Application For License To Perform Marriages - Lincoln County
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1Office of the County Clerk
In and for the County of Lincoln County
State of Nevada
In the Matter of the Application of
)
)
________________________________________)
)
for a Certificate of Permission to
)
Perform Marriages
)
Application
The undersigned, a duly licensed or ordained minister, in good standing within his denomination, whose denomination or
church is duly incorporated or organized or established in the State of Nevada, as of the ____________ day of
________________________________, 20_______, respectfully submits the following:
1. I reside in the County of Lincoln, State of Nevada, at ______________________________________________________________________
and my SS# is ________________________________________________________________________________________________________
2. The date of my licensure or ordination was ______________________________________________________________________________
3. The name of the denomination or church with which I am affiliated is _______________________________________________________
________________________ and is located at ______________________________________________________________________________
4. Attached hereto and made a part of this Application are two copies of my denominational standing in support of the above
statements.
5. Is your ministry primarily one of service to your congregation or denomination? _____________________________________________
a) If retired, did you have active charge of a congregation within the State of Nevada for a period of at least three (3) years?
___________________ (Details should be included in attached denominational standing.)
b) If applying for temporary replacement, how long is the temporary period? _________________ (Authorization for
replacement must be attached hereto.)
6. Have you ever been convicted of a felony or any crime of which moral turpitude is an element? ________________________________
a) Are your fingerprints on file in the Lincoln County Sheriff’s Office? _________________________
7. Have you ever had a Certificate of Permission to Perform Marriages cancelled for having knowingly violated the law? (If answer to
6 or 7 is “yes”, explain on a separate sheet.) _________________________
STATE OF NEVADA
COUNTY OF LINCOLN
____________________________________________________, being first duly sworn, deposes and says: I have read the foregoing
Application and know the contents thereof; that the same are true of my own knowledge, except as to those matters alleged on
information and belief and as to them, I believe them to be true.
________________________________________
Signature of Applicant
Subscribed and sworn before me
this _________ day of ___________________20___.
____________________________________________
County Clerk
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