Probate Court Form No. 197a
Certificate of Marriage
STATE OF VERMONT PROBATE COURT
DISTRICT OF ________________
CERTIFICATE OF MARRIAGE
(Declaration of Intention and Marriage Certificate)
_________________________________ ________________________________
Full Name of Groom Full Name of Bride
_________________________________ ________________________________
Residence ( Street & Number ) Residence ( Street & Number )
_________________________________ _________________________________
Town State or County Town State or County
_________________________________ _________________________________
Place of Birth Place of Birth
_________________________________ _________________________________
Date of Birth Date of Birth
_________________________________ _________________________________
Father=s Full Name Father=s Full Name
_________________________________ _________________________________
Father=s Birthplace Father=s Birthplace
_________________________________ _________________________________
Mother=s Maiden Name Mother=s Maiden Name
_________________________________ _________________________________
Mother=s Birthplace Mother=s Birthplace
I hereby certify that the facts given within are true and correct to the best of my knowledge
and belief:
Signature of Bride and/ or Groom: _____________________________________
I hereby certify that the within named ________________________ this day applied for a certificate
of marriage, made oath to the truth of the facts stated in the foregoing declaration of intention of marriage and
have complied with the marriage laws of the State of Vermont. A true copy of the within license and
declaration of intention of marriage is duly filed in this office.
Date on which license was issued: _________________________________
Signature of Town or City Clerk: __________________________________
Town or City of : _______________________________________________
