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Tippecanoe County Clerk
Marriage Dissolution Decree
Complete Name of Party1
Complete Name of Party2
Approx. Date of Dissolution
(mm-dd-yyyy)
Person Requesting
Submitter Name
Address
City
State
ZIP
Phone Number
Ext.
Fax#
Email Address
Best Time and way to contact you
Comments
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Fees
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Faxed/Emailed Document: $1.00/page
Court Record: $1.00/page
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