Virginia Marriage certificate application form

SPOUSE 1 NAME AND INFORMATION

SPOUSE FIRST NAME

SPOUSE MIDDLE NAME

SPOUSE LAST NAME AT TIME OF THE EVENT (BEFORE MARRIAGE)

SUFFIX

HAS SPOUSE CHANGED HER/HIS LAST NAME BEFORE OR AFTER THE EVENT?

Yes

SPOUSE DATE OF BIRTH

GENDER

Male

Female

SPOUSE 2 NAME AND INFORMATION

SPOUSE FIRST NAME

SPOUSE MIDDLE NAME

SPOUSE LAST NAME AT TIME OF THE EVENT (BEFORE MARRIAGE)

SUFFIX

HAS SPOUSE CHANGED HER/HIS LAST NAME BEFORE OR AFTER THE EVENT?

Yes

SPOUSE DATE OF BIRTH

GENDER

Male

Female

YOUR NAME AND CONTACT INFORMATION

Please enter your name and contact information here.

FIRST NAME

MIDDLE NAME

LAST NAME

PHONE NUMBER

EMAIL ADDRESS

CONFIRM EMAIL ADDRESS

RELATIONSHIP TO THE PERSON ON RECORD

WHAT IS YOUR RELATIONSHIP WITH THE PERSON ON THE CERTIFICATE?

WHY ARE YOU APPLYING FOR A MARRIAGE CERTIFICATE?

ADDRESS WHERE YOU WOULD LIKE THE MARRIAGE CERTIFICATE TO BE DELIVERED

STREET

APT, SUITE, FLOOR, ETC.

CITY

STATE

ZIP CODE

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MARRIAGE INFORMATION

SPOUSE 1 NAME AND INFORMATION

SPOUSE 2 NAME AND INFORMATION

YOUR NAME AND CONTACT INFORMATION

RELATIONSHIP TO THE PERSON ON RECORD

ADDRESS WHERE YOU WOULD LIKE THE MARRIAGE CERTIFICATE TO BE DELIVERED