Application For Marriage License - Jefferson Parish Clerk Of Court
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1Application for Marriage License
Date of
State of Louisiana
License Number
Application
Jefferson Parish Clerk of Court
Time of
Application
Check if consanguineous or adoptive relationship
PARTY A
Sex:
Male
Female
Last Name
Suffix
First Name
Middle Name
Last Name Before First Marriage (if different than current legal last name)
Residence Address
City
Parish/County
State
ZIP
Race
Date of Birth
Place of Birth (city, state, country)
Mother/Parent's Name (before first marriage)
Mother/Parent's Birthplace (city, state, country)
Father/Parent's Name (before first marriage)
Father/Parent's Birthplace (city, state, country)
PARTY B
Male
Female
Sex:
Last Name
Suffix
First Name
Middle Name
Last Name Before First Marriage (if different than current legal last name)
Residence Address
City
Parish/County
State
ZIP
Race
Date of Birth
Place of Birth (city, state, country)
Mother/Parent's Name (before first marriage)
Mother/Parent's Birthplace (city, state, country)
Father/Parent's Name (before first marriage)
Father/Parent's Birthplace (city, state, country)
YES
NO
Is this a Covenant Marriage?
(If YES, complete below):
We, ___________________________________ and ______________________________ do hereby declare our intent to contract a
Covenant Marriage and, accordingly, have executed a declaration of intent attached hereto.
Formerly Married?
Number of Previous Marriages?
Currently Divorced?
Date Last Marriage Ended (mm/dd/yy)
Yes
No
Yes
No
Party A
Highest Education Completed:
Reason Last Marriage Ended
Divorce
Death
Annulment
Formerly Married?
Number of Previous Marriages?
Currently Divorced?
)
Date Last Marriage Ended (mm/dd/yy
Yes
No
Yes
No
Party B
Highest Education Completed:
Reason Last Marriage Ended
Divorce
Death
Annulment
I ______________________________________ (print name of groom/bride/spouse) do swear or affirm that the information contained in this application for marriage is true and
correct. I further swear or affirm that this is my ______ (1st, 2nd, etc. number) marriage but that I am not currently married to anyone else, and that I am free to marry under the laws of
the State of Louisiana. I further understand and acknowledge that giving any false information or false statement in this application for marriage shall constitute the crime of filing a
false public record in violation of the Louisiana Criminal Code (R.S. 14:133).
Signature of Party A ______________________________________________
Sworn to and subscribed before me this _________ day of ____________________, 20_____.
Signature of Notary Public or Deputy Clerk of Court __________________________________ Notary ID ________________
I ______________________________________ (print name of groom/bride/spouse) do swear or affirm that the information contained in this application for marriage is true and
correct. I further swear or affirm that this is my ______ (1st, 2nd, etc. number) marriage but that I am not currently married to anyone else, and that I am free to marry under the laws of
the State of Louisiana. I further understand and acknowledge that giving any false information or false statement in this application for marriage shall constitute the crime of filing a
false public record in violation of the Louisiana Criminal Code (R.S. 14:133).
Signature of Party B ______________________________________________
Sworn to and subscribed before me this _________ day of ____________________, 20_____.
Signature of Notary Public or Deputy Clerk of Court __________________________________ Notary ID ________________
Social Security Number
Keep Confidential?
Phone Number
Party A
Yes
No
Social Security Number
Phone Number
Keep Confidential?
Party B
Yes
No
Mailing Address AFTER Marriage:
Rev 04/16JP
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Parent category: Legal