REG-77 PAGE 2
JUN 18
UPON COMPLETION, APPLICATION IS TO BE RETAINED AS A PERMANENT RECORD.
DECLARATION OF IDENTIFYING WITNESS
(Giving false information constitutes perjury)
1. Name (First, Middle, Last):
Mailing Address (Street/PO Box):
2. Have the applicants correctly stated their ages and usual residences? Yes No
3. Did the applicants make you aware of any legal impediment to their
marriage / remarriage / civil union / reaffirmation of civil union? Yes No
OATH OR AFFIRMATION OF APPLICANTS AND IDENTIFYING WITNESS
NOTE TO REGISTRAR - Applicants and witness should be told that taking a false oath constitutes perjury, which is punishable by a
maximum fine of $7,500.00. In any case where application is made by only one applicant to begin the waiting period, the same
identifying witness must return when the second applicant completes the application. In such a case the same witness must sign once
again on the line below that on which he/she signed when appearing with the first applicant.
We, who have hereunder signed our names, do solemnly swear (or affirm) that we are not currently ruled mentally incompetent;
the answers given by us in this application for a marriage, remarriage, civil union, or reaffirmation of civil union license are true,
full and perfect answers to each and all of said questions.
Signature of Applicant A:
Signature of Applicant B:
Second Signature of
Sworn (or affirmed) and subscribed before me at
REGISTRAR - DO NOT insert place and date of ceremony or file the application until either the completed certificate or copy
thereof is sent to you. Follow-up on all licenses for completion.
Ceremony Performed in (City, Borough, Twp.):
NOTE 1. This is the permanent home and principal establishment to
which, when absent, the applicant intends to return.
NOTE 2. Both applicants must be a minimum of 18 years of age at the
time of application.
NOTE 3. When a remarriage or reaffirmation of civil union license is
requested, indicate in Question 6 that the parties are already married
or joined in a civil union. It is required that proof of the previous
marriage or civil union be submitted to you. Common law marriages,
which were legal prior to December 1, 1939, must be established by
affidavit showing the place and date of the common law marriage
contract. The place and date of the previous marriage or civil union
should be stated on both the application and the license. The seventy-
two hour waiting period is waived. Consent of parents is required for
the remarriage or reaffirmation of a civil union of a minor previously
joined in a marriage or civil union to the same partner in another state.
NOTE 4. Municipality of residence is the municipality where applicant
physically resides, not the mailing address.
If both applicants are
nonresidents of New Jersey, the application must be made in the
municipality where the ceremony will be performed. Registrar should
mark the license accordingly.
NOTE 5. The Registrar’s review of a divorce decree, dissolution of Civil
Union, or termination of Domestic Partnership, submitted with this
application, in no way implies the validity of the submitted document.
Such determination can only be made by a court of law.
APPLICANTS MUST PROVIDE THEIR SOCIAL SECURITY NUMBERS (N. J. S. 37:1-17)
Social Security Number of Applicant A
Social Security Number of Applicant B
Social Security Numbers shall be kept confidential and may only be released for child support purposes and
this document shall not be considered a public record pursuant to P. L. 1963, C.73 (C.47:1A-1 et seq.).