OFFICE OF THE SECRETARY OF THE STATE

AUTHENTICATION / APOSTILLE ORDER FORM

Website: www.sots.ct.gov

Telephone: (860) 509-6100

Mailing Address: (Direccion postal)

Connecticut Secretary of the State, Attn: Authentications

P.O. Box 150470, Hartford, CT 06115-0470

FEES: Child Adoption: $15.00 each.

Regular Documents: $40.00 each.

Expedited Regular Documents: $90.00 each.

Delivery by Fedex, UPS, DHL (Servicio de Mensajero)

Connecticut Secretary of the State, Attn: Authentications

30 Trinity Street, Hartford, CT 06106

PAGO: Adopcion es $15.00 Por Documento

Otros documents son $40.00

Checks payable to: Secretary of the State ( Haga los cheques a nombre de la Secretary of the State)

EXPEDITED SERVICE: Orders will be processed and mailed within 24 hours. Adoption documents can not be expedited.(Las
órdenes serán procesadas y enviadas en 24 horas.. Documentos de adopción no se pueden agilizar.) Rejected documents will result in the
forfeiture of expedited fee. **EXPEDITED SERVICE IS NOT WHILE YOU WAIT. (El servicio acelerado no es mientras
espera.)

PLEASE TYPE OR PRINT LEGIBLY. (FAVOR DE ESCRIBIR O IMPRIMIR LEGIBLEMENTE): Will not be responsible for
misdirected mail if illegible. (No somos responsable de correo mal dirigido. )

1.DATE: (Fecha)

DAYTIME PHONE NO.: (Telefono durante el dia

2.EMAIL ADDRESS (Dirección de correo electrónico)

3.NAME: (Nombre): First/Primer

Last/Apellido

4.COMPANY (Compania) (If applicable)

5.ADDRESS: (Direccion)

CITY(Ciudad)

STATE (Estado)

ZIP CODE(código)

6.FOREIGN COUNTRY in which your documents will be used

(Pais donde sus documentos seran usados)

7.CHECK IF DOCUMENTS ARE FOR AN ADOPTION (Marcar si los documentos son para adopcion)

8.NUMBER OF AUTHENTICATION/APOSTILLES REQUESTED

(Numero de certificados para autenticacion/apostilla solicitado)

9.CHECK IF DOCUMENTS ARE FOR AN ADOPTION (Marcar si los documentos son para adopcion)

TOTAL DUE:

PAYMENT METHOD (Método del pago CREDIT CARD (Tarjeta de crédito CASH (Efectivo) CHECK (Compruebe)

***Please complete the attached credit card sheet. (Por favor complete la hoja de procesamiento de tarjeta de crédito adjunta.

10.HOW WOULD YOU LIKE YOUR ORDER TO BE RETURNED? (CHECK ONE) **IF NOTHING IS INDICATED, YOUR
ORDER WILL BE MAILED.

Providing a self-addressed stamped envelope would be appreciated. ¿ Cómo quiere que su orden sea devuelta a usted? (Marque uno) Si

no se indica nada, se enviara su pedido.

11.Hold for pickup

(retener mi orden para ser recogida)

First class mail

(Correo de primera clase)

Prepaid courier service (provide label)_

(Servicio de mensajero prepagado – envie etiqueta)

Office of the Secertary of the state

State of Connecticut

P.O Box 150470,Hartford, CT 06115-0470

DENISE W. EMRRILL

Secretary of the state

SCOTT D. BATES

Deputy Seceretary pf the state

Credit Card processing Requirments

Cardholder Name (must match credit card):

Billing Address (must match credit card):

Credit Card Number:

Expiration Date:

Security Code:

Authorized Amount: $

Authorizing Signature

**All Fields required to complete request.

Internet home Page: www.sots.ct.gov

Shipping Options

I have my own shipping account. I will upload my digital prepaid shipping label (FedEx, UPS, USPS, or DHL) in PDF format

I would like to buy a 2 days FedEx envelop to ship and return my documents for a fee of $10.00 each. A total of: $20.00

I would like to buy a Next day FedEx envelop to ship and return my documents for a fee of $25.00 each. A total of: $50.00

Shipping from my address to

ORIGIN ID:GBOA

UNITED STATES

ACTVVGT: 0.20 LB

CAD:119084289/WSXI3400

BILL SENDER

REF:

INV:

PO: DEPT:

5678FGH657

TRK#
0201

7946 3014 0400

SE GBOA

Thu - 10 Sep

** 1,2 DAYS **

- US

Shipping from to my address