application for marriage license - Sibley County

application for marriage license - Sibley County

APPLICATION FOR MARRIAGE LICENSE STATE OF MINNESOTA, COUNTY OF SIBLEY NAME G R O O M ( FIRST ) DOCUMENT # (MI DDLE) SOCIAL SECURITY NO I CERTIFY ...

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APPLICATION FOR MARRIAGE LICENSE STATE OF MINNESOTA, COUNTY OF SIBLEY NAME

G R O O M

( FIRST )

DOCUMENT # (MI DDLE)

SOCIAL SECURITY NO

I CERTIFY THAT I DO NOT HAVE A SOCIAL SECURITY NUMBER Signature Required CITY STATE

ADDRESS ( NUMBER AND STREET ) AGE

BIRTHDATE

BIRTHPLACE ( STATE OR FOREIGN COUNTRY )

COUNTY

SEX

NO. OF PREVIOUS MARRIAGES

HOW LAST MARRIAGE TERMINATED

DATE TERMINATED

(DEATH, DIVORCE, ANNULMENT)

( MIDDLE )

**DOES THE GROOM HAVE A FELONY CONVICTION FOR A CRIME COMMITTED ON OR AFTER AUGUST 1, 2000 UNDER MINNESOTA LAW OR THE LAW OF ANOTHER STATE OR FEDERAL JURISDICTION:

NO

( FIRST )



BIRTHDATE

( LAST )

YES



IF YES, JURISDICTION

( LAST )

BIRTHPLACE ( STATE OR FOREIGN COUNTRY )

COUNTY

SEX

HOW LAST MARRIAGE TERMINATED

DATE TERMINATED

(DEATH, DIVORCE, ANNULMENT)

F

PLACE TERMINATED (COUNTY)

PREVIOUS MARRIED NAME ( FIRST )

( MIDDLE )

**DOES THE BRIDE HAVE A FELONY CONVICTION FOR A CRIME COMMITTED ON OR AFTER AUGUST 1, 2000 UNDER MINNESOTA LAW OR THE LAW OF ANOTHER STATE OR FEDERAL JURISDICTION:

NO



ZIP

RACE

M NO. OF PREVIOUS MARRIAGES

COURT (DISTRICT,CIRCUIT)

I CERTIFY THAT I DO NOT HAVE A SOCIAL SECURITY NUMBER Signature Required CITY STATE

ADDRESS (NUMBER AND STREET ) AGE

PLACE TERMINATED

( MIDDLE )

SOCIAL SECURITY NO

F

(COUNTY)

PREVIOUS MARRIED NAME ( FIRST )

ZIP

RACE

M

NAME

B R I D E

( LAST )

COURT (DISTRICT,CIRCUIT)

( LAST )

YES



IF YES, JURISDICTION

NAME: IF EITHER OF THE PARTIES IS UNDER 18 YEARS OF AGE, GIVE THE NAME AND ADDRESS OF HIS/HER CUSTODIAL PARENTS, GUARDIAN OR COURT. (MS 517.02) ARE THE PARTIES RELATED TO EACH OTHER BY BLOOD OR ADOPTION? YES

ADDRESS:

IF YES, WHAT IS THE RELATIONSHIP?

NO

GIVE THE NAMES THE PARTIES WILL HAVE AFTER MARRIAGE:

GROOM’S NAME ( FIRST )

( MIDDLE )

( LAST )

BRIDE’S NAME ( FIRST )

( MIDDLE )

( LAST )

ADDRESS ( NUMBER AND STREET ) ADDRESS THE PARTIES WILL HAVE AFTER MARRIAGE: (Will not appear on marriage certificate, but will be mailed to this address)

CITY

STATE

ZIP

STOP HERE – must take the oath in front of a Local registrar before signing. TENNESSEN WARNING FOR THE COLLECTION OF SOCIAL SECURITY NUMBERS: IF YOU HAVE A SOCIAL SECURITY NUMBER YOU ARE REQUIRED BY FEDERAL AND STATE LAW TO PUT IT ON THE MARRIAGE LICENSE APPLICATION (TITLE 42, US CODE SEC 666 (a) (13) (A) , MN STATUTES, SECTION 144.223, AND MN STATUTES, SEC 517.08 SUBD 1A (1997). YOUR SOCIAL SECURITY NUMBER IS REPORTED TO THE MN DEPARTMENT OF HEALTH AND WILL BE KEPT PRIVATE. IF NECESSARY YOUR SOCIAL SECURITY NUMBER MAY BE USED TO HELP OBTAIN FINANCIAL SUPPORT OF YOUR CHILD. NOTICE: A PARTY WHO HAS A FELONY CONVICTION FOR A CRIME COMMITTED ON OR AFTER AUGUST 1, 2000 UNDER MINNESOTA LAW OR THE LAW OF ANOTHER STATE OR FEDERAL JURISDICTION MAY NOT USE A DIFFERENT NAME AFTER MARRIAGE EXCEPT AS AUTHORIZED BY MINNESOTA STATUTE 259.13, AND DOING SO IS A GROSS MISDEMEANOR. I, THE UNDERSIGNED, HEREBY APPLY FOR A LICENSE TO MARRY AND DECLARE UPON OATH THAT ALL OF THE ABOVE ANSWERS AND STATEMENTS OF FACT ARE TRUE AND CORRECT; THAT NEITHER OF US HAS A SPOUSE LIVING; THAT NEITHER OF US IS A MENTALLY DEFICIENT PERSON COMMITTED TO THE GUARDIANSHIP OR CONSERVATORSHIP OF THE COMMISSIONER OF HUMAN SERVICES, AND THAT ONE OF THE APPLICANTS IS A MAN AND THE OTHER IS A WOMAN.

SIGNATURE(S) X _________________________________________________________ PHONE Number (

)_____________________________

SIGNATURE(S) X _________________________________________________________ PHONE Number (

)_____________________________

SUBSCRIBED AND SWORN to before me this

day of

KATHY DIETZ, SIBLEY COUNTY RECORDER

BY: _______________________________________________________, DEPUTY

OFFICE USE ONLY

`

DATE ISSUED:

ISSUED VIA: MAIL PICK UP

PAYMENT TYPE CASH CHECK

, 20

DATE OF MARRIAGE

PLACE OF MARRIAGE

CEREMONY TYPE: RELIGIOUS CIVIL