Full Text
APPLICATION ISSUING COUNTY: STATE FILE APPLICANT 1 1. FIRST NAME 2. MIDDLE NAME 3. LAST NAME PRIOR TO FIRST MARRIAGE 4. CURRENT LAST NAME 5. GENDER 6. LABEL FOR MARRIAGE CERTIFICATE 7. TELEPHONE NUMBER [ ] None [ ] Spouse [ ] Bride [ ] Groom 8. USUAL RESIDENCE ADDRESS 9. RESIDENCE CITY 10. ZIP CODE 11. COUNTY 12. STATE OR COUNTRY 13. CITY OF BIRTH 14. COUNTY OF BIRTH 15. BIRTH STATE OR COUNTRY 16. DATE OF BIRTH mm/dd/yy 17. AGE 18. SOCIAL SECURITY NUMBER 19. RACE White, Black, American Indian etc. Specify: 20. 1st, 2nd, 3rd #MARRIAGE? 21. LAST MARRIAGE DISSOLUTION BY: 22. DATE ENDED 23. EDUCATION Highest grade [ ] Divorce [ ] Annulment [ ] Death [ ] Unknown 0-12, 13-16 college, 17+ : 24. PARENT 1 BIRTH NAME 25. CITY OF BIRTH 26. COUNTY OF BIRTH 27. STATE/COUNTRY 28. PARENT 2 BIRTH NAME 29. CITY OF BIRTH 30. COUNTY OF BIRTH 31. STATE/COUNTRY APPLICANT 2 32. FIRST NAME 33. MIDDLE NAME 34. LAST NAME PRIOR TO FIRST MARRIAGE 35. CURRENT LAST NAME 36. GENDER 37. LABEL FOR MARRIAGE CERTIFICATE 38. TELEPHONE NUMBER [ ] None [ ] Spouse [ ] Bride [ ] Groom 39. USUAL RESIDENCE ADDRESS 40. RESIDENCE CITY 41. ZIP CODE 42. COUNTY 43. STATE OR COUNTRY 44. CITY OF BIRTH 45. COUNTY OF BIRTH 46. BIRTH STATE OR COUNTRY 47. DATE OF BIRTH mm/dd/yy 48. AGE 49. SOCIAL SECURITY NUMBER 50. RACE White, Black, American Indian etc. Specify: 51. 1st, 2nd, 3rd #MARRIAGE? 52. LAST MARRIAGE DISSOLUTION BY: 53. DATE ENDED 54. EDUCATION Highest grade [ ] Divorce [ ] Annulment [ ] Death [ ] Unknown 0-12, 13-16 college, 17+ : 55. PARENT 1 BIRTH NAME 56. CITY OF BIRTH 57. COUNTY OF BIRTH 58. STATE/COUNTRY 59. PARENT 2 BIRTH NAME 60. CITY OF BIRTH 61. COUNTY OF BIRTH 62. STATE/COUNTRY 63.PLANNED 63a. DATE 63b. CITY 63c. COUNTY 63d. OFFICIANT NAME 63e. OFFICIANT TITLE MARRIAGE: SIGNATURES WE each, desiring to procure a license to marry, do solemnly swear that we are unmarried and may lawfully contract and be joined in marriage; that we are not related to each other within, but not including, the fifth degree of consanguinity (generally means first cousins or closer) and that the above information is true, according to our best knowledge and belief: 64a. Applicant 1 64b. Applicant 2 Signature Signature Does applicant need to re-register to vote because of address or name change due to this marriage? Applicant 1 [ ] Yes [ ] No Applicant 2 [ ] Yes [ ] No CLERK USE 65. Clerk Name 66. Clerk Signature 67. Date: Application Void after 30 days ACTUAL MARRIAGE To be completed by the County Clerk or Officiant. 69. CITY OF MARRIAGE 70. COUNTY 71. STATE 72. NAME OF OFFICIANT 73. PHONE NUMBER 74. TITLE OF OFFICIANT 75. TYPE OF CEREMONY [ ] Religious [ ] Civil 76. OFFICIANT AFFILIATION: [ ] LDS [ ] CATHOLIC [ ] PROTESTANT [ ] JEWISH [ ] RELIGIOUS Other Specify: [ ] JUDGE [ ] JUSTICE OF THE PEACE [ ] COUNTY CLERK [ ] CIVIL Other Specify: CLERK USE 77. LOCAL OFFICAL MAKING RETURN TO STATE 78. DATE RECEIVED BY LOCAL OFFICIAL 79. DATE RECEIVED BY STATE OFFICIAL UDOH-OVRS-400 Oct 2019 IF UNDER 18, must submit Addendum IF UNDER 18, must submit Addendum APPLICATION FOR LICENSE TO MARRY 68. DATE ---PAGE BREAK--- COUNTY STATE FILE NUMBER APPLICANT 1 NAME: PARENT OR GUARDIAN I do solemnly swear that I have the following relationship with the applicant: [ ] Parent [ ] Divorced parent with legal custody [ ] Divorced parent with joint custody and physical custody the majority of time [ ] Legal Guardian - proof of guardianship provided by court order is required [ ] Written authorization for this individual to marry has been obtained from a judge or court commissioner I do hereby give my consent to this marriage. SIGNATURE: DATE: IF Applicant 2 is also a minor: APPLICANT 2 NAME: PARENT OR GUARDIAN I do solemnly swear that I have the following relationship with the applicant. [ ] Parent [ ] Divorced parent with legal custody [ ] Divorced parent with joint custody and physical custody the majority of time [ ] Legal Guardian - proof of guardianship provided by court order is required [ ] Written authorization for this individual to marry has been obtained from a judge or court commissioner I do hereby give my consent to this marriage. SIGNATURE: DATE: COUNTY CLERK Excerpts from Utah Code 30-1-9 Marriage by minors: For the purposes of this section, "minor' means an individual that is 16 or 17 years old. A license may not be issued without the signed consent of the minor's parent or guardian given in person to the clerk. The minor and parent or guardian of the minor shall obtain a written authorization to marry from: a judge of the court exercising juvenile jurisdiction in the county where either party to the marriage resides; or (ii) a court commissioner as permitted by rule of the Judicial Council. ADDENDUM TO APPLICATION FOR LICENSE TO MARRY A MINOR Minor = Individual who is 16 or 17 years old