Affidavit In Lieu Of Personal Appearance For Marriage License Application Form

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Affidavit in Lieu of Personal Appearance for Marriage License Application
I, ________________________________________, appearing before the undersigned notary and being duly sworn, say that:
(Applicant’s Name)
1. I am applying for a marriage license in _________________________County, North Carolina, to marry
______________________________________________, in North Carolina within the next 60 days, and that I am
(Full Legal Name of Other Party to the Marriage)
authorized under North Carolina General Statute 51-8.2 to complete this Affidavit in Lieu of Personal Appearance for
Marriage License Application.
I attach the Original or Certified copy of:
a) Documentation that I am over 18 years of age as required by county of issuance
(Driver License, State ID or Passport)
b) If under the age of 21 the certified copy of my birth certificate
2. I submit the following information, as pertaining to me, in applying for a marriage license:
My Full Name: ______________________________________________________________________________
(First)
(Middle)
(Maiden)
(Last)
Residence:
______________________________________________________________________________
(Number & Street)
(City/Town)
(County)
(State)
Inside City Limits?  Yes  No
Birthplace:
____________________________________________ Race: _______________
(County & State or Country)
(optional)
Date of Birth: _________________
Age: ______
Social Security # ________-______-___________
(if applicant does not have social security number, attach affidavit of ineligibility)
Father’s Name: _____________________________________________ State or Country of Birth: ___________
(First)
(Middle)
(Last)
Address:
______________________________________________________________________________
(if living or write deceased)
(Number & Street)
(City/Town)
(County)
(State)
Mother’s Name: ____________________________________________ State or Country of Birth: ___________
(First)
(Middle)
(Maiden)
(Last)
Address:
______________________________________________________________________________
(if living or write deceased)
(Number & Street)
(City/Town)
(County)
(State)
What Number is This Marriage?
st
nd
____________
(1
, 2
, etc.)
Last marriage ended by:  Death  Divorce  Annulment
Date Marriage Ended: _________
(select one)
Education
(optional): Specify Highest Grade Completed: Elementary (1,2,3,4,…8) High School (1,2,3,4) College (1,2,3,4,5)
I hereby make application to the Register of Deeds for a Marriage License and solemnly swear/affirm that all of the statements
contained in the above application are true and I further make oath that there is no legal impediment to such marriage.
_____________________________________________________
(Signature of Applicant)
Notary Statement (required)
I certify that the person listed in the Attestation above personally appeared before me and signed this document in my presence on this day,
the __________
of ___________________
, 20 _____
(day)
(month)
(year)
(Official Signature of Notary) _____________________________________________
(Notary’s typed or printed name) ____________________________________
My Commission expires: _______________________________
Notary Seal Above
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Register of Deeds Use Only: _________________________________
(Signature of other applicant)

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