11 July 2025
Repeat Customers: Please notify if changed address and/or changed email address

SAMPUBCO ORDER FORM - GUARDIANSHIPS / MINORS

Name: ___________________________________________________________________________

Email (REQUIRED!): ______________________________________________________________

Street/P.O. Box: ________________________________________________________________

City/State/ZipCode+4: ___________________________________________________________
(out of USA - City, Province, Country, Postal Code)

Order (do NOT alter the information as listed in any way):

Name of Person:     Residence:  County of Record:  State, County # Vol, Page #
Example: DOE, JOHN  Anyplace    Anycounty          XX-50-35-80

1. ______________________________________________________________________________

2. ______________________________________________________________________________

3. ______________________________________________________________________________

4. ______________________________________________________________________________

5. ______________________________________________________________________________

6. ______________________________________________________________________________

Please check: Scanned Image _____ and/or PDF _____
Cost:
Scanned Copy - Download by Email notice
$6.00 if paid through PayPal / Credit or Debit Card / eCheck
$8.00 if paid by check
Paper Copy is not available

(if paying by credit card, please email order and request credit card invoice.)
Email address is sammyslc at gmail.com for sending this order as attachment and
for sending payment via PayPal.

Number of records: _______ X USD $_____ = ______________
Please do NOT staple or tape check to the order. Please do NOT combine with
any other types of records
Make check out to:
SAMPUBCO

Mail to:
W DAVID SAMUELSEN
629 S HARMONY CT
Salt Lake City, UT 84102-3446
Stop! Have you checked for accuracy in information you filled in?
Have you remembered to list county/state in required space?