Application Orleans Parish

1 Anticipated Date of Marriage:I _____ (print name of groom/ bride /spouse) do swear or affirm that the information contained in this Application for marriage is true and correct. I further swear or affirm that this is my _____ (1st, 2nd, etc. number) marriage but that I am not currently married to anyone else, and that I am free to marry under the laws of the State of Louisiana. I further understand and acknowledge that giving any false information or false statement in this Application for marriage shall constitute the crime of filing a false public record in violation of the Louisiana Criminal Code ( 14:133). PARTY B: PARTY A: Application for Marriage License State of Louisiana Party AFormerly Married?

2 Number of Previous Marriages?Currently Divorced?Date Last Marriage Ended (mm/dd/yy): Party BFormerly Married?Number of Previous Marriages?Currently Divorced?Date Last Marriage Ended (mm/dd/yy):Reason Last Marriage Ended:Reason Last Marriage Ended:DivorceDeathAnnulmentDivorceDeathA nnulmentCovenant MarriageWe, _____ and _____ do hereby declare our intent to contract a Covenant Marriage and, accordingly, have executed a declaration of intent attached NameDate of BirthFather/Parent's Name (before first marriage)RaceYESNO Address within city limits?First NamePhone NumberLast Name Before First Marriage (if different than current legal last name)Residence AddressCityParish/CountyStateZIPF ather/Parent's Birthplace (city, state, country)Mother/Parent's Birthplace (city, state, country)Mother/Parent's Name (before first marriage)Sex:MaleFemaleBRIDESPOUSEGROOMP ARTY BLast NamePlace of Birth (city, state, country)Date of BirthFather/Parent's Name (before first marriage)RaceYESNOA ddress within city limits?

3 First NameMiddle NameLast Name Before First Marriage (if different than current legal last name)Residence AddressCityParish/CountyZIPF ather/Parent's Birthplace (city, state, country)Mother/Parent's Birthplace (city, state, country)Mother/Parent's Name (before first marriage)Sex:MaleFemaleBRIDESPOUSEGROOMY esNoYesNoYesNoYesNoTime of ApplicationDate of ApplicationSignature of Notary Public or Vital Records Marriage Office Staff _____ Notary ID _____I _____ (print name of groom/ bride /spouse) do swear or affirm that the information contained in this Application for marriage is true and correct. I further swear or affirm that this is my _____ (1st, 2nd, etc.)

4 Number) marriage but that I am not currently married to anyone else, and that I am free to marry under the laws of the State of Louisiana. I further understand and acknowledge that giving any false information or false statement in this Application for marriage shall constitute the crime of filing a false public record in violation of the Louisiana Criminal Code ( 14:133).Signature of Party A _____Sworn to and subscribed before me this _____ day of _____, 20_____. StateSignature of Party B _____Sworn to and subscribed before me this _____ day of _____, 20_____. Is this a Covenant Marriage?(If YES, complete below):YESNOL icense Number:Highest Education Completed: Highest Education Completed: Orleans ParishSuffixSuffixPARTY ACheck if consanguineous or adoptive relationshipPhone NumberSocial Security Number: (If none, attach statement)Social Security Number: (If none, attach statement)Rev 3/17 Signature of Notary Public or Vital Records Marriage Office Staff _____ Notary ID _____Middle Name Place of Birth (city, state, country)Do not sign until instructed by Vital Records Staff or NotaryDo not sign until instructed by Vital Records Staff or NotaryBureau of Vital Records and Statistics