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 (R.S. 14:133).
PARTY B: PARTY A:
Application for Marriage License
State of Louisiana
Party A
Formerly Married? Number of Previous Marriages? Currently Divorced?
Date Last Marriage Ended (mm/dd/yy):
Party B
Formerly Married? Number of Previous Marriages?
Currently Divorced? Date Last Marriage Ended (mm/dd/yy):
Reason Last Marriage Ended:
Reason Last Marriage Ended:
Divorce Death Annulment
Divorce Death Annulment
Covenant Marriage
We, ___________________________________ and ______________________________ do hereby declare our intent to contract a
Covenant Marriage and, accordingly, have executed a declaration of intent attached hereto.
Last Name
Date of Birth
Father/Parent's Name (before first marriage)
Race
YES NO
Address within
city limits?
First Name
Phone NumberLast Name Before First Marriage (if different than current legal last name)
Residence Address City
Parish/County State ZIP
Father/Parent's Birthplace (city, state, country)
Mother/Parent's Birthplace (city, state, country)Mother/Parent's Name (before first marriage)
Sex:
Male Female
BRIDE SPOUSEGROOM
PARTY B
Last Name
Place of Birth (city, state, country)Date of Birth
Father/Parent's Name (before first marriage)
Race
YES NO
Address within
city limits?
First Name Middle Name
Last Name Before First Marriage (if different than current legal last name)
Residence Address City
Parish/County ZIP
Father/Parent's Birthplace (city, state, country)
Mother/Parent's Birthplace (city, state, country)Mother/Parent's Name (before first marriage)
Sex:
Male Female
BRIDE SPOUSEGROOM
Yes No
Yes No
Yes No
Yes No
Time of
Application
Date of
Application
Signature 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. 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 (R.S. 14:133).
Signature of Party A ______________________________________________
Sworn to and subscribed before me this _________ day of ____________________, 20_____.
State
Signature of Party B ______________________________________________
Sworn to and subscribed before me this _________ day of ____________________, 20_____.
Is this a Covenant Marriage? (If YES, complete below):
YES NO
License Number:
Highest Education Completed:
Highest Education Completed:
Orleans Parish
Suffix
Suffix
PARTY A
Check if consanguineous or adoptive relationship
Phone Number
Social 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 Notary
Do not sign until instructed by Vital Records Staff or Notary
Bureau of Vital Records and Statistics
