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Marriage License Request Information Sheet

LICENSE REQUEST INFORMATION

MARRIAGE OPTION:*

Select an option

Groom or Bride (1st person on the marriage license) -*

Select an option

FIRST NAME -*

MIDDLE NAME -

CURRENT LEGAL LAST NAME -*

LAST NAME AT BIRTH -*

DATE OF BIRTH - MONTH/DAY/YEAR - *

STATE OF BIRTH -*

Country of birth if born outside of the U.S. -

# OF PREV MARRIAGES / SRDP -

DATE LAST MARRIAGE ENDED - MONTH/DAY/YEAR -

LAST MARRIAGE / SRDP ENDED BY -

Select an option

ADDRESS, CITY, STATE, ZIP CODE -*

FULL BIRTH NAME OF FATHER/PARENT -*

FATHER'S STATE OF BIRTH -*

FULL BIRTH NAME OF MOTHER/PARENT -*

MOTHER'S STATE OF BIRTH -*

Phone #1*

ID TYPE -*

ID # -*

When does the ID expire?

DO YOU WISH TO CHANGING YOUR LAST NAME? -*

BRIEF COMMENTS

Groom or Bride (2nd person on the wedding license)*

Select an option

FIRST NAME *

MIDDLE NAME

CURRENT LEGAL LAST NAME *

LAST NAME AT BIRTH*

DATE OF BIRTH - MONTH/DAY/YEAR *

STATE OF BIRTH --

Country if born outside of U.S.-*

# OF PREV MARRIAGES / SRDP .... / .... # DE MATRIMONIOS ANTERIORES *

DATE LAST MARRIAGE ENDED MONTH/DAY/YEAR ---

LAST MARRIAGE / SRDP ENDED BY

Select an option

ADDRESS, CITY, STATE, ZIP CODE*

FULL BIRTH NAME OF FATHER/PARENT *

FATHER'S STATE OF BIRTH*

FULL BIRTH NAME OF MOTHER/PARENT *

MOTHER'S STATE OF BIRTH*

Phone #2 --*

ID # *

Type of ID --*

When does the ID expire?--

CHANGING YOUR LAST NAME? *

BRIEF COMMENTS --

Email Address

Preferred Date of Marriage (Month/Day/Year), all dates must be confirmed in person, with payment of the total cost to make set an appointment.

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