Clerk of the Court.
- Submitting the form without the Superior Court Clerk's signature in item 5.
- Writing in ink that is not permanent black, or handwriting that is not legible; the form says to type or print in permanent black ink.
- Entering dates in a format other than MM/DD/YYYY for the decree, birth and marriage dates.
- Giving only the state for a birth or marriage outside the United States; the form says to give the country if not USA.
- Counting children who were not born alive of this marriage in item 11.
- Using this form for the dissolution of a domestic partnership, which the Department of Health lists as Certificate of Dissolution of Domestic Partnership (422-055).
Frequently asked questions
What is a certificate of dissolution in Washington?
It is the Washington State Department of Health form (DOH 422-027) that reports a decree of dissolution of marriage, legal separation or declaration of invalidity of marriage. The court clerk completes the court items, and the attorney or pro se petitioner completes the personal details.
Who completes the Certificate of Dissolution?
Two people share it. The Clerk of the Court completes items 1-5. The petitioner's attorney, or the petitioner pro se, completes items 6a-16. The form's instructions say all items must be completed.
When does the court send the certificate to the state?
On or before the tenth day of each month, the Clerk of the Court forwards to the State Registrar of Vital Statistics the certificate of each decree granted during the preceding month, as stated under RCW 26.09.150.
Can I fill out the Certificate of Dissolution online?
Yes, you can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service and does not file the form; it reaches the State Registrar through the court clerk's forwarding.
Is this the form for ending a domestic partnership?
No. The Department of Health lists a separate Certificate of Dissolution of Domestic Partnership, form 422-055. Form 422-027 covers a dissolution of marriage, legal separation or declaration of invalidity of marriage.
What goes in item 11 on the Certificate of Dissolution?
Item 11 is the number of children born alive of this marriage. It is the last of the marriage details, after the place of the marriage (items 8 and 9) and the date of the marriage (item 10, MM/DD/YYYY).
Do I need to fill out every item on form 422-027?
Yes. The instructions on the form say all items must be completed, because complete information is required for registering and locating certificates and for legal and statistical purposes.
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