Fillable You will swear or affirm and sign the (Revize)

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You will swear or affirm and sign the (Revize)

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Information Sheet for Marriage License Application
You will swear or affirm and sign the application provided to you by the clerk.
You can shorten the application process by completing this form, printing it out and bringing it with you.
APPLICANT ONE INFORMATION:
Name
(First, Middle, Current Last Name, Suffix)
Maiden Name (if applicable)
Telephone Number:
Street Address:
City, State, Zip
Date of Birth:
Place of Birth
(city, county, state)
Social Security Number: Bring this with you
Answer True or False:
True
False
True
False
True
False
⦁ an ancestor or descendant, by blood or adoption;
⦁ a brother or sister, of the whole or half blood or by adoption;
⦁ a parent’s brother or sister, of the whole or half blood or by adoption;
⦁ a son or daughter of a brother or sister, of the whole or half blood or by adoption;
⦁ a current or former stepchild or stepparent; or
True
False
I wish to make a voluntary contribution of $5.00 to promote health early childhood by supporting the Texas Home Visitation
Program administered by the Office of Early Childhood Coordination of Health and Human Services. Tex. Family Code § 2.004(13).
APPLICANT TWO INFORMATION:
Name
(First, Middle, Current Last Name, Suffix)
Maiden Name (if applicable)
Telephone Number:
Street Address:
City, State, Zip
Date of Birth:
Place of Birth
(city, county, state)
Social Security Number: Bring this with you
Answer True or False:
True
False
True
False
True
False
⦁ an ancestor or descendant, by blood or adoption;
⦁ a brother or sister, of the whole or half blood or by adoption;
⦁ a parent’s brother or sister, of the whole or half blood or by adoption;
⦁ a son or daughter of a brother or sister, of the whole or half blood or by adoption;
⦁ a current or former stepchild or stepparent; or
True
False
I wish to make a voluntary contribution of $5.00 to promote health early childhood by supporting the Texas Home Visitation
Program administered by the Office of Early Childhood Coordination of Health and Human Services. Tex. Family Code § 2.004(13).
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You will swear or affirm and sign the (Revize)

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Completed 16 November 2021

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