North Carolina General Statutes Chapter 51. Marriage § 51-8.2. Issuance of marriage license when applicant is unable to appear

____________________, [applicant] appearing before the undersigned notary and being duly sworn, says that:

1. I, ____________________, [applicant's name] am applying for a license in _______________ County, North Carolina, to marry ____________________ [name of other applicant] in North Carolina within the next 60 days and I am authorized under G.S. 51-8.2 to complete this Affidavit in Lieu of Personal Appearance for Marriage License Application.

I attach: (1) documentation that I am over 18 years of age as required in county of issuance; and (2) documentation of divorce as required by county of issuance.

2. I submit the following information in applying for a marriage license:

Name: _______________________________________________________________________________________

First

Middle

Last

Residence: __________________________________________________________________________________

State

County

City or Town

______________________________________________________________________________________________

Street and Number

Inside City Limits (Yes or No)

Birthplace: __________________________ Birth Date: __________ Age: __________________________________________________________

             County & State or Country

Birth Date: __________ Age: _________________________________________________________________________

Father: _____________________________________________________________________________________

Name

State of Birth

Address (if living) or Deceased

Mother: _____________________________________________________________________________________

Name

State of Birth

Address (if living) or Deceased

Race (Optional): _______________ Number of this marriage: ________________________________________________

Last Marriage Ended by: ________________________ Date Marriage Ended: _____________________________________________

Death, Divorce, Annulment

Specify Highest Grade Completed in School (Optional):

Social Security # _________________________ (If applicant does not have Social Security number, attach affidavit of ineligibility)

I hereby make application to the Register of Deeds for a Marriage License and solemnly swear that all of the statements contained in the above application are true and I further make oath that there is no legal impediment to such marriage.

_______________________________________________

Signature of Applicant

Sworn to (or affirmed) and subscribed before me this __________ day of _______________, ___.

_______________________________________________

[Seal]

Notary Public

_______________________________________________

My commission expires: ________________________

[Notary's typed or printed name].