AFFIDAVIT OF ABSENT APPLICANT ON APPLICATION FOR MARRIAGE LICENSE

 

NAME:__________________________________________________________________________________________

            FIRST                          MIDDLE                                  LAST               MAIDEN/SURNAME

ADDRESS:______________________________________________________________________________________

                        STREET NAME AND NUMBER                       CITY                            STATE/ZIP

DATE OF BIRTH:___________________PLACE OF BIRTH:__________________________________________

                                    M/D/Y                                                      CITY                        COUNTY         ST.

CITIZENSHIP:_____________________ SOCIAL SECURITY #:_______________________________________

 

ARE YOU PRESENTLY MARRIED.      YES________      NO_________

 

IS THE OTHER APPLICANT RELATED TO YOU AS: AN ANCESTOR OR DESCENDANT, BY BLOOD

OR ADOPTION; OR A PARENT’S BROTHER OR SISTER OF THE WHOLE OR HALF BLOOD; OR 

A SON OR DAUGHTER OF A  BROTHER OR SISTER OF THE WHOLE OR HALF BLOOD OR BY

ADOPTION.

YES_________  NO_________

 

HAVE YOU BEEN MARRIED BEFORE?           YES_________  NO_________

 

IF DIVORCED, HAS IT BEEN 30 DAYS?          YES_________  NO_________

 

ARE YOU ACTIVE MILITARY?                        YES_________  NO_________

 

ARE YOU PRESENTLY DELINQUENT IN THE PAYMENT OF COURT ORDERED CHILD SUPPORT.        

YES__________            NO___________

I DO DESIRE TO MARRY.   TRUE_________               FALSE__________.  THE PARTY I DESIRE TO

MARRY IS _________________________ AGE________,

ADDRESS:__________________________________________________________________.

 

APPROXIMATE DATE OF MARRIAGE:________________________

                                                                        MM/DD/YYYY

REASON APPLICANT IS UNABLE TO APPEAR PERSONNALLY BEFORE THE COUNTY CLERK

FOR THE ISSUANCE OF THE LICENSE:_________________________________________________________.

_________________________________________________________________________________________________

IF THE ABSENT APPLICANT WILL BE UNABLE TO ATTEND THE CEREMONY, THE PERSON

APPOINTED TO ACT AS PROXY WILL BE:_______________________________________________________.

(YOU MUST USE THE PROXY NAMED HERE)

 

YOUR DRIVERS LICENSE OR A CERTIFIED COPY OF YOUR BIRTH CERTIFICATE MUST BE SUBMITTED WITH THIS APPLICATION AT THE TIME THE LICENSE IS ISSUED.

                                                                                   

__________________________________

                                                                                                                SIGNATURE OF APPLICANT

 

SUBSCRIBED AND SWORN TO BEFORE ME ON     ________________________,20_______.

 

                                                                                    __________________________________

                                                                                                                                NOTARY PUBLIC

                                                                                    ______________COUNTY,___________