Application for Marriage Certificate - Washington State
Washington State
CERTIFICATE OF MARRIAGE
COUNTY OF LICENSE:
DATE VALID
| |
NOT VALID AFTER
| |
Marriage ceremony must be performed in the State of Washington.
Please type or print clearly in permanent black ink. State File Number
COUNTY AUDITOR
COUNTY AUDITOR’S SIGNATURE
X
DATE RECEIVED (MM|DD|YYYY)
| |
PERSON A CHECK ONE BRIDE GROOM SPOUSE
PERSON B CHECK ONE BRIDE GROOM SPOUSE
LEGAL NAME BEFORE MARRIAGE (FIRST/MIDDLE/LAST)
LEGAL NAME BEFORE MARRIAGE (FIRST/MIDDLE/LAST)
BIRTH NAME (IF DIFFERENT)
MALE FEMALE
BIRTH NAME (IF DIFFERENT)
MALE FEMALE
CURRENT RESIDENCE – STREET, CITY/TOWN
CURRENT RESIDENCE – STREET, CITY/TOWN
COUNTY OF RESIDENCE
STATE OF RESIDENCE
COUNTY OF RESIDENCE
STATE OF RESIDENCE
DATE OF BIRTH (MM|DD|YYYY)
| |
BIRTH STATE (IF NOT USA, PROVIDE
COUNTRY)
DATE OF BIRTH (MM|DD|YYYY)
| |
BIRTH STATE (IF NOT USA, PROVIDE
COUNTRY)
MOTHER/PARENT BIRTH NAME
MOTHER/PARENT BIRTH NAME
FATHER/PARENT BIRTH NAME
FATHER/PARENT BIRTH NAME
MOTHER/PARENT BIRTH STATE (OR
COUNTRY)
FATHER/PARENT BIRTH STATE (OR
COUNTRY)
MOTHER/PARENT BIRTH STATE (OR
COUNTRY)
FATHER/PARENT BIRTH STATE (OR
COUNTRY)
OFFICIANT
I certify that the undersigned, by authority of license issued by the County noted above, did on this day join in lawful wedlock with
their mutual consent in the presence of witnesses. In testimony whereof, witness our signatures:
DATE OF MARRIAGE (MM|DD|YYYY)
| |
COUNTY OF CEREMONY
TYPE OF CEREMONY (CHECK ONE)
RELIGIOUS CIVIL
DATE SIGNED (MM|DD|YYYY)
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OFFICIANT’S ADDRESS (STREET, CITY, STATE AND ZIP CODE) PLEASE PRINT
OFFICIANT’S DAYTIME PHONE
OFFICIANT’S NAME (PRINT)
OFFICIANT’S SIGNATURE
X
WITNESS SIGNATURE
X
WITNESS SIGNATURE
X
PERSON A SIGNATURE
X
DATE SIGNED (MM|DD|YYYY)
| |
PERSON B SIGNATURE
X
DATE SIGNED (MM|DD|YYYY)
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DOH/CHS 005 (REV 12/2012) FORM VALID ON DECEMBER 6, 2012
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