
MARRIAGE LICENSE PRE-APPLICATION
This box for office use only:
Application # Receipt # __________________________________
IMPORTANT NOTES
1) By Florida Law, a marriage license is valid for 60 days only. If your planned wedding date is more than 60 days
away, you must wait to apply for a license.
2) A Florida marriage license is valid only for marriages solemnized in Florida. If you’re planning to be married out of
state or in another country, you must contact that jurisdiction about obtaining a marriage license. THIS LICENSE
IS NOT VALID OUT OF STATE OR IN ANOTHER COUNTRY.
Date of Birth: _______ / ______ / ____________
MM DD YYYY
Birth Place: (State or Foreign Country)
Maiden Name, if different
Date of Birth: ______ / ______ / ____________
MM DD YYYY
Birth Place: (State or Foreign Country)
The statistical information below is required, will not appear on the marriage certificate and will not be recorded.
For Statistical Purposes Only
BUT IS REQUIRED
Race
☐ Black ☐ White ☐ Other
Race
☐ Black ☐ White ☐ Other
Date Last Marriage Ended
_____ / _____ / __________
MM DD YYYY
Date Last Marriage Ended
_____ / _____ / __________
MM DD YYYY
How Did Last Marriage End?
☐ Divorce ☐ Death ☐ Annulment
How Did Last Marriage End?
☐ Divorce ☐ Death ☐ Annulment
**Pursuant to the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996, each party is required to provide his or her social security number.
Disclosure of social security numbers shall be limited to the purpose of administration of the Title IV-D program for child support enforcement.
Family Law Statement
We, (groom name) __________________________________ and (bride name) ________________________________
attest that we: _____ have or _____ have not
_____ separately or _____ together
completed the Pre-Marital preparation course. We have also obtained and read the information contained in the handbook
of rights and responsibilities of marriage specified in Florida Statute 741.0306.
_________________________________________ ___________________________________________
Groom Signature Bride Signature
Sworn to and subscribed before me on _________________, 20_____. By: _______________________________,D.C.