Sample Application
(Please
Type)
No._________
APPLICATION FOR MARRIAGE LICENSE
MALE
FEMALE Full
Name _____Andy Nathan Amazing______ ____ Dorie
Sweetness_ ___ SS
No. _______870-59-6592 _______ ______174-87-6269____________ Date
of Birth _July 9 1948 ____________ _____August
8 1959____________ Place
of Birth ___Hartford Conn. ______ ____Raleigh
NC________________ Nationality
____American_________________ ____American___________________ Usual
Residence __New York NY____________ _____New York
NY__________________ Parents: Present Name
__Mary Louise Amazing ___Betty Lou
Sweetness____________ Maiden Name ___Mary
Louise Smith__ ____Betty Lou
Jones_______________ Place of Birth
Stamford Conn._(mothers) ____Cary
NC_______________________ Related
to other Applicant? __no_________ _______no____________________ In
what degree? _____n/a__________________ ______n/a
____________________ Signature
____sign your name_____________ _______sign your
name___________ _ THE
COURT, HAVING REVIEWED THIS APPLICATION DETERMINES THAT SPECIAL CIRCUMSTANCES
EXIST TO ISSUE A LICENSE WITHOUT THE POSTING REQUIRED BY TITLE 16 SECTION
38 OF THE VIRGIN ISLANDS CODE. ______________________________________________ ______________________________________________ Subscribed
and sworn to by each of the above parties this
_________ day of _________, ____ License
issued this __________ day of __________, ____ Filed
this __________ day of __________, ____
Clerk
of the Territorial Court
By ________________________
Deputy Clerk |