EAST BATON ROUGE PARISH CLERK OF COURT
MARRIAGE APPLICATION WORKSHEET



   
Last Name:
 
Suffix
First Name:
 
Middle Name:
Last Name Before First Marriage (if different than current legal last name):
Residence Address:
 
City:  
Parish/County:  
5. State:   ZIP:  
Race:
 
Date of Birth
     (mm/dd/yyyy):
   
Place of Birth (City, State, Country)
     (If Not in U.S.A., Name Country):
 
Mother/Parent's Name (before first marrage):
 
Mother/Parent's Birthplace (City, State, Country):
 
Father/Parent's Name (before first marrage):
Father/Parent's Birthplace (City, State, Country):

    
Last Name:
 
Suffix:
First Name:
 
Middle Name:
Last Name Before First Marriage (if different than current legal last name):
Residence Address:  
City:  
Parish/County:   State:   ZIP:  
Race:
 
Date of Birth (mm/dd/yyyy):
 
Place of Birth (City, State, country)
 
Mother/Parent's Name (before first marrage):
 
Mother/Parent's Birthplace (City, State, Country):
 
Father/Parent's Name (before first marrage):
Father/Parent's Birthplace (City, State, Country):
COVENANT MARRIAGES
24A. Covenant Marriages:  

GROOM/APPLICATE 1
No. of This Marriage If Previously Married Date Education-Highest Grade Completed (Select One):
1st, 2nd, etc.(Specify):  
 
Last Marriage Ended by Death,
Divorce or Annulment (Specify):
(mm/dd/yyyy):
 
Elementary
0, 1, 2, 3, 4,... or 8 
High School
1, 2, 3 or 4
College
1, 2, 3, 4, or 5

BRIDE/APPLICATE 2
No. of This Marriage If Previously Married Date Education-Highest Grade Completed (Select One):
1st, 2nd, etc.(Specify):   Last Marriage Ended by Death,
Divorce or Annulment (Specify):
(mm/dd/yyyy):
 
Elementary
0, 1, 2, 3, 4,... or 8 
High School
1, 2, 3 or 4
College
1, 2, 3, 4, or 5

SSN
Groom/Applicant 1's Social Security Number (xxx-xx-xxxx):     Bride/Applicant 2's Social Security Number (xxx-xx-xxxx):    
Consanguineous or Adoptive Relationship (Are you related by birth or adoption? Specify; if no relationship type NONE:
 

INFORMATION REQUESTED BY CLERK
Daytime Phone Number for Groom/Applicant1 (Include Area Code): Daytime Phone Number for Bride/Applicant 2 (Include Area Code):
Address After Wedding
City:
State:
 
Zip:
 
Ceremony Date (If Known) (mm/dd/yyyy):