EmailMe Form - APPLICATION FOR MARRIAGE LICENSE IN AMHERST NY

BRIDE/GROOM INFORMATION

Who is performing ceremony *

Date of Marriage? *

MM / DD / YYYY

Spouse-A or Spouse-B *

Spouse-A

Spouse-B

FIRST NAME *

MIDDLE NAME

CURRENT LAST NAME *

BIRTH NAME (IF DIFFERENT)

LAST NAME WHEN MARRIED *

SOCIAL SECURITY# *

RESIDENCE

Phone *

### - ### - ####

Email *

ADDRESS *

Street Address City State / Province / Region Postal / Zip Code

COUNTY *

AGE

DATE OF BIRTH *

MM / DD / YYYY

GENDER (OPTIONAL)

Male

Female

Rather not say

OCCUPATION

TYPE OF INDUSTRY *

TITLE/POSITION *

ACTIVE MILITARY *

YES

NO

FAMILY HISTORY

BIRTH PLACE: CITY/STATE/COUNTRY *

FATHER'S NAME/BIRTH COUNTRY *

MOTHER'S FULL MAIDEN NAME/BIRTH COUNTRY *

IS THIS YOUR FIRST MARRIAGE

IS THIS YOUR FIRST MARRIAGE *

YES

NO

IF YES: SKIP PAGE 2

**IF NO:

NUMBER OF PREVIOUS MARRIAGES (PLEASE FILL PAGE 2 OF APPLICATION)

NUMBER ENDING IN DIVORCE

NUMBER ENDING IN LEGAL ANNULMENT

NUMBER ENDING IN DEATH

HOW DID LAST MARRIAGE END

DIVORCE

ANNULMENT

DEATH

LAST MARRIAGE ENDED (GRANTED DATE)

MM / DD / YYYY

ARE ANY FORMER SPOUSES LIVING

YES

NO

**PLEASE ENTER PREVIOUS MARRIAGE INFORMATION ON NEXT PAGE

1 / 2