First Middle Last (Maiden)
First Middle Last (Maiden)
)
(
Phone Number:
)
(
Phone Number:
Zip Code:
Gender:
Zip Code:
FIRST
SECOND
THIRD
FOURTH
FIFTH
SIXTH
SEVENTH
EIGHTH
NINTH
OTHER
No College
1 Year College
2 Years College
3 Years College
4 Years College
5 Years College
More Than 5 Years College
0
12th Grade
11th Grade
10th Grade
9th Grade
8th Grade
7th Grade
6th Grade
5th Grade
4th Grade
3rd Grade
2nd Grade
1st Grade
No College
1 Year College
2 Years College
3 Years College
4 Years College
5 Years College
More Than 5 Years College
mm/dd/yyyy
mm/dd/yyyy
WIDOWED
DIVORCED
Highest Grade Completed:
Previous Marriage Ended By:
Number of this Marriage:
Suffix (ie: Jr, Sr, III):
SPOUSE 1 INFORMATION
Age:
State:
First Name:
Last Name:
Maiden Name:
County:
City or Town of Residence:
Current Physical Address
(no P.O. Boxes):
Parent Name:
Full Middle Name:
Birth Date:
Virginia
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other - Type in Below
0
12th Grade
11th Grade
10th Grade
9th Grade
8th Grade
7th Grade
6th Grade
5th Grade
4th Grade
3rd Grade
2nd Grade
1st Grade
Highest Grade Completed:
Previous Marriage Ended By:
Number of this Marriage:
Last Name:
SPOUSE 2 INFORMATION
State:
Full Middle Name:
Birth Date:
Virginia
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other - Type in Below
Age:
First Name:
Maiden Name:
Suffix (ie: Jr, Sr, III):
County:
City or Town of Residence:
Current Physical Address
(no P.O. Boxes):
Parent Name:
WIDOWED
DIVORCED
Note: Social Security Number is required for the issuance of a Marriage License. As a security measure, this information will be taken at the courthouse when the license is issued.
FIRST
SECOND
THIRD
FOURTH
FIFTH
SIXTH
SEVENTH
EIGHTH
NINTH
OTHER
Virginia
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other - Type in Below
Birth State or
Foreign Country (use other):
Birth State or
Foreign Country (use other):
Virginia
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other - Type in Below
(if independent city, leave blank)
First Middle Last (Maiden)
First Middle Last (Maiden)
(Street Address, City, State, Zip)
(Street Address, City, State, Zip)
Use tab key (not enter key) to navigate through data entry fields
(if independent city, leave blank)
Officiant's Phone:
(mm/dd/yyyy)
Location of wedding:
Officiant's Address:
Officiant's name:
Expected date of marriage:
Male
Female
Parent Name:
Gender:
Male
Female
Male
Female
Male
Female
Gender:
Gender:
Parent Name:
Gender:
Gender:
Male
Female
Male
Female