La. Stat. tit. 9 § 223
Application for Marriage __________________(Parish), State of Louisiana Date of Application: Hour of Application: | ||||
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[] No If 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 | ||||
La. R.S. § 9:223