MARRIAGE LICENSE APPLICATION WORKSHEET - DOUGLAS COUNTY, NEBRASKA
IMPORTANT: If this form is not filled out legibly and/or accurately, it may delay the issuance of your marriage license.
If you have questions, please contact the Clerk's Office at 402-444-6080 or marriage@douglascounty-ne.gov
1a. GROOM/APPLICANT #1 - FULL LEGAL NAME
1b. MAIDEN LAST NAME (if applicable)
3b. STATE (if applicable)
3c. COUNTY (if applicable)
3d. CITY, TOWN OR LOCATION
4. BIRTHPLACE (CITY AND STATE OR FOREIGN COUNTRY)
5. DATE OF BIRTH (mm/dd/yyyy)
6a. FATHER’S FULL LEGAL NAME (First, Middle, Last, Suffix)
6b. BIRTHPLACE (City and State or Foreign Country)
7a. MOTHER’S FULL LEGAL MAIDEN NAME (First, Middle, Maiden)
7b. BIRTHPLACE (City and State or Foreign Country)
8a. BRIDE/APPLICANT #2 - FULL LEGAL NAME
8b. MAIDEN LAST NAME (if applicable)
10b. STATE (if applicable)
10c. COUNTY (if applicable)
10d. CITY, TOWN OR LOCATION
11. BIRTHPLACE (CITY AND STATE OR FOREIGN COUNTRY)
12. DATE OF BIRTH (mm/dd/yyyy)
13a. FATHER’S FULL LEGAL NAME (First, Middle, Last, Suffix)
13b. BIRTHPLACE (City and State or Foreign Country)
14a. MOTHER’S FULL LEGAL MAIDEN NAME (First, Middle, Maiden)
14b. BIRTHPLACE (City and State or Foreign Country)
15a. SOCIAL SECURITY NUMBER-Groom/Applicant 1
15b. SOCIAL SECURITY NUMBER-Bride/Applicant 2
16a. If APPLICANT #1 was previously married, last marriage ended by:
Death Dissolution Annulment
Date previous marriage ended (mm/dd/yyyy)
Divorce/Annulment was final in State/Country of __________________
16b. If APPLICANT #2 was previously married, last marriage ended by:
Death Dissolution Annulment
Date previous marriage ended (mm/dd/yyyy)
Divorce/Annulment was final in State/Country of ___________________
17a. Is Groom/Applicant 1 of Hispanic or Latino Origin? Yes No
17b. Is Bride/Applicant 2 of Hispanic or Latino Origin? Yes No
Check one or more options per applicant
18a. APPLICANT #1 18b. APPLICANT #2
___________ White
___________ Black or African American ____
___________ American Indian or Alaska Native
___________ Asian ___________
Native Hawaiian or other Pacific Islander _
FEES
The fee for a marriage license and certified copy is $34.00.
Certified copies will be mailed once the license is returned
to the County Clerk's Office following the ceremony.
Applicant #1 ID: ___________DL___________SID_________PP
___________OTHER(Type:_______________)
Applicant #2 ID: ___________DL___________SID_________PP
___________OTHER(Type:_______________)
MAIL LICENSE/CERTIFIED COPY TO:
Applicant #1 Address
Applicant #2 Address
Other Name (c/o):
____________________________________
Address:_________________________________
City/St/Zip:
_____________________________
