Your Names(*)
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Phone Number(*)
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Email Address(*)
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Your Full Address (You must state that you live together at this address)
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Mailing Address (if different)
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City and County Where Your Ceremony Is Taking Place
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Date of Ceremony
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FIRST PERSONS INFORMATION
What do You Prefer to be Listed As
Bride Groom
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P1 First Name
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P1 Middle Name
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P1 Last Name
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P1 Last name at Birth (If Different)
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P1 Date of Birth (please use this format MM/DD/YYYY)
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P1 Place of Birth (enter first few letters of your State or Country of Birth)
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Unknown Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia-Herzegovina Botswana Brazil British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Island Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia-Montenegro Seychelles Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa South Georgia South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands Wallis and Futuna Islands Western Sahara Western Samoa Yemen Zambia Zimbabwe
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P1 Number of Previous Marriages
None 1 2 3 4 5 6 7 8 9
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P1 Last Marriage ended in (Select One)
N/A Divorce Annulment Death SRDP
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P1 Date Last Marriage Ended (MM/DD/YYYY)
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If your last marriage ended in the last 2 years you will need to show proof of dissolution
P1 Father's/Parent's Birth Name: First, Middle, and Last
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P1 Mother's/Parent's Birth Name: First, Middle, and Last (MAIDEN NAME)
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SECOND PERSONS INFORMATION
What do You Prefer to be Listed As
Bride Groom
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P2 First Name
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P2 Middle Name
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P2 Last Name
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P2 Last name at Birth (If Different)
Invalid Input
P2 Date of Birth MM/DD/YYYY
Invalid Input
P2 Place of Birth (enter first few letters of your State or Country of Birth)
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Unknown Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia-Herzegovina Botswana Brazil British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Island Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia-Montenegro Seychelles Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa South Georgia South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands Wallis and Futuna Islands Western Sahara Western Samoa Yemen Zambia Zimbabwe
Invalid Input
P2 Number of Previous Marriages
None 1 2 3 4 5 6 7 8 9
Invalid Input
P2 Last Marriage ended in (Select One)
N/A Divorce Annulment Death SRDP
Invalid Input
P2 Date Last Marriage Ended (MM/DD/YYYY)
Invalid Input
If your last marriage ended in the last 2 years you will need to show proof of dissolution
P2 Father's/Parent's Birth Name: First, Middle, and Last
Invalid Input
P2 Mother's/Parent's Birth Name: First, Middle, and Last (MAIDEN NAME)
Invalid Input
Would either of you like to change your Name? Here is your Chance.
First Persons New Middle Name
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First Persons New Last Name
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Second Persons Middle Name
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Second Persons New Last Name
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Appointment Information
Have you set an appointment for your license with us yet?
Yes - I have one set No - I would like to set one
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Where did you want it Issued?
Already booked for a Chapel Ceremony (included in Chapel/Terrace Package) At Our Long Beach Office (starting at $170) Delivered to Your Home or Office (starting at $240) Delivered to Your Wedding Ceremony (starting at $240)
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What Date, Time and Location did you want it issued?
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Would you like us to Perform your Ceremony too?
Yes - We would like you to do our ceremony No - We Already Have an Officiant Maybe - Tell me more
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Additional Information or Questions
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Please Double Check and Make Sure All Entries are Correct(*)
All Correct
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