Marriage Application Form
Application Date
 -
Month
 -
Day
Year
Date
Partner A Information
Full Legal Name
First Name
Last Name
Age
Date of Birth
 -
Month
 -
Day
Year
Date
Place of Birth
Citizenship
Religion
Ethnicity
Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation/Job Title
Company Name
Driver's License No.
Father's Name
First Name
Last Name
Mother's Name
First Name
Last Name
Previously married?
Yes
No
How many previous marriages?
Please provide the reason why the marriage ended? (Only the latest marriage)
When did it dissolved?
 -
Month
 -
Day
Year
Date
How was dissolved?
Required Supporting Documents
Document related to changing legal name
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Agreement
I confirm that all information in this document is accurate and true.
I confirm that I am not under the influence of any alcohol or drugs when signing this form.
I confirm that I do not have any communicable diseases.
I allow this form to collect sensitive information.
Partner A Signature
Date Signed
 -
Month
 -
Day
Year
Date
Back
Next
Partner B Information
Full Legal Name
First Name
Last Name
Age
Date of Birth
 -
Month
 -
Day
Year
Date
Place of Birth
Citizenship
Religion
Ethnicity
Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation/Job Title
Company Name
Father's Name
First Name
Last Name
Mother's Name
First Name
Last Name
Previously married?
Yes
No
How many previous marriages?
Please provide the reason why the marriage ended? (Only the latest marriage)
When did it dissolved?
 -
Month
 -
Day
Year
Date
How was dissolved?
Required Supporting Documents
Document related to changing legal name
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Agreement
I confirm that all information in this document is accurate and true.
I confirm that I am not under the influence of any alcohol or drugs when signing this form.
I confirm that I do not have any communicable diseases.
I allow this form to collect sensitive information.
Partner B Signature
Date Signed
 -
Month
 -
Day
Year
Date
Back
Next
Payment Fee
Payment Details
prev
next
( X )
Marriage License Fee
$10.00
$
10.00
Â
Â
Postage Fee
$10.00
$
10.00
Â
Â
Processing Fee
$10.00
$
10.00
Â
Â
Payment method
Cash
Check
Credit Card
Bank Payment
Wire Transfer
PayPal
Any special instructions?
Submit
Should be Empty: