APPLICATION FOR A PUBLIC LICENSE AND CERTIFICATE OF MARRIAGE
(
FOR A CONFIDENTIAL OR NON-CLERY LICENSE, YOU MUST NOTIFY STAFF PRIOR TO COMPLETION OF THIS FORM)
MUST BE LEGIBLE
PARTY A DATA PHONE NUMBER:_________________________
Bride Groom
1A. NAME FIRST (GIVEN)
1B. MIDDLE
1C. CURRENT LAST
1D. LAST NAME AT BIRTH
(If different than 1C)
2. DATE OF BIRTH
MONTH/DAY/YEAR
3. STATE OF BIRTH
(IF OUTSIDE U.S., ENTER
COUNTRY)
4. NUMBER OF PREVIOUS
MARRIAGES
5. LAST MARRIAGE/SRDP ENDED BY:
DEATH DISSOLUTION ANNULMENT TERM SRDP N/A
6. ADDRESS
MAILING ADDRESS-IF DIFFERENT
7. CITY
8. STATE/COUNTRY
9. ZIP CODE
10A. FULL NAME OF FATHER
10B. STATE OF BIRTH (IF
OUTSIDE U.S., ENTER COUNTRY)
11A. FULL NAME OF MOTHER (MAIDEN)
11B. STATE OF BIRTH (IF
OUTSIDE U.S., ENTER COUNTRY)
PARTY B DATA
Bride Groom
12A. NAME FIRST (GIVEN)
12B. MIDDLE
12C. CURRENT LAST
12D. LAST NAME AT BIRTH
(If different than 12C)
13. DATE OF BIRTH
MONTH/DAY/YEAR
14. STATE OF BIRTH
(IF OUTSIDE U.S., ENTER
COUNTRY)
15. NUMBER OF
PREVIOUS MARRIAGES
16A. LAST MARRIAGE/SRDP ENDED BY:
DEATH DISSOLUTION ANNULMENT TERM SRDP N/A
17. ADDRESS
MAILING ADDRESS-IF DIFFERENT
18. CITY
19. STATE/COUNTRY
20. ZIP CODE
21A. FULL NAME OF FATHER
21B. STATE OF BIRTH (IF
OUTSIDE U.S., ENTER COUNTRY)
22A. FULL NAME OF MOTHER (MAIDEN)
22B. STATE OF BIRTH (IF
OUTSIDE U.S., ENTER COUNTRY)
26B. WITNESS NAME
26C. WITNESS ADDRESS (PHYSICAL)
27B. WITNESS NAME
27C. WITNESS ADDRESS (PHYSICAL)
NEW MIDDLE AND LAST NAME OF PERSON LISTED IN 1A-1D (IF ANY) FOR USE UPON SOLEMNIZATION OF MARRIAGE (SEE REVERSE FOR INFORMATION)
30A. FIRST (MUST BE SAME AS 1A)
30B. MIDDLE
30C. LAST
NEW MIDDLE AND LAST NAME OF PERSON LISTED IN 12A-12D (IF ANY) FOR USE UPON SOLEMNIZATION OF MARRIAGE (SEE REVERSE FOR INFORMATION)
31A. FIRST (MUST BE SAME AS 12A)
31B. MIDDLE
31C. LAST
GENERAL INFORMATION
Applicants must have a marriage ceremony performed in the State of California by an individual authorized to perform a marriage ceremony per California Family Code
Section 400. The ceremony must take place within 90 days from the date the License and Certificate of Marriage is issued. Once a ceremony is performed, the license
must be registered/recorded in the County Recorder’s Office where the license was issued within 10 days of the ceremony date.
It is the applicants’ responsibility to review the License and Certificate of Marriage printed by County Clerk staff and they shall certify by their signatures that the license is
correct and free of errors. Any error(s) or omissions identified after removal of the document from the County Clerk’s Office may require the applicants to file an Affidavit to
Amend a Record through the California Department of Public Health, additional processing time and fees will apply.
NAME CHANGE INFORMATION
The Name Equality Act of 2007 provides that at the time of application for a marriage license, one or both parties to the marriage may elect to change the middle or last
names, or both, by which that party wishes to be known after they are married by entering that information on the marriage license application.
You are not required to change your name, nor are parties required to have the same name.
The parties may choose any of the following middle or last names as the name they wish to be known as after marriage [FC
§ 306.5(b)(2)]:
Current last name of the other spouse
Last name of either spouse given at birth
A name combining into a single last name all or a segment of the current last name or the name of either spouse given at birth
A hyphenated combination for a middle name of the current middle or current or given last name of either party/ A hyphenated combination for a last name of the
current or given last names of either party (hyphenated combinations may or may not include an actual hyphen (-) between the names)
If one or both parties do not wish to identify a new name on the marriage license, as applicable, the marriage license will be completed with two single dashes.
IMPORTANT: You MAY NOT amend the marriage license after it has been issued to add or change the name you wish to be known as after you are married
unless a clerical error has occurred. (A “clerical error” is when the information shown on the marriage license differs from that shown on the application for a
marriage license.) A name change after the fact can only be completed by a court process, not the County Clerk, additional processing time and fees apply.
The marriage certificate is used by multiple local, state, federal and private agencies, each of which have different rules and/or regulations regarding what documents are
acceptable to change your name on their records following marriage. It is recommended that you contact these agencies to verify their requirements prior to applying for
your marriage license.
It is unlawful for our employees to answer questions of legal nature. County Clerk staff cannot advise you how to complete the marriage license application as it relates to
your entry of a new name or retention of your former name on the marriage license application. For your protection, if you have any questions regarding whether you
should or should not list your new name on the marriage license application, and/or how the Name Equality Act of 2007 may affect you, please consult an attorney prior to
applying for your marriage license.
IMPORTANT REGISTRATION INFORMATION
A MARRIAGE LICENSE IS A LEGAL DOCUMENT AND MUST BE KEPT CLEAN AND IN TACT PRIOR TO REGISTRATION. ALL INFORMATION AND SIGNATURES
ON THE ISSUED LICENSE MUST BE LEGIBLE AND CONTAINED WITHIN THE APPROPRIATE BOXES. THE LICENSE WILL NOT BE IN COMPLIANCE WITH
CALIFORNIA STATE REGISTRATION LAWS IF THERE ARE STAINS, ALTERATIONS, ERASURES OR STRIKEOVERS ON THE FORM AND IT WILL BE DEEMED
UNACCEPTABLE FOR REGISTRATION.
We, the undersigned, have reviewed the information above. We understand that we are signing under penalty of perjury that we are unmarried individuals and
that the foregoing application information is true and correct to the best of our knowledge and belief. We understand the information provided and that if the
marriage license is lost, destroyed, or deemed unacceptable for registration we will be responsible to purchase a new or duplicate marriage license. We
acknowledge the receipt of the information required by Family Code Section 358 and hereby apply for a License and Certificate of Marriage.
____________________________________ Date_____________ ________________________________Date____________
(First Person Signature) (Second Person Signature)