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New Application

License Type: Marriage Civil Union

Groom - Basic Information

First Name *	Full Middle Name (Required if you have one)	Last Name *
Birth Last Name (Maiden if Applicable)	Gender *
Full Street Address *	City (Do Not Abbreviate) *	State *	Zip -
County *	Designation * Bride Groom Spouse Partner
Date of Birth * (MM/DD/YYYY)	Current Age *
Birth Place *	Social Security Number (Required if You Have One)	Occupation/Job Title (If unemployed, put None) *
Phone Number *	Email Address

Groom - Parental Information

Father's First Name (Unknown if not known) *	Father's Last Name (Unknown if not known) *
Father's City of Residence (or put Unknown or Deceased) *	Father's State of Residence *	Father's Birth State *
Mother's First Name (Unknown if not known) *	Mother's Last Name (Unknown if not known)	Mother's Maiden Name *
Mother's City of Residence (or put Unknown or Deceased) *	Mother's State of Residence *	Mother's Birth Place *

Groom - Statistical Information

Race *	Hispanic *	Hispanic Type
Years of Education Completed *	Years of College Education Completed *

Groom - Prior Marriages Information

Number of Marriages Including This One *	How Last Marriage Ended	Approximate Date Last Marriage Ended (MM/DD/YYYY)
County or Country Where Last Marriage Ended (do not abbreviate)	State Where Last Marriage Ended

Bride - Basic Information

First Name *	Full Middle Name (Required if you have one)	Last Name *
Birth Last Name (Maiden if Applicable)	Gender *
Full Street Address *	City (Do Not Abbreviate) *	State *	Zip -
County *	Designation * Bride Groom Spouse Partner
Date of Birth * (MM/DD/YYYY)	Current Age *
Birth Place *	Social Security Number (Required if You Have One)	Occupation/Job Title (If unemployed, put None) *
Phone Number *	Email Address

Bride - Parental Information

Father's First Name (Unknown if not known) *	Father's Last Name (Unknown if not known) *
Father's City of Residence (or put Unknown or Deceased) *	Father's State of Residence *	Father's Birth State *
Mother's First Name (Unknown if not known) *	Mother's Last Name (Unknown if not known)	Mother's Maiden Name *
Mother's City of Residence (or put Unknown or Deceased) *	Mother's State of Residence *	Mother's Birth Place *

Bride - Statistical Information

Race *	Hispanic *	Hispanic Type
Years of Education Completed *	Years of College Education Completed *

Bride - Prior Marriages Information

Number of Marriages Including This One *	How Last Marriage Ended	Approximate Date Last Marriage Ended (MM/DD/YYYY)
County or Country Where Last Marriage Ended (do not abbreviate)	State Where Last Marriage Ended

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