Marriage Application - Escambia County Clerk
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1MARRIAGE APPLICATION - STATE OF FLORIDA ONLY
APPLICANT 1
APPLICANT 2
(Please print)
(Please print)
________________________________________
________________________________________
First name
Middle name
Last name
First name
Middle name
Last name
): G Male
G Female
): G Male
G Female
Sex (
Sex (
Check one
Check one
): G American Indian GAsian
): G American Indian G Asian
Race (
Race (
Check one
Check one
G Black G Hispanic G White G Other
G Black G Hispanic G White G Other
Social Security No.:|__|__|__| - |__|__| - |__|__|__|__|
Social Security No.:|__|__|__| - |__|__| - |__|__|__|__|
Date of Birth: |__|__| / |__|__| / |__|__|__|__|
Date of Birth: |__|__| / |__|__| / |__|__|__|__|
Month
Day
Year
Month
Day
Year
If you are NOT at least 18 years of age, please notify the Clerk
County of Residence: ______________________
County of Residence: __________________________
City of Residence: _________________________
City of Residence: _____________________________
State of Residence: ________________________
State of Residence: ____________________________
Birthplace: _______________________________
Birthplace: ___________________________________
(State or Foreign Country)
(State or Foreign Country)
Birth Last Name: __________________________
Birth Last Name:______________________________
Previous Marriage Information:
Previous Marriage Information:
G Yes G No
G Yes G No
Is this your first marriage?
Is this your first marriage?
If No, this will be number G 2 G 3 G 4 G 5 G 6
If No, this will be number G 2 G 3 G 4 G 5 G 6
If No, last marriage ended by:
If No, last marriage ended by
G Death G Divorce G Annulment
G Death G Divorce G Annulment
Date last marriage ended |__|__| / |__|__| / |__|__|__|__|
Date last marriage ended |__|__| / |__|__| / |__|__|__|__|
Month
Day
Year
Month
Day
Year
Have you G together or G separately completed a premarital preparation course? G Yes G No
When do you plan to be married? |__|__| / |__|__| / |__|__|__|__|
Month
Day
Year
Are you the parents of a child(ren) in common, born in the State of Florida? G Yes G No
If Yes, please complete the “Affirmation of Common Children Born in Florida” form attached.
Contact Mailing Address:___________________________________________________________________
Contact Phone No: (|__|__|__|) |__|__|__| - |__|__|__|__|
Area Code
Telephone Number
We attest that we have obtained and read or otherwise accessed the information contained in the Family Law
Handbook, or other electronic media presentation of the rights and responsibilities of parties to a marriage
specified in F.S. 741.0306. We hereby acknowledge that this license must be used in the State of Florida
within the effective and expiration dates reflected on the license.
Applicant 1 Signature: __________________________ Applicant 2 Signature: _________________________
Signature Date: _____________________________
MARRIAGE_APPLICATION.DOC (01/02/2015)
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