MLR

Marriage License Request Information Sheet

LICENSE REQUEST INFORMATION

FIRST NAME -*

1ST PERSON

MIDDLE NAME -

1ST PERSON IF NO MIDDLE NAME ENTER --

CURRENT LEGAL LAST NAME -*

1ST PERSON

LAST NAME AT BIRTH -*

1ST PERSON

DATE OF BIRTH - MONTH/DAY/YEAR -*

1ST PERSON MM/DD/YYYY

STATE/COUNTRY OF BIRTH -*

1ST PERSON (IF OUTSIDE U.S. ENTER JUST THE COUNTRY)

# OF PREV MARRIAGES / SRDP -*

1ST PERSON INCLUDES (DISSOLUTION, ANNULMENT, DEATH, TERMINATION OF SRDP) OR FOR NONE TYPE --

DATE LAST MARRIAGE ENDED -*

1ST PERSON MM/DD/YYYY

LAST MARRIAGE / SRDP ENDED BY: -*

1ST PERSON INCLUDES (DISSOLUTION, ANNULMENT, DEATH, TERMINATION OF SRDP) OR FOR NONE TYPE --

ADDRESS, CITY, STATE, ZIP CODE -*

1ST PERSON

FULL BIRTH NAME OF FATHER/PARENT -*

1ST PERSON IF UNKNOWN PLEASE PUT "UNKNOWN"

FATHER'S STATE OF BIRTH -*

1ST PERSON (IF OUTSIDE U.S. ENTER JUST THE COUNTRY)

FULL BIRTH NAME OF MOTHER/PARENT -*

1ST PERSON (IF UNKNOWN PLEASE PUT UNKNOWN)

MOTHER'S STATE OF BIRTH -*

1ST PERSON (IF OUTSIDE U.S. ENTER JUST THE COUNTRY)

ID TYPE:-*

ID # -*

1ST PERSON

CHANGING YOUR LAST NAME? -*

1ST PERSON

BRIEF COMMENTS: -

1ST PERSON

FIRST NAME *

2ND PERSON

MIDDLE NAME

2ND PERSON IS NO MIDDLE NAME ENTER --

CURRENT LAST NAME *

2ND PERSON

LAST NAME AT BIRTH*

2ND PERSON

DATE OF BIRTH - MONTH/DAY/YEAR*

2ND PERSON MM/DD/YYYY

STATE/COUNTRY OF BIRTH*

2ND PERSON (IF OUTSIDE U.S. ENTER JUST THE COUNTRY)

# OF PREV MARRIAGES / SRDP*

2ND PERSON INCLUDES (DISSOLUTION, ANNULMENT, DEATH, TERMINATION OF SRDP) OR FOR NONE TYPE --

DATE LAST MARRIAGE ENDED*

2ND PERSON MM/DD/YYYY OR FOR NONE TYPE --

LAST MARRIAGE / SRDP ENDED BY:*

2ND PERSON INCLUDES (DISSOLUTION, ANNULMENT, DEATH, TERMINATION OF SRDP) OR FOR NONE TYPE --

ADDRESS, CITY, STATE, ZIP CODE*

2ND PERSON IF SAME OR WILL BE THE SAME AS 1ST PERSON ENTER SAME

FULL BIRTH NAME OF FATHER/PARENT*

2ND PERSON IF UNKNOWN PLEASE PUT "UNKNOWN"

FATHER'S STATE OF BIRTH*

2ND PERSON (IF OUTSIDE U.S. ENTER JUST THE COUNTRY)

FULL BIRTH NAME OF MOTHER/PARENT*

2ND PERSON IF UNKNOWN PLEASE PUT "UNKNOWN"

MOTHER'S STATE OF BIRTH*

2ND PERSON (IF OUTSIDE U.S. ENTER JUST THE COUNTRY)

ID TYPE*

ID #:*

2ND PERSON ID

CHANGING YOUR LAST NAME?*

2ND PERSON

BRIEF COMMENT:

2ND PERSON

Email Address

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San Jose Civil Weddings

Marriage License Request Information Sheet