Marriage License Application

Name of Applilcant for Marriage Officiant License *

First

Last

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Applicant Address (legal residence) *

Address Line 1

Address Line 2

City

State

Zip Code

Applicant Email *

Applicant Phone Number *

Applicant Date of Birth *

Attach Applicant Identification (Drivers license, Passport, Student ID or ID that provides your picture with current address) *

Click or drag files to this area to upload. You can upload up to 4 files.

Marriage Applicants Information

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MARRIAGE APPLICANT 1 *

First

Last

Marriage Applicant 1- Date of Birth *

Marriage Applicant 1 Address (legal residence) *

Address Line 1

Address Line 2

City

State

Zip Code

MARRIAGE APPLICANT 2 *

First

Last

Marriage Applicant 2- Date of Birth *

Marriage Applicant 2 Address (legal residence) *

Address Line 1

Address Line 2

City

State

Zip Code

Signature - By signing and submitting this form you are declaring that the following information is true and accurate. *

Date *

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