TO: CLERK OF MONTGOMERY COUNTY CIRCUIT COURT
50 Maryland Ave, Rockville, Maryland 20850
SUBJECT: REQUEST FOR CORRECTION OF MARRIAGE LICENSE
DATE:
I, the undersigned, hereby request that the Clerk of the Circuit Court for Montgomery County,
Maryland, correct the following marriage license, to which I am a party:
Marriage License Number:
Date License issued:
Parties' full names as shown on record:
The reason for this request is that the following item of information on the marriage record is incorrect:
Data item(s): Name of a Party
Birth date and/or Age of:
Other:
Information as currently shown:
Correct information:
After correcting the record, please send certified copy(s) of the corrected record to me.
I am enclosing a check or money order, payable to Clerk of Circuit Court, in the amount of $5.50 for
each certified copy requested.
I hereby certify, under penalties of perjury, that the information given above is true and correct to the
best of my knowledge, information, and belief.
Requestor’s Signature
Requestor’s Name Printed
Requestor’s Current Mailing Address
Requestor’s Current Daytime Phone:
