REQ
UIRED PREMARITAL STATEMENT
Florida Statute §741.04
We, the undersigned hereby state: Trans#
Printed Name of Spouse 1 Printed Name of Spouse 2
(Che
ck the appropriate statements)
1. I, Spouse 1, have completed a premarital preparation course.
I, Spouse 2, have completed a premarital preparation course.
We, Spouse 1 and Spouse 2 together, have completed a premarital preparation course.
We, Spouse 1 and Spouse 2 together, have not completed a premarital preparation course.
2. We have both obtained and read or otherwise accessed the information contained in the handbook or other electronic media
presentation of the rights and responsibilities of parties to a marriage specified in s. 741.0306, Florida Statutes.
3.
We, Spouse 1 and Spouse 2 together, are are not the parents of a minor child(ren) born is the State of Florida.
4. Spouse 1 Social Security Number Spouse 1 Current Age
5. Spouse 2 Social Security Number Spouse 2 Current Age
All of
the following information is required for questions regarding your marriage license and for mailing a certified copy of the
marriage license:
Name:
Mailing Address:
City, State, and Zip Code:
Phone Number:
Signature of Spouse 1 Signature of Spouse 2
Subscribed and sworn before me on .
Deputy Clerk
