City/Town of Marriage Spouse 1 First Name Middle Name Last Name Sex Age Date of Birth Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 Birthplace (State or Foreign Country) EducationFill in number of years completed for each level. Grades 1-8 Pick One12345678 Grades 9-12 Pick One1234 College Pick One012345678 Residence (No. and Street, Apt.) City or Town County State Pick OneAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Number of Prior Marriages Number of Prior Civil Unions If previously in marriage or civil union, last relationship was Marriage Civil Union Last relationship ended by Death Dissolution Annulment Previous Civil Union did not end. Marrying Civil Union partner. Supervision or Control by Guardian or Conservator Yes No Father's First Middle and Last Name Father's Birthplace (State or Foreign Country) Mother's First Middle and Last Name Mother's MAIDEN Name Mother's Birthplace (State or Foreign Country) Spouse 2 First Name Middle Name Last Name Sex Age Date of Birth Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 Birthplace (State or Foreign Country) EducationFill in number of years completed at each level. Grades 1-8 Pick One12345678 Grades 9-12 Pick One1234 College Pick One012345678 Residence (No. and Street, Apt.) City or Town County State Pick OneAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Number of Prior Marriages Number of Prior Civil Unions If previously in marriage or civil union, last relationship was Marriage Civil Union Last relationship ended by Death Dissolution Annulment Previous Civil Union did not end. Marrying Civil Union partner. Supervision or Control by Guardian or Conservator Yes No Father's First, Middle and Last Name Father's Birthplace (State or Foreign Country) Mother's First, Middle and Last Name Mother's MAIDEN Name Mother's Birthplace (State or Foreign Country) Date of Marriage * Month MonthAprMayJunJul Day Day12345678910111213141516171819202122232425262728293031 Year Year2024 Spouse 1 Telephone Number Spouse 2 Telephone Number Best Contact Email Address Person Performing Ceremony Name * Title * Address * Telephone Number * Mailing address for certified copy of marriage license to be sent after ceremony Leave this field blank
