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Duplicate Marriage License Request Form
NOTE:
*
field type richtext
Once the form is submitted you will get a reply of how to pay by credit card. Please do NOT include credit card information in the form as we can not process your card online from our office.
Bride/Groom's First Name
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Bride/Groom's Last Name
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Bride/Groom's First Name
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Bride/Groom's Last Name (When applied)
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Name of Person Requesting
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Wedding Year
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Address Line 1
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Address Line 2
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
City
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
State
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Zip Code
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Email Address
*
field type email
Phone Number
*
field type single line
Ex: 717-555-1212
Input blocked. Maximum character limit of 4000 characters reached.
Number of Copies
*
field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Delivery Method
*
field type drop-down
Mail
Pick Up
Comments
field type multi line
Spam capture please leave empty
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