Affidavit - Inability to appear form and request for issuance of a marriage license
Check one of the following: Confidential marriage license (Family Code §502)
Public marriage license (Family Code §426)
We, the undersigned, do hereby declare that _____________________________________________
(Print full legal name of person unable to appear)
is 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 ______________________________________
(Name of person performing ceremony)
who is the officiant who will be solemnizing the marriage for the following:
_____________________________________________ ________________________
(Print full legal name of first person) (Date of birth: mm/dd/yyyy)
_____________________________________________ ________________________
(Print full legal name of second person) (Date of birth: mm/dd/yyyy)
We certify under penalty of perjury under the laws of the State of California that the foregoing
information is true and correct:
►_____________________________________________________ Date: _____________________
(Signature of first person)
►_____________________________________________________ Date: _____________________
(Signature of second person)
►_____________________________________________________ Date: _____________________
(Signature of person solemnizing marriage)
The person solemnizing the marriage must physically present this 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 §426(c); 502(c)
Government Code §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 the marriage.
Couples applying for a Confidential Marriage License must already be living together as spouses. Family Code §500
Santa Cruz County Clerk, 701 Ocean St., Room 310, Santa Cruz, CA, 831-454-2060
