Marriage Application Administration


First Applicant's
Information
First Name: Middle Name: Last Name: Suffix:
 
Last Name at Birth (if different):

    Gender (Optional):


   

Residence State: County: City/Town/Location: Inside City Limits:
If Other, Please Specify:
Street And Number: Birth County & State: Birthdate (mm/dd/yyyy): Age:
//

Father's Name: State of Birth: Address (if living):  
   
If Other, Please Specify:
Mother's MAIDEN Name: State of Birth: Address (if living):  
 
If Other, Please Specify:

Race: 		Number of
this Marriage: 		If previously Married, Last Marriage
ended by:       On date (mm/yyyy): 		Education-Specify
highest grade completed:
    /  
Second Applicants's
Information
First Name: Middle Name: Last Name: Suffix:


Last Name at Birth (if different):

    Gender (Optional):


   

Residence State: County: City/Town/Location: Inside City Limits:
 
If Other, Please Specify:
Street And Number: Birth County & State: Birthdate (mm/dd/yyyy): Age:
/ /

Father's Name: State of Birth: Address (if living):  
   
If Other, Please Specify:
Mother's MAIDEN Name: State of Birth: Address (if living):  
   
If Other, Please Specify:

Race: 		Number of
this Marriage: 		If previously Married, Last Marriage
ended by:       On date (mm/yyyy): 		Education-Specify
highest grade completed:
    /  


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