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MARRIAGE LICENSE PRE-APPLICATION |
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This box for office use only: |
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Application # |
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Receipt # __________________________________ |
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IMPORTANT NOTES
1)By Florida Law, a marriage license is valid for 60 days only. If your planned wedding date is more than 60 days away, you must wait to apply for a license.
2)A Florida marriage license is valid only for marriages solemnized in Florida. If you’re planning to be married out of state or in another country, you must contact that jurisdiction about obtaining a marriage license. THIS LICENSE IS NOT VALID OUT OF STATE OR IN ANOTHER COUNTRY.
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First Name |
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Middle Name |
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Last Name |
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Information▼ |
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Birth Place: (State or Foreign Country) |
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Date of Birth: |
_______ / ______ / ____________ |
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YYYY |
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▼Groom |
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Residence: City |
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County/Parish |
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State |
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Date of Birth: |
______ / ______ / ____________ |
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YYYY |
Residence: City |
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County/Parish |
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Last Name |
Maiden Name, if different |
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Birth Place: (State or Foreign Country)
State
The statistical information below is required, will not appear on the marriage certificate and will not be recorded.
Future Mailing Address:
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Only |
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Groom Information |
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Race |
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Social Security Number** |
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PurposesStatistical |
REQUIREDISBUT |
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☐ Black |
☐ WHITE |
☐ OTHER |
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Number of this Marriage |
Date Last Marriage Ended |
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_____ / _____ / __________ |
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YYYY |
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How Did Last Marriage End? |
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For |
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☐ DIVORCE |
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☐ DEATH |
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☐ ANNULMENT |
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Telephone Number:
Bride Information
Race |
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Social Security Number** |
☐ Black ☐ WHITE |
☐ OTHER |
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Number of this Marriage |
Date Last Marriage Ended |
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_____ / _____ / __________ |
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MM |
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YYYY |
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How Did Last Marriage End? |
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☐ DIVORCE |
☐ DEATH |
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☐ ANNULMENT |
**Pursuant to the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996, each party is required to provide his or her social security number.
Disclosure of social security numbers shall be limited to the purpose of administration of the Title IV-D program for child support enforcement.
Family Law Statement
We, (groom name) __________________________________ and (bride name) ________________________________
attest that we: |
_____ have |
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_____ have not |
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_____ together |
completed the Pre-Marital preparation course. We have also obtained and read the information contained in the handbook of rights and responsibilities of marriage specified in Florida Statute 741.0306.
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Groom Signature |
Bride Signature |
Sworn to and subscribed before me on _________________, 20_____. By: _______________________________,D.C.