STATE OF COLORADO APPLICATION FOR CIVIL UNION LICENSE County of ________________________ License # _____________
PARTY ONE:
Legal Name: ___________________________________________________________________________________________
First
Middle Name
Last
Suffix
Address: ______________________________________________________________________________________________
Number/Street
City
State/ Zip
Birth Date: ___ ___ _____ Gender (check one): Male
Female
Last name at birth if different (opt): ________________
Social Security Number: ____ ___ _____ City & State of Birth: ___________________________________________________
Parent/Legal Guardian: ______________________________________________ City & State:__________________________
First
Middle Name
Last
Parent/Legal Guardian: ______________________________________________ City & State:_________________________
First
Middle Name
Last
Present Marital/Union Status
Single
Widowed
Divorced/Dissolved
Married
Civil Union
(check one):
If Divorced/Dissolved/Widowed Date: ___ ___ _____ City & State: ___________________________ Type of Court: _________
Previous spouse/partner name: ______________________________________________________________
Proof of Age:
Valid Drivers License
Passport
Birth Certificate
Other
___________________
(check one)
(specify)
______________________________________________________________________________________________________
PARTY TWO:
Legal Name:____________________________________________________________________________________________
First
Middle Name
Last
Suffix
Address: ______________________________________________________________________________________________
Number/Street
City
State / Zip
Birth Date: ___ ___ _____ Gender (check one): Male
Female
Last name at birth if different (opt): _________________
Social Security Number: ____ ___ _____ City & State of Birth: ___________________________________________________
Parent/Legal Guardian: ______________________________________________ City & State: __________________________
First
Middle Name
Last
Parent/Legal Guardian: ______________________________________________ City & State: __________________________
First
Middle Name
Last
Present Marital/Union Status
Single
Widowed
Divorced/Dissolved
Married
Civil Union
(check one):
If Divorced/Dissolved/Widowed Date: ___ ___ _____ City & State: __________________________ Type of Court: __________
Previous spouse/partner name:____________________________________________________________________
Proof of Age:
Valid Drivers License
Passport
Birth Certificate
Other
_________________
(check one)
(specify)
_______________________________________________________________________________________________________
Are the applicants related by blood? Yes
No
If “yes”, how? ___________________________________________
OATH:
We the undersigned hereby make application for a license to unite in civil union and under oath we state that the information given is true and correct to the best of our knowledge, that
neither applicant is under legal guardianship and believe that there exists no legal reason why we should not be joined in civil union.
PARTY ONE Signature: _______________________________ PARTY TWO Signature: ____________________________________
Subscribed and affirmed, or sworn to, before me this ___ day of _________, 20___at _____ __m.
_______________________________
By: __________________________________
(seal)
County Clerk and Recorder
Deputy County Clerk
Type of Ceremony (check one): Religious
Civil
Self
Date of Ceremony: _______________________
Return Mail Address: ________________________________________________ Registration Info ___________________
Form CU1, Approved by the Office of the State Registrar of Vital Statistics, Revised 05/2013