Commonwealth of Massachusetts
Out of State Non-Resident Clergy - Petition to Solemnize Marriage
TO: HIS HONOR, THE SECRETARY OF THE COMMONWEALTH
Pursuant to and in compliance with G.L. Chapter 207, §39, I hereby petition for authorization to solemnize a marriage within the
Commonwealth of Massachusetts as a:
PLEASE CHECK ONE
■ Non-resident minister of the Gospel. (including Catholic Priests)
■ Authorized representative of a Spiritual Assembly of the Baha’is
■ A commissioned cantor or duly ordained rabbi of the Jewish Faith.
■ Imam of the Orthodox Islamic religion.
■ Duly ordained priest or minister of the Buddhist religion.
■ Leader of an Ethical Culture Society which is recognized by the American Ethical Union and who is duly appointed and
in good and regular standing with the American Ethical Union.
■ Minister in fellowship with the Unitarian Universalist Association and ordained by a local church.
■ A justice of a court or a Justice of the Peace authorized to solemnize a marriage by virtue of their offi ce within their state of residence.
■ In a regular or special meeting for worship conducted by or under the oversight of a Friends or Quaker Monthly Meeting
in accordance with the usage of their Society.
■ Other: _______________________________________________________________________________________
PLEASE TYPE OR PRINT NEATLY
Solemnizer’s full name: ______________________________________________________________________________
Out of state residence: ________________________________________________________________________________
Street City/Town
__________________________________________________________________________________________________
State/Zip Day Phone Evening Phone
Party A’s full name: __________________________________________________________________________________
Residence: _________________________________________________________________________________________
Street City/Town
__________________________________________________________________________________________________
State/Zip Day Phone Evening Phone
Party B’s full name: __________________________________________________________________________________
Residence: _________________________________________________________________________________________
Street City/Town
__________________________________________________________________________________________________
State/Zip Day Phone Evening Phone
Date of marriage: ____________________________________________________________________________________
Location of marriage: _________________________________________________________________________________
I certify that the above information is a true statement made in compliancewith G.L. Chapter 207, §39, and under the penalties of perjury.
I understand that I am responsible to fi le the Solemnization Certifi cate (that I will receive as a result of this Petition) with the
appropriate City or Town clerk where the marriage license has been issued within ten (10) days of the date of the ceremony
under penalty of law.
Signature of Solemnizer: ______________________________________________ Date: ____________________________
Send or fax completed application to: William Francis Galvin, Secretary of the Commonwealth
Room 1719 - Commissions Section
One Ashburton Place
Boston, MA 02108
(FAX) 617-727-5914
Please allow 2 - 4 weeks for processing and return of solemnization certifi cate.
Please do not submit application more than six(6) weeks in advance.
