Marriage License Application Worksheet

• Marriage Date:
• Place of Marriage:
• Name of Official:
• Official's Phone No.
• Applicants Phone No.
• Address to mail Marriage Certificate after married:
• Date:
• Marriage License #

Documents Needed:

• Original Birth Certificate
• Driver's License (Photo I.D.)
• Divorce Papers (If applicable)
• $40.00 (Cash or Check Only)

BRIDE/GROOM/SPOUSE

The worksheet has two matching columns, one for each spouse. Items 1 to 10 are for the first and items 11 to 20 for the second.

1. A. FULL NAME (FIRST, MIDDLE, CURRENT SURNAME)
   B. BIRTH NAME, IF DIFFERENT
   C. SURNAME AFTER MARRIAGE (OPTIONAL - SEE REVERSE)
   D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. (STATE) B. (COUNTY)
   C. CHECK ONE AND SPECIFY: CITY, TOWN, VILLAGE
   D. STREET ADDRESS, ZIP
   E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? YES / NO
3. A. AGE B. DATE OF BIRTH (MM/DD/YYYY) C. SEX (OPTIONAL)
4. EMPLOYMENT
   A. USUAL OCCUPATION
   B. TYPE OF INDUSTRY OR BUSINESS
5. PLACE OF BIRTH (CITY, STATE / COUNTRY, IF NOT USA)
6. FATHER OR PARENT
   A. NAME (OR MAIDEN NAME, IF APPLICABLE)
   B. COUNTRY OF BIRTH
7. MOTHER OR PARENT
   A. NAME (OR MAIDEN NAME, IF APPLICABLE)
   B. COUNTRY OF BIRTH
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
   A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE: CIVIL ANNULMENT: DEATH:
   B. HOW DID LAST MARRIAGE END? DIVORCE (3) ANNULMENT (3) DEATH (2)
   C. DATE LAST MARRIAGE ENDED? (MM/DD/YYYY)
   D. ARE ANY FORMER SPOUSE(S) ALIVE? YES / NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION: DATE OF DECREE (MONTH, DAY, YEAR), PLACE ISSUED (CITY/COUNTY, STATE/COUNTRY, IF NOT USA), AGAINST WHOM (SELF / SPOUSE) - lines for 1ST, 2ND, 3RD, 4TH

Payment: Cash ________ Check ________