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- Non-Resident Marriage License or Certificate Application Form - Maryland
- Application for Marriage License or Certificate - Colorado
- Application for Marriage Certificate - Alaska
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- Application for Certified Copy of Marriage Certificate - Kansas
Fillable Printable Application for Marriage Certificate - Washington State
Fillable Printable Application for Marriage Certificate - Washington State
Application for Marriage Certificate - Washington State
Washington State
CERTIFICATE OF MARRIAGE
COUNTY OF LICENSE:
DATE VALID
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NOT VALID AFTER
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Marriage ceremony must be performed in the State of Washington.
Please type or print clearly in permanent black ink. State File Number
COUNTY AUDITOR
COUNTY AUDITOR’S SIGNATURE
X
DATE RECEIVED (MM|DD|YYYY)
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PERSON A CHECK ONE BRIDE GROOM SPOUSE
PERSON B CHECK ONE BRIDE GROOM SPOUSE
LEGAL NAME BEFORE MARRIAGE (FIRST/MIDDLE/LAST)
LEGAL NAME BEFORE MARRIAGE (FIRST/MIDDLE/LAST)
BIRTH NAME (IF DIFFERENT)
MALE FEMALE
BIRTH NAME (IF DIFFERENT)
MALE FEMALE
CURRENT RESIDENCE – STREET, CITY/TOWN
CURRENT RESIDENCE – STREET, CITY/TOWN
COUNTY OF RESIDENCE
STATE OF RESIDENCE
COUNTY OF RESIDENCE
STATE OF RESIDENCE
DATE OF BIRTH (MM|DD|YYYY)
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BIRTH STATE (IF NOT USA, PROVIDE
COUNTRY)
DATE OF BIRTH (MM|DD|YYYY)
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BIRTH STATE (IF NOT USA, PROVIDE
COUNTRY)
MOTHER/PARENT BIRTH NAME
MOTHER/PARENT BIRTH NAME
FATHER/PARENT BIRTH NAME
FATHER/PARENT BIRTH NAME
MOTHER/PARENT BIRTH STATE (OR
COUNTRY)
FATHER/PARENT BIRTH STATE (OR
COUNTRY)
MOTHER/PARENT BIRTH STATE (OR
COUNTRY)
FATHER/PARENT BIRTH STATE (OR
COUNTRY)
OFFICIANT
I certify that the undersigned, by authority of license issued by the County noted above, did on this day join in lawful wedlock with
their mutual consent in the presence of witnesses. In testimony whereof, witness our signatures:
DATE OF MARRIAGE (MM|DD|YYYY)
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COUNTY OF CEREMONY
TYPE OF CEREMONY (CHECK ONE)
RELIGIOUS CIVIL
DATE SIGNED (MM|DD|YYYY)
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OFFICIANT’S ADDRESS (STREET, CITY, STATE AND ZIP CODE) PLEASE PRINT
OFFICIANT’S DAYTIME PHONE
OFFICIANT’S NAME (PRINT)
OFFICIANT’S SIGNATURE
X
WITNESS SIGNATURE
X
WITNESS SIGNATURE
X
PERSON A SIGNATURE
X
DATE SIGNED (MM|DD|YYYY)
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PERSON B SIGNATURE
X
DATE SIGNED (MM|DD|YYYY)
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DOH/CHS 005 (REV 12/2012) FORM VALID ON DECEMBER 6, 2012
Social Security Number for Applicants
Department of Health is required to collect your Social Security Number in order to assist in child support laws
(Section 7, Chapter 160 Laws of 1998). If you do not have a Social Security Number, you are required to complete
the Social Security Declaration.
PERSON A - SOCIAL SECURITY NUMBER
PERSON B - SOCIAL SECURITY NUMBER
PERSON A - NAME
PERSON B - NAME
Declaration in Absence of a Social Security Number
I have not furnished a Social Security Number on my application for registration of a marriage certificate, because
I do not have a Social Security Number.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.
Person A Signature
Date
Person B Signature
Date
Center for Health Statistics
MARRIAGE CERTIFICATE
INSTRUCTIONS
(RCW 26.04.090)
County Section
Dates Valid ------------- Completed at the time the application for marriage license is filed.
Spouse Information -- Completed at the time the application for marriage license is filed.
Received ---------------- Completed by the county auditor when the certificate is filed.
Officiant Section
Ceremony -------------- Date and county of ceremony are required.
Officiant Information-- Signature and complete address are required.
Signatures -------------- The signatures of the spouses, two witnesses and date signed are required.
Back
SSN verification ------- Completed at the time the application for marriage license is filed.
NOTE:
The officiant is required by law to return the marriage certificate to the county auditor
where the license was obtained within thirty (30) days of the marriage ceremony.
DOH/CHS 005 (REV 12/2012)
