DECLARATION AND REGISTRATION OF INFORMAL MARRIAGE,
__________________COUNTY, TEXAS
The form and content of this application is prescribed by section 2.004 of the Texas Family Code.
WARNING: IT IS A FELONY TO FALSIFY INFORMATION ON THIS DOCUMENT. THE PENALTY FOR KNOWINGLY MAKING A FALSE STATEMENT ON THIS
FORM OR FOR SIGNING A FORM WHICH CONTAINS A FALSE STATEMENT IS 2 TO 10 YEARS IMPRISONMENT AND A FINE OF UP TO $10,000. (HEALTH AND
SAFETY CODE, CHAPTER 195, SEC. 195.003)
Woman’s Maiden Name (If Applicable)
Place of Birth (including city, county and state)
I am not related to the other applicant as: □ TRUE □ FALSE
an ancestor or descendant, by blood or adoption;
a brother or sister, of the whole or half blood or by adoption;
a parent's brother or sister, of the whole or half blood or by adoption;
a son or daughter of a brother or sister, of the whole or half blood or by adoption;
a current or former stepchild or stepparent; or
a son or daughter of a parent's brother or sister, of the whole or half blood or by adoption;
I solemnly swear (or affirm) that we, the undersigned, are married to each other by virtue of the following facts: on or about
____________________ we agreed to be married, and after that date we lived together as a married couple and in this state
represented to others that we were married. Since the date of marriage to the other party I have not been married to any other
person. This declaration is true and the information in it which I have given is correct.
Applicant’s Signature and Date Signed
Woman’s Maiden Name (If Applicable)
Place of Birth (including city, county and state)
I am not related to the other applicant as: □ TRUE □ FALSE
an ancestor or descendant, by blood or adoption;
a brother or sister, of the whole or half blood or by adoption;
a parent's brother or sister, of the whole or half blood or by adoption;
a son or daughter of a brother or sister, of the whole or half blood or by adoption;
a current or former stepchild or stepparent; or
a son or daughter of a parent's brother or sister, of the whole or half blood or by adoption;
I solemnly swear (or affirm) that we, the undersigned, are married to each other by virtue of the following facts: on or about
____________________ we agreed to be married, and after that date we lived together as a married couple and in this state
represented to others that we were married. Since the date of marriage to the other party I have not been married to any other
person. This declaration is true and the information in it which I have given is correct.
Applicant’s Signature and Date Signed
For County Clerk Office Use Only
Subscribed and sworn to before me on ________________________, 20_____ at _______________am/pm
______________________________________ County Clerk ___________________County, Texas
By ___________________________________ Deputy
Applicant One Identification Type (ID & Age)___________________________________ License Number _______________________
Applicant Two Identification Type (ID & Age)___________________________________ Volume _______________ Page _______________
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