1
Home #: ____________________ Marriage License Application Approved By: __________ Date: __________ [This is not a Marriage License] Cell #: ____________________ Book #: __________ Page #: __________ State File Number 101 Groom Identification Bride (For Office Use Only) DL: _______________________ DL: _______________________ BC: _______________________ BC: _______________________ Other: ____________________ Other: ____________________ * Full Name, No Initials * 1. Issuing County MOBILE Grooms’ Information 2. Groom’s Name First Middle Last 3. Date of Birth (Month, Day, Year) 4. Race (Black, White, Hispanic, Asian, etc) 5. Residence (Street Address, City, State, Zip) 6. Inside City Limits Yes or No) 7. County 8. State 9. Number of Previous Marriages 10. If Previously Married; Marriage Ended by: Death, Divorce, Dissolution, Annulment & Include Approximate Date 11. Education (Specify ONLY the highest grade completed) 12. Social Security Number ____ ____ ____ - ____ ____ - ____ ____ ____ ____ Elementary or High School (0 – 12): Years in College: 13. Father’s Name First Middle Last 14. Mother’s Name First Middle Maiden Last Name Brides’ Information 15. Bride’s Name First Middle Last 16. Bride’s Maiden Last Name (if different) 17. Date of Birth (Month, Day, Year) 18. Race (Black, White, Hispanic, Asian, etc) 19. Residence (Street Address, City, State, Zip) 20. Inside City Limits (Yes or No) 21. County 22. State 23. Number of Previous Marriages 24. If Previously Married; Marriage Ended by: Death, Divorce, Dissolution, Annulment & Include Approximate Date 25. Education (Specify ONLY the highest grade completed) 26. Social Security Number ____ ____ ____ - ____ ____ - ____ ____ ____ ____ Elementary or High School (0 – 12): Years in College: 27. Father’s Name First Middle Last 28. Mother’s Name First Middle Maiden Last Name We hereby certify that the information provided is correct to the best of our knowledge and belief and we are free to marry under the laws of this state. 29. Groom’s Signature 30. Bride’s Signature
