MARRIAGE LICENSE APPLICATION
Please fill out this form completely and accurately to the best of your knowledge.
Any corrections needed AFTER the license is recorded will require a COURT ORDER to change.
FIRST PARTY : ☐ MALE ☐ FEMALE ☐ OTHER ☐ BRIDE ☐ GROOM ☐ SPOUSE
FIRST NAME : ___________________________________ MI : ______ LAST : _____________________________________
CURRENT PHYSICAL ADDRESS : _________________________________________________________________________
[ Street Address ] [ City & State ] [ ZIP ]
DATE OF BIRTH : _____ / _____ / ________ PLACE OF BIRTH (City, State) : __________________________________
MOTHER FIRST NAME : ____________________________ MOTHER MAIDEN NAME : _____________________
FATHER FIRST NAME : _____________________________ FATHER LAST NAME : _________________________
I AM CURRENTLY : ☐ Single ☐ Divorced ☐ Widowed ☐ Annulled NUMBER OF PREVIOUS MARRIAGES : _____
OCCUPATION : __________________________________________________________________________________________
[ Job title (i.e. Cashier, Manager, Secretary, Nurse, etc.) OR Unemployed, Retired, Disabled, Homemaker, etc. ]
RACE : ☐ White ☐ Black ☐ Hispanic / Latino ☐ Asian ☐ American Indian ☐ Pacific Islander ☐ Other : ________________
ARE YOU RELATED TO THE OTHER PARTY? ☐ Yes. ☐ No. SSN : _______________________________________
SECOND PARTY : ☐ MALE ☐ FEMALE ☐ OTHER ☐ BRIDE ☐ GROOM ☐ SPOUSE
FIRST NAME : ___________________________________ MI : ______ LAST : _____________________________________
CURRENT PHYSICAL ADDRESS : _________________________________________________________________________
[ Street Address ] [ City & State ] [ ZIP ]
DATE OF BIRTH : _____ / _____ / ________ PLACE OF BIRTH (City, State) : __________________________________
MOTHER FIRST NAME : ____________________________ MOTHER MAIDEN NAME : _____________________
FATHER FIRST NAME : _____________________________ FATHER LAST NAME : _________________________
I AM CURRENTLY : ☐ Single ☐ Divorced ☐ Widowed ☐ Annulled NUMBER OF PREVIOUS MARRIAGES : _____
OCCUPATION : __________________________________________________________________________________________
[ Job title (i.e. Cashier, Manager, Secretary, Nurse, etc.) OR Unemployed, Retired, Disabled, Homemaker, etc. ]
RACE : ☐ White ☐ Black ☐ Hispanic / Latino ☐ Asian ☐ American Indian ☐ Pacific Islander ☐ Other : ________________
ARE YOU RELATED TO THE OTHER PARTY? ☐ Yes. ☐ No. SSN : _______________________________________
After you are married, you will return the completed license to our office to be recorded.
We will mail certified and regular copies of the recorded license to your mailing address below:
MAILING ADDRESS : ____________________________________________________________________________________
[ Street Address ] [ City & State ] [ ZIP ]
PHONE NUMBER (in case we need to contact you) : __________________________________________________________
