Your Names(*) |
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Phone Number(*) |
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Email Address(*) |
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Your Full Address (You must state that you live together at this address) |
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Mailing Address (if different) |
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City and County Where Your Ceremony Is Taking Place |
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Date of Ceremony |
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FIRST PERSONS INFORMATION |
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What do You Prefer to be Listed As |
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P1 First Name |
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P1 Middle Name |
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P1 Last Name |
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P1 Last name at Birth (If Different) |
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P1 Date of Birth (please use this format MM/DD/YYYY) |
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P1 Place of Birth (enter first few letters of your State or Country of Birth) |
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P1 Number of Previous Marriages |
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P1 Last Marriage ended in (Select One) |
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P1 Date Last Marriage Ended (MM/DD/YYYY) |
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If your last marriage ended in the last 2 years you will need to show proof of dissolution |
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P1 Father's/Parent's Birth Name: First, Middle and Last |
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P1 Mother's/Parent's Birth Name: First, Middle and Last |
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SECOND PERSONS INFORMATION |
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What do You Prefer to be Listed As |
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P2 First Name |
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P2 Middle Name |
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P2 Last Name |
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P2 Last name at Birth (If Different) |
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P2 Date of Birth MM/DD/YYYY |
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P2 Place of Birth (enter first few letters of your State or Country of Birth) |
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P2 Number of Previous Marriages |
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P2 Last Marriage ended in (Select One) |
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P2 Date Last Marriage Ended (MM/DD/YYYY) |
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If your last marriage ended in the last 2 years you will need to show proof of dissolution |
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P2 Father's/Parent's Birth Name: First, Middle and Last |
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P2 Mother's/Parent's Birth Name: First, Middle and Last |
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Would either of you like to change your Name? Here is your Chance. |
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First Persons New Middle Name |
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First Persons New Last Name |
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Second Persons Middle Name |
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Second Persons New Last Name |
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Appointment Information |
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Have you set an appointment with us yet? |
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Where did you want it Issued? |
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What Date, TIme and Location did you want it issued? |
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Would you like us to Perform your Ceremony too? |
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Additional Information or Questions |
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Please Double Check and Make Sure All Entries are Correct(*) |
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