APPLICATION FOR A PUBLIC MARRIAGE LICENSE
When completing this application,
you must complete the application in its entirety. Once you have completed all items on this page please click the continue button to create the form for printing.
GROOM'S PERSONAL DATA
First Name:
Middle Name:
Current Last Name:
Date of Birth:
Month
Day
Year
State/Country of Birth:
Select State ----->
Born Outside of US
ALABAMA - AL
ALASKA - AK
ARIZONA - AZ
ARKANSAS - AR
CALIFORNIA - CA
COLORADO - CO
CONNECTICUT - CT
DELAWARE - DE
FLORIDA - FL
GEORGIA - GA
HAWAII - HI
IDAHO - ID
ILLINOIS - IL
INDIANA - IN
IOWA - IA
KANSAS - KS
KENTUCKY - KY
LOUISIANA - LA
MAINE - ME
MARYLAND - MD
MASSACHUSETTS - MA
MICHIGAN - MI
MINNESOTA - MN
MISSISSIPPI - MS
MISSOURI - MO
MONTANA - MT
NEBRASKA - NE
NEVADA - NV
NEW HAMPSHIRE - NH
NEW JERSEY - NJ
NEW MEXICO - NM
NEW YORK - NY
NORTH CAROLINA - NC
NORTH DAKOTA - ND
OHIO - OH
OKLAHOMA - OK
OREGON - OR
PENNSYLVANIA - PA
RHODE ISLAND - RI
SOUTH CAROLINA - SC
SOUTH DAKOTA - SD
TENNESSEE - TN
TEXAS - TX
UTAH - UT
VERMONT - VT
VIRGINIA - VA
WASHINGTON - WA
WASHINGTON, D.C. - DC
WEST VIRGINIA - WV
WISCONSIN - WI
WYOMING - WY
Number of Previous Marriages/SRDP:
Last Marriage/SRDP Ended By:
(Select One)
Death
Dissolution
Annulment
Term SRDP
N/A
Date last Marriage/SRDP Ended:
Month
Day
Year
Full Birth Name of Father/Parent:
Father's State/Country of Birth:
Select State ----->
Born Outside of US
ALABAMA - AL
ALASKA - AK
ARIZONA - AZ
ARKANSAS - AR
CALIFORNIA - CA
COLORADO - CO
CONNECTICUT - CT
DELAWARE - DE
FLORIDA - FL
GEORGIA - GA
HAWAII - HI
IDAHO - ID
ILLINOIS - IL
INDIANA - IN
IOWA - IA
KANSAS - KS
KENTUCKY - KY
LOUISIANA - LA
MAINE - ME
MARYLAND - MD
MASSACHUSETTS - MA
MICHIGAN - MI
MINNESOTA - MN
MISSISSIPPI - MS
MISSOURI - MO
MONTANA - MT
NEBRASKA - NE
NEVADA - NV
NEW HAMPSHIRE - NH
NEW JERSEY - NJ
NEW MEXICO - NM
NEW YORK - NY
NORTH CAROLINA - NC
NORTH DAKOTA - ND
OHIO - OH
OKLAHOMA - OK
OREGON - OR
PENNSYLVANIA - PA
RHODE ISLAND - RI
SOUTH CAROLINA - SC
SOUTH DAKOTA - SD
TENNESSEE - TN
TEXAS - TX
UTAH - UT
VERMONT - VT
VIRGINIA - VA
WASHINGTON - WA
WASHINGTON, D.C. - DC
WEST VIRGINIA - WV
WISCONSIN - WI
WYOMING - WY
Full Birth Name of Mother/Parent:
Mother's State/Country of Birth:
Select State ----->
Born Outside of US
ALABAMA - AL
ALASKA - AK
ARIZONA - AZ
ARKANSAS - AR
CALIFORNIA - CA
COLORADO - CO
CONNECTICUT - CT
DELAWARE - DE
FLORIDA - FL
GEORGIA - GA
HAWAII - HI
IDAHO - ID
ILLINOIS - IL
INDIANA - IN
IOWA - IA
KANSAS - KS
KENTUCKY - KY
LOUISIANA - LA
MAINE - ME
MARYLAND - MD
MASSACHUSETTS - MA
MICHIGAN - MI
MINNESOTA - MN
MISSISSIPPI - MS
MISSOURI - MO
MONTANA - MT
NEBRASKA - NE
NEVADA - NV
NEW HAMPSHIRE - NH
NEW JERSEY - NJ
NEW MEXICO - NM
NEW YORK - NY
NORTH CAROLINA - NC
NORTH DAKOTA - ND
OHIO - OH
OKLAHOMA - OK
OREGON - OR
PENNSYLVANIA - PA
RHODE ISLAND - RI
SOUTH CAROLINA - SC
SOUTH DAKOTA - SD
TENNESSEE - TN
TEXAS - TX
UTAH - UT
VERMONT - VT
VIRGINIA - VA
WASHINGTON - WA
WASHINGTON, D.C. - DC
WEST VIRGINIA - WV
WISCONSIN - WI
WYOMING - WY
Groom's Address:
City:
Zip:
County/State/Country:
Mailing Address:
(if different)
City:
Zip:
County:
BRIDE'S PERSONAL DATA
First Name:
Middle Name:
Current Last Name:
Last Name at Birth:
Date of Birth:
Month
Day
Year
State/Country of Birth:
Select State ----->
Born Outside of US
ALABAMA - AL
ALASKA - AK
ARIZONA - AZ
ARKANSAS - AR
CALIFORNIA - CA
COLORADO - CO
CONNECTICUT - CT
DELAWARE - DE
FLORIDA - FL
GEORGIA - GA
HAWAII - HI
IDAHO - ID
ILLINOIS - IL
INDIANA - IN
IOWA - IA
KANSAS - KS
KENTUCKY - KY
LOUISIANA - LA
MAINE - ME
MARYLAND - MD
MASSACHUSETTS - MA
MICHIGAN - MI
MINNESOTA - MN
MISSISSIPPI - MS
MISSOURI - MO
MONTANA - MT
NEBRASKA - NE
NEVADA - NV
NEW HAMPSHIRE - NH
NEW JERSEY - NJ
NEW MEXICO - NM
NEW YORK - NY
NORTH CAROLINA - NC
NORTH DAKOTA - ND
OHIO - OH
OKLAHOMA - OK
OREGON - OR
PENNSYLVANIA - PA
RHODE ISLAND - RI
SOUTH CAROLINA - SC
SOUTH DAKOTA - SD
TENNESSEE - TN
TEXAS - TX
UTAH - UT
VERMONT - VT
VIRGINIA - VA
WASHINGTON - WA
WASHINGTON, D.C. - DC
WEST VIRGINIA - WV
WISCONSIN - WI
WYOMING - WY
Number of Previous Marriages/SRDP:
Last Marriage/SRDP Ended By:
(Select One)
Death
Dissolution
Annulment
Term SRDP
N/A
Date last Marriage/SRDP Ended:
Month
Day
Year
Full Birth Name of Father/Parent:
Father's State/Country of Birth:
Select State ----->
Born Outside of US
ALABAMA - AL
ALASKA - AK
ARIZONA - AZ
ARKANSAS - AR
CALIFORNIA - CA
COLORADO - CO
CONNECTICUT - CT
DELAWARE - DE
FLORIDA - FL
GEORGIA - GA
HAWAII - HI
IDAHO - ID
ILLINOIS - IL
INDIANA - IN
IOWA - IA
KANSAS - KS
KENTUCKY - KY
LOUISIANA - LA
MAINE - ME
MARYLAND - MD
MASSACHUSETTS - MA
MICHIGAN - MI
MINNESOTA - MN
MISSISSIPPI - MS
MISSOURI - MO
MONTANA - MT
NEBRASKA - NE
NEVADA - NV
NEW HAMPSHIRE - NH
NEW JERSEY - NJ
NEW MEXICO - NM
NEW YORK - NY
NORTH CAROLINA - NC
NORTH DAKOTA - ND
OHIO - OH
OKLAHOMA - OK
OREGON - OR
PENNSYLVANIA - PA
RHODE ISLAND - RI
SOUTH CAROLINA - SC
SOUTH DAKOTA - SD
TENNESSEE - TN
TEXAS - TX
UTAH - UT
VERMONT - VT
VIRGINIA - VA
WASHINGTON - WA
WASHINGTON, D.C. - DC
WEST VIRGINIA - WV
WISCONSIN - WI
WYOMING - WY
Full Birth Name of Mother/Parent:
Mother's State/Country of Birth:
Select State ----->
Born Outside of US
ALABAMA - AL
ALASKA - AK
ARIZONA - AZ
ARKANSAS - AR
CALIFORNIA - CA
COLORADO - CO
CONNECTICUT - CT
DELAWARE - DE
FLORIDA - FL
GEORGIA - GA
HAWAII - HI
IDAHO - ID
ILLINOIS - IL
INDIANA - IN
IOWA - IA
KANSAS - KS
KENTUCKY - KY
LOUISIANA - LA
MAINE - ME
MARYLAND - MD
MASSACHUSETTS - MA
MICHIGAN - MI
MINNESOTA - MN
MISSISSIPPI - MS
MISSOURI - MO
MONTANA - MT
NEBRASKA - NE
NEVADA - NV
NEW HAMPSHIRE - NH
NEW JERSEY - NJ
NEW MEXICO - NM
NEW YORK - NY
NORTH CAROLINA - NC
NORTH DAKOTA - ND
OHIO - OH
OKLAHOMA - OK
OREGON - OR
PENNSYLVANIA - PA
RHODE ISLAND - RI
SOUTH CAROLINA - SC
SOUTH DAKOTA - SD
TENNESSEE - TN
TEXAS - TX
UTAH - UT
VERMONT - VT
VIRGINIA - VA
WASHINGTON - WA
WASHINGTON, D.C. - DC
WEST VIRGINIA - WV
WISCONSIN - WI
WYOMING - WY
Bride's Address:
City:
Zip:
County/State/Country:
Mailing Address:
(if different)
City:
Zip:
County:
Click to create the printable form.
SRDP = State Registered Domestic Partnership