Marriage Application – Town of Berlin
06/19/2021
Date of Marriage ____________
Pastor Lianette Torres
Officiator’s Name & Telephone Number: _______________________________________________
x
Would you like to prepay for a certified copy of your Marriage License? YES _____ NO _____
(Certified copies are used for a variety of purposes including notifying Social Security that you are married, changing your name with the DMV,
obtaining spousal health insurance with an employer. The cost per certified copy is $20). 1
# of copies ___________
Name and Address for Copies:
Marielis Laboy
Name ______________________________________________
128 Shawn Dr C-10
Address _________________________________________________________
Bristrol
City ____________________________ ct
State ______ 06010
Zip Code ___________
GROOM/SPOUSE INFORMATION
First Name Middle Name Last Name Suffix (Jr,Sr,III,etc)
Isaiah
__________________ J
__________________ Bell
_______________________ _______
Birthplace (State or Foreign Country) Birthdate Age Social Security Number
Hartford Ct
_______________________ 06/11/1996
__________ 24
____ 049-94-9418
___________________
Race Sex Supervision or control by guardian or conservator?
Africa American
_________________ m
_____ YES _____ x
NO _____
Residence (No and Street)
128 Shawn Dr C-10
_______________________________________________________________________
City or Town County State
Bristol
______________________________ Hartford
_______________________ Ct
_________________
Phone Number Highest Level of Education Number of Years Completed
(High School, College, etc)
860798-8958
________________________ High School
______________________________ 4
___________
No. of this Number of If previously in Marriage or Civil Union, Last Relationship
st nd
Marriage (1 , 2 , etc) Civil Unions last relationship was: ended by Div,Death,Annul):
1st
________ 0
_______ _____________________ _________________
Father’s Name
Jeffery Bell
_______________________________________________________________
Father’s Birthplace (State or Foreign Country)
Hartford Ct
_______________________________________________________________
Mother’s Maiden Name (First and Last)
Shirley Thomas
_______________________________________________________________
Mother’s Birthplace (State or Foreign Country)
Hartford ct
________________________________________________________________
BRIDE/SPOUSE INFORMATION
First Name Middle Name Last Name Suffix (Jr,Sr,III,etc)
Marielis Laboy
__________________ __________________ _______________________ _______
Birthplace (State or Foreign Country) Birthdate Age Social Security Number
Hartford Ct
_______________________ 10/08/1990
__________ 30
____ 040-88-0796
___________________
Race Sex Supervision or control by guardian or conservator?
Hispanic
_________________ F
_____ YES _____ x
NO _____
Residence (No and Street)
128 Shawn Dr C-10
_______________________________________________________________________
City or Town County State
Bristol
______________________________ Hartford
_______________________ CT
_________________
Phone Number Highest Level of Education Number of Years Completed
(High School, College, etc)
860798-8958
________________________ High school
______________________________ 2
___________
No. of this Number of If previously in Marriage or Civil Union, Last Relationship
st nd
Marriage (1 , 2 , etc) Civil Unions last relationship was: ended by (Div,Death,Annul):
1st
________ 0
_______ _____________________ _________________
Father’s Name
Osvaldo Laboy
_______________________________________________________________
Father’s Birthplace (State or Foreign Country)
Puerto Rico
_______________________________________________________________
Mother’s Maiden Name (First and Last)
Florentina Zavala
_______________________________________________________________
Mother’s Birthplace (State or Foreign Country)
Hartford Ct
________________________________________________________________
