AFFIDAVIT OF INABILITY TO APPEAR
AND REQUEST FOR ISSUANCE OF A
Check one of the following:
[ ] CONFIDENTIAL MARRIAGE LICENSE PURSUANT TO FAMILY CODE SECTION 502
[ ] PUBLIC MARRIAGE LICENSE PURSUANT TO FAMILY CODE SECTION 426
We, the undersigned, do hereby declare:
That __________________________________________________________________________
Print full legal name(s) of person(s) unable to appear
is/are physically unable to appear in person at the County Clerk’s Office to apply for a marriage
license due to:
Check one of the following
[ ] Hospitalization (must attach proof of hospitalization)
[ ] Incarceration
[ ] Other ___________________________________________
Reason proved to the satisfaction of the County Clerk
And hereby request the marriage license be issued to ____________________________________
Print name of person solemnizing marriage
as the officiant who will be solemnizing the marriage.
__________________________________________________________ ____________________
Print Full Legal Name of Party A Date of Birth (MM/DD/CCYY)
_________________________________________________________ ____________________
Print Full Legal Name of Party B Date of Birth (MM/DD/CCYY)
We certify under penalty of perjury under the laws of the State of California that the foregoing
information is true and correct.
Executed on: ___________________________ at _________________________________
(MM/DD/CCYY) City/State
__________________________________________________________________________
Signature of Party A
Executed on: ___________________________ at _________________________________
(MM/DD/CCYY) City/State
__________________________________________________________________________
Signature of Party B
Executed on: ___________________________ at _________________________________
(MM/DD/CCYY) City/State
__________________________________________________________________________
Signature of Person Solemnizing Marriage
NOTE: The person solemnizing the marriage must physically present the completed affidavit to the County Clerk at the time the marriage license
is issued [Family Code Sections 426(a); 502(a)].
The signature(s) of the person(s) who is/are physically unable to appear in person at the County Clerk’s Office must be authenticated by
a Notary Public or a Court prior to the County Clerk issuing the marriage license [Family Code Sections 426(c); 502(c)]. NOTE: GC
8224(a) prohibits the notary public who has authenticated the signature(s) of the person(s) who is/are unable to physically appear in
person at the County Clerk’s Office from also being the person solemnizing this marriage.
Pursuant to Family Code Section 500, couples applying for a Confidential Marriage License must already be living together as spouses.
In addition, the confidential marriage license may only be used in the county in which the license is issued.
Rev. 06/2008
