Rensselaer County Office of the City Clerk Registration #______
District #4102 Troy, New York
READ BEFORE STARTING APPLICATION: There is a non-refundable $40.00 fee per couple which includes the
license and one certificate of marriage. The fee may only be waived for active-duty military personnel who present
proof of current service. New York State law requires that you wait at least 24 hours after receiving the license
before having a ceremony. You must have your ceremony within 59 days thereafter. You must be at least 18 years
of age to apply for this license. Both parties to this marriage must appear in person at the Office of the City Clerk.
Licenses obtained in the City of Troy may be used anywhere in New York State.
All documents must be original or certified copies. No exceptions. Photocopied, faxed, or digital images are
not acceptable. New York State law requires that you must have one item from each group below:
**Group 1: ID driver’s license, valid passport, or employment photo ID (no benefit cards).
**Group 2: Birth Record original or certified copy of birth certificate with raised seal, original baptismal record
with date of birth, or original naturalization record with date of birth. If your birth certificate is in another language, it
must be translated into English and notarized as a certified copy.
**Group 3: Previous Marriage(s), if applicable certified copies of judgement of divorce, court-ordered
annulment, or a death certificate are required for each previous marriage. If in another language, each copy must be
translated into English and notarized as a certified copy.
Write in print, as clearly as possible.
Full Legal Name:
Social Security #:
New Last Name:
I do not want to change my last name
Birth Name: (if different than current name)
Current Home Address:
Phone #:
Address where you would like your certificate mailed, if different:
Birth Date:
Birth Place:
Gender: Female Male
Your Occupation:
Type of Industry or Business:
Father’s First and Last Name:
Country of Birth:
Mother’s First and Maiden Name:
Country of Birth:
Number of Previous Marriages ending in Divorce: Legal Annulment: or Death:
Is/are your former spouse(s) alive? Yes No
Date 1
Marriage Ended:
Date 3
Marriage Ended:
Date 2
Marriage Ended:
Date 4
Marriage Ended:
If you fill out the application prior to visiting our office, do not sign. You must sign in person at our office.
By signing this application, I hereby swear and affirm that there are no legal impediments to the marriage and that
the information contained herein is true and correct to the best of my knowledge.
Signature: Date:
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