State Of Maine Intentions Of Marriage - Department Of Health And Human Services
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State of Maine Intentions of Marriage
Reset Form
Department of Health and Human Services
INSTRUCTIONS: Please type or clearly print with black ink. Complete every item carefully, sign the certification statement, and return an application
to the municipality in which at least one applicant resides. If neither applicant is a Maine resident, return the application to any municipality. The License
and Certificate of Marriage will be prepared from the information on this form. It is valid only for marriages performed in the State of Maine.
PARTY A
Bride
Groom
Spouse (check one)
1a. First Name
1b. Middle Name
1c. Maiden/Birth Surname
1d. Current Last Name
1e. Jr., etc.
(State or Foreign country)
2. Age Last Birthday
3. Date of Birth
4. Birthplace
5. Sex
6. Residence – State
(mm/dd/yyyy)
Female
Male
7. County
8. City or Town
9. Street and Number
(First, mi, last name)
(State or Foreign country)
(First, mi, maiden/birth last name)
10. Father/Parent Name
11. Birthplace
12. Mother/Parent Name
13. Birthplace
(State or Foreign
country)
PARTY B
Bride
Groom
Spouse (check one)
14a. First Name
14b. Middle Name
14c. Maiden/Birth Surname
14d. Current Last Name
14e. Jr., etc
.
17. Birthplace
(State or Foreign country)
15.
16. Date of Birth
Sex
19. Residence - State
Age Last Birthday
(mm/dd/yyyy)
18.
Female
Male
20. County
21. City or Town
22. Street and Number
(First, mi, last name)
(State or Foreign country)
(First, mi, maiden/birth last name)
23. Father/Parent Name
24. Birthplace
25. Mother/Parent Name
26. Birthplace
(State or Foreign
country)
MARITAL STATUS SECTION
Party A
Party B
27. Number of this Marriage
28. If Previously Married, Last Marriage Ended
29. Number of this Marriage
30. If Previously Married, Last Marriage Ended
First, Second, etc
First, Second, etc.
.
(Specify)
(Specify)
Death
Divorce
Annulment
Death
Divorce
Annulment
Date:
(mm/dd/yyyy)
Date:
(mm/dd/yyyy)
Name of former spouse:
Name of former spouse:
28a. Location/Name of Court:
30a. Location/Name of Court:
Is Party B currently registered with the State of Maine as a Domestic Partner?
Yes
No
Yes
No
Is Party A currently registered with the State of Maine as a Domestic Partner?
If ‘yes’, indicate year registered:
If ‘yes’ indicate year registered:
First cousins are required by law to obtain a certificate of genetic counseling by a physician. Are you first cousins?
Yes
No
I hereby certify that the information provided is correct to the best of my knowledge and belief and that I am free to marry under the laws of Maine.
(Signature of Party A)
(Signature of Party B)
Social Security No.:
Social Security No.:
Telephone Number:
Telephone Number:
Personally appeared before me the above named and made oath to the truth and foregoing statement:
(Signature of Notary Public/Municipal Clerk)
(Signature of Notary Public/Municipal Clerk)
My term expires:
My term expires:
State of
State of
County of
County of
Town/City of
Town/City of
at
Marriage is planned to take place on
Date (mm/dd/yyyy)
Officiant (if known) will be:
Title:
(Religious/civil)
Telephone # (Optional)
Officiant’s Address
(State)
(Street)
(City)
(Zip code)
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S:\vradminf\AMaster forms\intentions VS2A R02/2014
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