Marriage Information Sheet
C
OMPLETE
F
ORM AND BRING WITH VALID
I.D.
AND
$71.00
TO
ANY OF OUR VITAL RECORDS LOCATIONS
Last Name
APPLICANT 1: _____________________________________ at Birth ______________________________
Social S
ecurity # ______________________________ (SS# required if born in U.S.)
Place of Birth: _________________________________________________________________________________
City County (Optional) State
1.
Have you ever been married before? Yes No
If yes (
check one): Divorced Widowed
If divorc
ed, for how long? _____________________ Where (State)? ________________
2. Is the other a
pplicant presently married? Yes No
3. Are you presently married? Yes No
4. Are you presently delinquent in court-ordered child support? Yes No
5. Is the other applicant related to you by blood or adoption? Yes No
Last Name
APPLICANT 2: _____________________________________ at Birth ______________________________
Social S
ecurity # ______________________________ (SS# required if born in U.S.)
Place of Birth: ______________________________________________________________
___________________
City County (Optional) State
6. Have you ev
er been married before? Yes No
If yes (
check one): Divorced Widowed
If divorced, for how long? _____________________ Where (State)? ________________
7. Is the other a
pplicant presently married? Yes No
8. Are you presently married? Yes No
9. Are you presently delinquent in court-ordered child support? Yes No
10. Is the other applicant related to you by blood or adoption? Yes No
Address to mail license after recorded by clerk:
Street Address City State ZIP
( )
Telephone Number