Form Vs2-A - State Of Maine Intentions Of Marriage
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3State of Maine Intentions of Marriage
Department of Health and Human Services
INSTRUCTIONS: Please type or clearly print with black ink. Complete every item carefully, sign the certification statement on page 2 and
return the completed intentions to the municipality in which at least one party resides. If neither applicant is a Maine resident, return the completed
intentions to any municipality.
○ Bride
○ Groom
○ Spouse
Party A (check one)
(
Please complete the Parental Consent Form if Party A is less than the age of 18.)
1. Current First Name
1a. Current Middle Name(s)
1b. Current Last Name
1c. Suffix (Jr., etc.)
2. Name Prior to First Marriage - First
2a. Middle Name(s)
2b. Last Name
2c. Suffix (Jr., etc.)
7. Sex: □ Male
3. Birthplace State
4. Birthplace Country
5. Date of Birth (mm/dd/yyyy)
6. Age
□ Female
8. Father/Parent Name Prior to First Marriage (First, Middle, Last Name, Suffix)
8a. Birthplace (State)
8b. Country
9. Mother/Parent Name Prior to First Marriage (First, Middle, Last Name, Suffix)
9a. Birthplace (State)
9b. Country
10. Party A Residence Street Address
10a. City/Town
10b. County
10c. State
10d. Country
10e. Zip Code
11. Party A Mailing Address (Street or PO) (Apt/Unit)
11a. City/Town
11b. State
11c. Country
11d. Zip Code
12. Party A Telephone Number (10 digits)
12a. Party A E-mail Address (If applicable)
13. Social Security Number *
14. Number of this Marriage:
15. If Previously Married, Last Marriage Ended
□ Death □ Divorce □ Annulment
(First, Second, etc.)
16. Date Last Marriage Ended (mm/dd/yyyy)
17. Name of Former Spouse (First, Middle, Last Name, Suffix)
18. Name of Court and/or Location Last Marriage Ended (City/State or Country)
19. Is Party A currently registered with the State
of Maine as a Domestic Partner? □ Yes □ No
○ Bride
○ Groom
○ Spouse
Party B (check one)
(
Please complete the Parental Consent Form if Party B is less than the age of 18.)
20. Current First Name
20a. Current Middle Name(s)
20b. Current Last Name
20c. Suffix (Jr., etc.)
21. Name Prior to First Marriage - First
21a. Middle Name(s)
21b. Last Name
21c. Suffix (Jr., etc.)
26. Sex: □ Male
22. Birthplace State
23. Birthplace Country
24. Date of Birth (mm/dd/yyyy)
25. Age
□ Female
27. Father/Parent Name Prior to First Marriage (First, Middle, Last Name, Suffix)
27a. Birthplace (State)
27b. Country
28. Mother/Parent Name Prior to First Marriage (First, Middle, Last Name, Suffix)
28a. Birthplace (State)
28b. Country
29. Party B Residence Street Address
29a. City/Town
29b. County
29c. State
29d. Country
29e. Zip Code
30. Party B Mailing Address (Street or PO) (Apt/Unit)
30a. City/Town
30b. State
30c. Country
30d. Zip Code
31. Party B Telephone Number (10 digits)
31a. Party B E-mail address (If applicable)
32. Social Security Number *
33. Number of this Marriage:
34. If Previously Married, Last Marriage Ended
□ Death □ Divorce
□ Annulment
(First, Second, etc.)
35. Date Last Marriage Ended (mm/dd/yyyy)
36. Name of Former Spouse (First, Middle, Last Name, Suffix)
37. Name of Court and/or Location Last Marriage Ended (City/State or Country)
38. Is Party B currently registered with the State of
Maine as a Domestic Partner? □ Yes □ No
Page 1 of 3
VS2-A 03/17
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