CONFIDENTIAL MARRIAGE LICENSE APPLICATION
(All fields must be completed)

Party A

Name

First:

Middle:

Last:

Last name at birth (if different than above):

Date of Birth:

State/Country of Birth:

Number of previous marriages:

Last marriage ended by:

Date ended:

Death:

Divorce:

Annulment:

N/A

 

Residence, Business or P.O. Box:

Address:

City:

State:

Country:

Zip Code:

Full Birth Name of Father/Parent:

Full Birth Name:

State/Country of Birth:

Full MAIDEN Name of Mother/Parent:

Full Maiden/Birth Name:

State/Country of Birth:

 

Party A:

Home Phone:

 

Work Phone:

E-mail:

Identification # (Picture ID):
Show ID at time of signing

Exp:

Party B

Name

First:

Middle:

Last:

Last name at birth (if different than above):

Date of Birth:

State/Country of Birth:

Number of previous marriages:

Last marriage ended by:

Date ended:

Death:

Divorce:

Annulment:

N/A

 

Residence, Business or P.O. Box:

Address:

City:

State:

Country:

Zip Code:

Full Birth Name of Father/Parent:

Full Birth Name:

State/Country of Birth:

Full MAIDEN Name of Mother/Parent:

Full Maiden/Birth Name:

State/Country of Birth:

 

Party B:

Home Phone:

 

Work Phone:

E-mail:

Identification # (Picture ID):
Show ID at time of signing

Exp:

New Middle and Last Name of Party A and Party B
 

Party A

First:

Middle:

Last:

Party B

First:

Middle:

Last:

 

Wedding Date:

Time

Officiant:

Wedding Location:

Comments:

Pastor Mike Mitschke • 619-890-5000 • pastormike@cox.net