Marriage License System - Pre-Application Questionnaire

PLEASE ADVISE THE CLERK IF YOU ARE EXEMPT UNDER FLORIDA STATUTE 119.071
* Required Fields,   ** Only Required if Number of This Marriage is 2 or more.
   
Your correct legal name is required and must match your identification.
*First:   Middle: *Last:  
*City:   County: *State or Country:  
*Date of Birth:
   /    /     *State or Country of Birth:
  *Race:
 
(mm/dd/yyyy)
*Number of this Marriage:                                        *Has the Groom taken a Pre-Marital Class?  
** Date Last Marriage Ended:   /    /     (mm/dd/yyyy) **How did the Groom's Last Marriage End?