San Bernardino County
Recorder-Clerk
222 W. Hospitality Lane, 1
st
Floor, San Bernardino CA 92415-0022
Hours 8 a.m. to 5:00 p.m., Monday-Friday.
855 REC-CLRK
www.sbcounty.gov/arc
APPLICATION FOR APPOINTMENT AS
DEPUTY COMMISSIONER OF CIVIL MARRIAGE
(Pursuant To California Family Code Section 401b)
Applicants must be at least 18 years of age.
Name of Applicant
Occupation
Residence Address
Mailing Address
Daytime Telephone Date of Birth
THIS COMMISSION APPLICATION IS FOR: (Please circle one)
1. A one-day, one event commission.
Date of Ceremony
Place of ceremony
First Person's Name
First Person's Address
Second Person's Name
Second Person's Address
2. A fixed time period beginning
and expiring on
Please briefly explain why you seek appointment as a commissioner of civil marriage in San
Bernardino County.
How did you become aware of this county's Deputy Commissioner of Marriage Program?
"I certify (or declare) under penalty of perjury under the laws of the State of California that the
foregoing is true and correct."
Date
Signature
PLEASE RETURN COMPLETED FORM AND $75.00 NON-REFUNDABLE FEE AT
LEAST 6 WEEKS IN ADVANCE TO THE ADDRESS SHOWN AT THE TOP OF THIS
FORM.
Approved:
B.D.
Rev. 02/21/18
