2015 Louisiana Laws
Revised Statutes
TITLE 9 - Civil Code-Ancillaries
RS 9:223 - Form
§223. Form
A. An application for a marriage license shall be made on a form provided by Subsection B of this Section.
B. The application form shall be as follows:
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☐ NoIf 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 |
Acts 1987, No. 886, §3, eff. Jan. 1, 1988; Acts 2015, No. 436, §1, eff. Jan. 1, 2016.
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