§223. Form
A. An application for a marriage license shall be made on a form provided by
Subsection B of this Section.
B. The application form shall be as follows:
Application for Marriage
__________________(Parish), State of Louisiana
Date of Application:
Hour of Application:
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GROOM
|
Last Name
of Groom
|
First Name of
Groom
|
Middle/Second
Name of Groom
|
|
Address
|
Is residence inside
city limits?
☐ Yes ☐ No
|
Parish/County
|
State
|
Race
|
Date of Birth
(month-day-year)
|
State of Birth
|
Father's
Name
|
State of Birth
|
Mother's
Maiden Name
|
State of Birth
|
BRIDE
|
Last Name
of Bride
|
First Name of Bride
|
Middle/Second
Name of Bride
|
Maiden
Name of
Bride
|
Address
|
Is residence inside
city limits?
☐ Yes ☐ No
|
Parish/County
|
State
|
Race
|
Date of Birth
(month-day-year)
|
State of Birth
|
Father's
Name
|
State of Birth
|
Mother's
Maiden Name
|
State of Birth
|
Covenant
Marriage
|
Covenant Marriage☐ Yes☐ NoIf yes, complete the following:
We, ___________________________ and
_____________________________
do hereby declare our intent to contract a Covenant Marriage and,
accordingly, have executed a declaration of intent attached hereto.
|
Groom
|
Has the groom been formerly
married?_________
How many times?________
|
Are you divorced ________?
|
Bride
|
Has the bride been formerly
married?_________
How many times?________
|
Are you divorced ________?
|
SSN
|
Grooms's Social Security Number
|
Bride's Social Security Number
|
I ___________________________ (print name of groom) 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 of marriage shall constitute the crime of filing a false public record in
violation of the Louisiana Criminal Code (R.S. 14:133).
____________________________
Signature of Groom
Sworn to and subscribed before me this ________ day of
__________________, 20___.
___________________ Notary Public/Deputy Clerk/Deputy
Registrar
I ___________________________ (print name of bride) 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 of marriage shall constitute the crime of filing a false public record in
violation of the Louisiana Criminal Code (R.S. 14:133).
____________________________
Signature of Bride
Sworn to and subscribed before me this ________ day of
__________________, 20___.
___________________ Notary Public/Deputy Clerk/Deputy
Registrar
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Acts 1987, No. 886, §3, eff. Jan. 1, 1988; Acts 2015, No. 436, §1, eff. Jan. 1, 2016.