Marriage License Application

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APPLICATION NO.

____________
MARRIAGE APPLICATION - STATE OF FLORIDA ONLY (office use only)

Applicant I - Full Name (Please print) Applicant II - Full Name (Please print)

First name Middle name Last name First name Middle name Last name
Race (Check one only): American Indian Asian Race (Check one only): American Indian Asian
Black Hispanic White Other Black Hispanic White Other
Sex: Male Female Sex: Male Female
Social Security No.: Social Security No.:
Date of Birth: Age:______ Date of Birth: Age:______
Month Day Year Month Day Year

If you are NOT at least 18 years of age, please notify the Clerk If you are NOT at least 18 years of age, please notify the Clerk

County of Residence: ________________________________ County of Residence: ________________________________


City of Residence: ___________________________________ City of Residence: ___________________________________
State of Residence: __________________________________ State of Residence: __________________________________
Birthplace: __________________________________________ Birthplace: __________________________________________
(State or Foreign Country) (State or Foreign Country)
Birth Name: _________________________________________ Birth Name: _________________________________________

Previous Marriage Information: Previous Marriage Information:


Is this your first marriage? Yes No Is this your first marriage? Yes No
If No, this will be number 2 3 4 _____ If No, this will be number 2 3 4 _____
If No, last marriage end by: Death Divorce Annulment If No, last marriage end by: Death Divorce Annulment
Date last marriage ended Date last marriage ended
Month Day Year Month Day Year

Contact Mailing Address:_____________________________________________________________________________


Contact Phone No: ( ) When do you plan to be married? |
Area Code Telephone Number Month Day Year

Have you, together or separately completed a premarital preparation course? Yes No


If Yes, you will be required to provide a copy of the certificate of completion during the license issuance process.

Are you the parents of a child(ren) in common, born in the State of Florida? Yes No
If Yes, please complete the "Affirmation of Common Children Born in Florida" form.

Applicant I Email :_____________________________________________________________________________


Applicant I Daytime Phone Number :____________________

Applicant II Email :_____________________________________________________________________________


Applicant II Daytime Phone Number :____________________

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