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Fillable Printable Application for Marriage License or Certificate - Texas

Fillable Printable Application for Marriage License or Certificate - Texas

Application for Marriage License or Certificate - Texas

Application for Marriage License or Certificate - Texas

APPLICATION FOR MARRIAGE LICENSE,
______________________________
COUNTY, TEXAS
The form and content of this application is prescribed by section 2.004 of the Texas Family Code.
WARNING: IT IS A FELONY TO FALSIFY INFORMATION ON THIS DOCUMENT. THE PENALTY FOR KNOWINGLY MAKING A FALSE STATEMENT ON THIS
FORM OR FOR SIGNING A FORM WHICH CONTAINS A FALSE STATEMENT IS 2 TO 10 YEARS IMPRISONMENT AND A FINE OF UP TO $10,000. (HEALTH AND
SAFETY CODE, CHAPTER 195, SEC. 195.003)
Applicant One
First Name
Middle Name Current Last Name Suffix
Woman’s Maiden Name (If Applicable)
Telephone Number
Street Address
City State Zip
Date of Birth
Place of Birth (including city, county and state) Social Security Number
I have not been divorced within the last 30 days
.
TRUE
FALSE
I am not presently married
.
TRUE
FALSE
I am not presently delinquent in the payment of court ordered child support.
TRUE
FALSE
The other applicant is not presently married
TRUE
FALSE
I am not related to the other applicant as:
TRUE
FALSE
an ancestor or descendant, by blood or adoption;
a brother or sister, of the whole or half blood or by adoption;
a parent's brother or sister, of the whole or half blood or by
adoption;
a son or daughter of a brother or sister, of the whole or half blood or
by adoption;
a current or former stepchild or stepparent; or
a son or daughter of a parent's brother or sister, of the whole or half
blood or by adoption;
I wish to make a voluntary contribution of $5.00 to promote healthy early childhood by supporting the Texas Home Visitation Program administered by the Office of Early
Childhood Coordination of Health and Human Services [Texas Family Code 2.004(13)].
I solemnly swear (or affirm) that the information I have given in this application is correct _____________________________________________
Applicant
s Signature and Date Signed
Applicant Two
First Name
Middle Name Current Last Name Suffix
Woman’s Maiden Name (If Applicable)
Telephone Number
Street Address
City State Zip
Date of Birth
Place of Birth (including city, county and state) Social Security Number
I have not been divorced within the last 30 days
.
TRUE
FALSE
I am not presently married
.
TRUE
FALSE
I am not presently delinquent in the payment of court ordered child support.
TRUE
FALSE
The other applicant is not presently married
TRUE
FALSE
I am not related to the other applicant as:
TRUE
FALSE
an ancestor or descendant, by blood or adoption;
a brother or sister, of the whole or half blood or by adoption;
a parent's brother or sister, of the whole or half blood or by
adoption;
a son or daughter of a brother or sister, of the whole or half blood or
by adoption;
a current or former stepchild or stepparent; or
a son or daughter of a parent's brother or sister, of the whole or half
blood or by adoption;
I wish to make a voluntary contribution of $5.00 to promote healthy early childhood by supporting the Texas Home Visitation Program administered by the Office of Early
Childhood Coordination of Health and Human Services [Texas Family Code 2.004(13)].
I solemnly swear (or affirm) that the information I have given in this application is correct _____________________________________________
Applicant
s Signature and Date Signed
Mail Executed License To (Street/P.O. Box, City, State, Zip)________________________________________________________________________
For County Clerk Office Use Only
Subscribed and sworn to before me, or I certified that the applicant did not appear personally but the prerequisites for the license have been fulfilled by
§2.007 of the Texas Family Code on ________________________, 20_____ at _______________am/pm
_____________________________ County Clerk ___________________County, Texas. Ceremony Performed By_____________________________
By ___________________________________ Deputy Date of Marriage_______________ County/Place of Marriage________________________
Applicant One Identification Type (ID & Age)___________________________________ License Number _______________________
Applicant Two Identification Type (ID & Age)___________________________________ Volume _______________ Page ______________
VS-180 Rev. 06/2015
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