Marriage License Application Form

2. Applicant #1*

   Name (First, Middle, Last)

3. Applicant #2*

   Name (First, Middle, Last)

5. Date of Birth #1*

   Month/Day/Year

6. Date of Birth #2*

   Month/Day/Year

8. Phone Number #1*

   (xxx-xxx-xxxx)

9. Phone Number #2*

   (xxx-xxx-xxxx)

11. Current Physical Address #1*

    Street Address, City, State, Zip Code

12. Current Physical Address #2*

    Street Address, City, State, Zip Code

14. Mailing Address (if different) #1

15. Mailing Address (if different) #2

17. Place of Birth #1*

    City and State or City and Country

18. Place of Birth #2*

    City and State or City and Country

20. Important Information
    **Form must be complete **We will call you to set up an appointment **Both parties must be present with ID **Cost is $25 cash only

    **Form must be complete **We will call you to set up an appointment **Both parties must be present with ID **Cost is $25 cash only

24. ***For Internal Use Only***

26. SSN #1

27. SSN #2

29. Book

30. Page

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field