Affidavit For Issuance Of Marriage License To One Party Hospitalized Applicant Form
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1
2Office of the County Clerk
Lynn Marie Goya
County Clerk
Commissioner of Civil Marriages
200 Lewis Avenue
Box 551604
Jim Pierce
Las Vegas, NV 89155-1604
Assistant County Clerk
702-671-0500 / 702-381-3611 Fax
AFFIDAVIT FOR ISSUANCE OF MARRIAGE LICENSE TO ONE PARTY
HOSPITALIZED APPLICANT
If either party is hospitalized within the boundaries of Clark County, an Affidavit for
Issuance of Marriage License to One Party is required.
A statement from the applicant’s physician is required, presented on the physician’s
letterhead, as to the applicant’s condition and expected recovery date. The statement
must be signed by the attending physician no more than 15 days prior to the
date the couple applies for a marriage license.
This statement must contain the reason why the applicant is unable to be present. The
statement must note that the applicant is alert, cognizant of the environment
and able to make his or her own decisions.
Upon approval from the County Clerk, a marriage license may be issued following
receipt of the completed and notarized Affidavit for Issuance of Marriage License to One
Party, Information for Marriage License form and approved photo identification.
Ex-Officio Clerk of:
Board of County Commissioners – Clark County Board of Equalization
Clark County Liquor and Gaming Board – Mt. Charleston Fire Protection District
Clark County Water Reclamation District Board of Trustees – Clark County Debt Management Commission
Clark County Redevelopment Agency – University Medical Center of Southern Nevada Board of Trustees
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