Louisiana Revised Statutes Tit. 9, § 223. Form

Application for Marriage

(Parish), State of Louisiana

Date of Application:

Hour of Application:

GROOM

First Name of Groom

Address

Is residence inside city limits?

Parish/County

State

☐ Yes

☐ No

Race

Date of Birth (month-day-year)

State of Birth

Father's Name

State of Birth

Mother's Maiden Name

State of Birth

BRIDE

First Name of Bride

Address

Is residence inside city limits?

Parish/County

State

☐ Yes

☐ No

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 ☐ 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?

Are you divorced ?

How many times?

Bride

Has the bride been formerly married?

Are you divorced ?

How many times?

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 (1, 2, 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 (1, 2, 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