MARRIAGE LICENSE APPLICATION

 (Please Print Legibly)

GROOM                                                                                             BRIDE

Full LEGAL Name (first/middle/last)                            Full LEGAL Name (first/middle/last)

_________________________________________              _________________________________________

                                                                                                            Maiden Name: ____________________

Date of Birth: _____________________________                 Date of Birth: ____________________________

Place of Birth (state): ______________________                   Place of Birth (state): ______________________

Social Security Number: ___________________                    Social Security Number: ___________________

Age:_____________________________________               Age:______________________________________

Mailing Address:__________________________                   Mailing Address:___________________________

Physical Address REQUIRED:_______________                 Physical Address REQUIRED:________________

City__________________State______Zip_______               City_______________State______Zip__________

County:__________________________________                County:___________________________________

Daytime Phone Number:__________________                       Daytime Phone Number:___________________

Father’s Full Legal Name:                                                         Father’s Full Legal Name:
___________________________________________          ___________________________________________

Father’s Place of Birth (STATE)_______________                 Father’s Place of Birth (STATE)_______________

Mother’s Full MAIDEN Name:                                                Mother’s Full MAIDEN Name:

____________________________________________        ___________________________________________

Mother’s Place of Birth (STATE):_______________   Mother’s Place of Birth (STATE):______________

Applicant’s Race:___________________________               Applicant’s Race:__________________________

Number of this Marriage:____________________                  Number of this Marriage:___________________

            Previous Marriage Ending Reason:                                            Previous Marriage Ending Reason:

            Divorced:____ Month/date/yr___________                             Divorced:____ Month/date/yr___________

            Annulled:____ Month/date/yr___________                              Annulled:____ Month/date/yr___________

            Widowed:____ Month/date/yr___________                            Widowed:____ Month/date/yr___________

Education:  List YEARS (1-12)____ College _____                 Education:  List YEARS (1-12)____ College____

YOU’RE INTENDED

Date of Marriage:_____________ Place of Marriage:____________________________  Performed by__________________

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