Affidavit For License To Marry Template
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2AFFIDAVIT FOR LICENSE TO MARRY
No.
STATE OF MICHIGAN
County of
The Undersigned, being duly sworn, depose(s) and say(s) that:
and
FULL NAME (First, Middle, Last)
MALE
FEMALE
FULL NAME (First, Middle, Last)
MALE
FEMALE
SURNAME ON BIRTH CERTIFICATE, IF DIFFERENT
SURNAME ON BIRTH CERTIFICATE, IF DIFFERENT
PRESENT AGE
DATE OF BIRTH
PRESENT AGE
DATE OF BIRTH
BIRTHPLACE – CITY AND STATE
BIRTHPLACE – CITY AND STATE
RESIDENCE NO.
STREET
RESIDENCE NO.
STREET
CITY, STATE, AND ZIP CODE
CITY, STATE, AND ZIP CODE
RESIDENCE COUNTY
RESIDENCE COUNTY
TIMES PREVIOUSLY MARRIED
TIMES PREVIOUSLY MARRIED
FULL NAME (First, Middle,Last)
FULL NAME (First, Middle,Last)
SURNAME AT BIRTH
BIRTHPLACE
SURNAME AT BIRTH
BIRTHPLACE
FULL NAME (First, Middle, Last)
FULL NAME (First, Middle,Last)
SURNAME AT BIRTH
BIRTHPLACE
SURNAME AT BIRTH
BIRTHPLACE
intend to marry and that this affidavit is made for the purpose of obtaining a marriage license; that each of the above-named
persons is of
age required by law, is not related to the other within the degree prohibited by statu e and is of sufficient mental
capacity to contract marriage; that said persons are acquainted with the laws of the State of Michigan relative to marriage;
that there is no legal impediment to said marriage; and that to the best knowledge and belief of the undersigned all of the
foregoing statements are true.
Educational materials regarding prenatal care and the transmission and prevention of venereal disease and
HIV infection as well as information on the availability of tests for these diseases have been received.
Signature___________________________________________
Signature___________________________________________
Social Security Number
______________________________
Social Security Number
______________________________
Subscribed to before me:
the County Clerk:
a Notary Public of __________________________County,
acting in ______________________ County, and whose commission expires on ____________________, 20______;
or
other person authorized to administer oaths, and sworn to on __________________________, 20______.
Signature _______________________________________________
DCH-0484 (Rev. 07/2015) AUTHORITY: ACT 368, P.A. 1978
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