Office of the Lieutenant Governor

Utah State Capitol, Suite 220

PO Box 142325

Salt Lake City, UT 84114

Website:http://lg.utah.gov

Phone: (801) 538-1041

DOCUMENT AUTHENTICATION OR APOSTILLE REQUEST FORM

/ /

Today’s date

am

pm

Time

# of documents

Foreign country documents will be used in

Name

Daytime telephone number with area code

Address

City/State/Zip Code

E-Mail

Please check one of the four boxes below:

Regular service

($15 per document)

Approximately 3-5 business days

Please mail documents to me

Please notify me for pick-up

Expedite Service

Next business day
($40 per document)

Same day service
($65 per document)

Acceptable forms of payment include: Check (made payable to State of Utah), Cash, VISA, or MasterCard
Please complete the section below if submitting your credit card information by mail

VISA OR MASTERCARD NUMBER

3 DIGIT

EXPIRATION

NAME AS IT APPEARS ON THE CARD

AUTHORIZATION SIGNATURE

NOTE: If you are mailing this form
and are paying for expedite service,
please contact our office on the day
you expect your document to arrive.
Failure to confirm your document’s
arrival may delay your request.

For Office Use Only

Dollar Amount due $

Date Picked up/ mailed / /

Date Paid

/ /

Receipt #

NOTES:

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

TO

,

REF:

INV:

PO: DEPT:

5678FGH657

TRK#
0201

7946 3014 0400

SE GBOA

Thu - 10 Sep

** 1,2 DAYS **

- US

Shipping from to my address