Clerk of the Circuit Court & Comptroller • Circuit Civil • P.O. Box 4667 • West Palm Beach, Florida 33402-4667
Phone: 561.355.2986 • Fax: 561.355.4643
Marriage License Application
INSTRUCTIONS
Please provide the information requested below to assist us in processing your marriage license. Please be prepared
to present proper identification and the applicable marriage license fee. Payable by Cash, Check, MasterCard or
Visa. The Clerk can perform your ceremony here in the office on or after the effective date for a fee of $30.00.
GENERAL INFORMATION – SPOUSE
Last Name:
First Name:
Middle:
Maiden
Surname:
Date of Birth:
Mon / Day / Year
Social Security Number:
(Req. by Sec. 7.41.04 F.S., as
revised by Chapter 97-170)
Street Address:
City:
State:
Zip:
County:
Phone Number:
( )
Previously
Married:
Yes
No
Number of marriage(s):
(including this one)
Last Marriage Ended by:
Death
Divorce
Annulment
Last Marriage Ended on:
Mon / Day / Year
Race:
Birthplace:
(State or Country)
GENERAL INFORMATION – SPOUSE
Last Name:
First Name:
Middle:
Maiden
Surname:
Date of Birth:
Mon / Day / Year
Social Security Number:
(Req. by Sec. 7.41.04 F.S., as
revised by Chapter 97-170)
Street Address:
City:
State:
Zip:
County:
Phone Number:
( )
Previously
Married:
Yes
No
Number of marriage(s):
(including this one)
Last Marriage Ended by:
Death
Divorce
Annulment
Last Marriage Ended on:
Mon / Day / Year
Race:
Birthplace:
(State or Country)
