Fillable Affidavit of Applicant A Applicant for Marriage License

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Affidavit of Applicant A Applicant for Marriage License

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Affidavit of Applicant A
Applicant for Marriage License
State of WASHINGTON
County of Benton
The undersigned, being first duly sworn,
deposes as follows:
That if I am afflicted with any contagious
sexually transmitted disease, the condition
is known to Applicant B and that I am not
related to Applicant B.
Birthdate
Age
Print Name in Full
X
Signature in Full
Subscribed and Sworn to before me on
day month year
Deputy Auditor/Notary Public
Birthplace
Single Widowed Divorced
Address
(present)
Street
Marriage license is not valid for three (3)
days from date of application and is void if
marriage is not solemnized in the State of
Washington within sixty (60) days of
issuance of license.
City
State
Zip
Address
(Past 6 Months)
Street
City
State
Zip
Affidavit of Applicant B
Applicant for Marriage License
State of WASHINGTON
County of Benton
The undersigned, being first duly sworn,
deposes as follows:
That if I am afflicted with any contagious
sexually transmitted disease, the condition
is known to Applicant A and that I am not
related to Applicant A.
Birthdate
Age
Print Name in Full
X
Signature in Full
Subscribed and Sworn to before me on
day month year
Deputy Auditor/Notary Public
Birthplace
Single Widowed Divorced
Address
(present)
Street
Marriage license is not valid for three (3)
days from date of application and is void if
marriage is not solemnized in the State of
Washington within sixty (60) days of
issuance of license.
City
State
Zip
Address
(Past 6 Months)
Street
City
State
Zip
Parents’ or Guardians’ Consent
Applicant A
Applicant B
Subscribed and Sworn to before me on
day month year
Deputy Auditor/Notary Public
I hereby certify that I am (Parent-Guardian) of I hereby certify that I am (Parent-Guardian) of
Who is ______ years of age and give my full
consent to their marriage to
Who is ______ years of age and give my full
consent to their marriage to
X
X
Signature Parent/Guardian of Applicant A
Signature Parent/Guardian of Applicant B
Date of Application
Date License Valid
Marriage License No.
Must be filled in by
Applicant A
Must be filled in by
Applicant B
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Affidavit of Applicant A Applicant for Marriage License

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Completed 1 February 2021

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