Provide details about the clerk with whom the marriage will take place (in the Commonwealth of Massachusetts)
Applicant A
Applicant B
Ceremony
No/Não
Yes/Si/Sim
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
- Territories -
AS
GU
MP
PR
UM
VI
- Armed Forces -
AA
AP
AE
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
No/Não
Yes/Si/Sim
Widowed/Viudo/Viúvo
Divorced/Divorciado
Void or annulled by court order/Nulo o anulado por orden judicial/Nulo ou anulado por ordem judicial
Void, under former GL c.207/§11 or by operation of law at time of marriage If void, see reverse for required evidence/Nulo, bajo la antigua GL c.207/§11 o por operación de la ley en el momento del matrimonio Si es nulo, consulte el reverso para obtener la evidencia requerida
Domestic Partner/Conyuge Domestico/Parceiro Doméstico
Civil Union/Conyuge Civil/União civil
None/Ninguno/Nenhum
No/Não
Yes/Si/Sim
No/Não
Yes/Si/Sim
No/Não
Yes/Si/Sim
Email
City/Town (Place of Birth)
Name of Most Recent Civil Union Partner
City/Town
Name of Most Recent Spouse
Have you been married before?
Are you related to Applicant B?
Father's Last Name at their Date of Birth
Residency Street Address
Phone #
SSN #
State
ZIP
# of times ever Married
Father's Last Name at PARTY A Date of Birth
Declaration of Applicant A
Father's First Name
Current Name (First, Middle, Last)
Are You Member of?
Is there any reason why you would be prohibited from marrying in Massachusetts due the laws of another state or jurisdiction?
If so, mention (State/Country)
Country
State
# of times ever in a Civil Union
Date of Birth
Status of Last Marriage?
If so, Dissolved?
If "Yes," how?
Surname to be used after marriage
is SSN issued?
Mother's Last Name at their Date of Birth
Mother's First Name
Country
Applicants MUST provide their social security numbers. Social Security Numbers shall be kept confidential and may only be released for child support purposes and this document shall not be considered a public record. Giving false information constitutes perjury.
Age
Occupation
Mother's Last Name at PARTY A Date of Birth
If not issued, indicate the reason
Pay Now
Pay Later
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
- Territories -
AS
GU
MP
PR
UM
VI
- Armed Forces -
AA
AP
AE
Pay Now/Pagar ahora/Pague agora
Pay Later/Paga después/Pague depois
Provide a mailing address and phone number where either applicant can be reached after the ceremony
I have reviewed a list of impediments to marriage and hereby state that there is an absence of any legal impediment to this marriage and do hereby depose and say that all of the statement as set forth in the above notice whereof I could have knowledge are true and are made under the penalties of perjury (M.G.L c.4 §6, Rule 6 General Laws).
Amount Due:
Marriage License
Fee
License Fee
$25
Mailing Address
Attachments
Certification
The applicants named in this application must appear before the Registrar
TOGETHER
, unless previously authorized by the Registrar, or in the event of an emergency.
Note that this application CANNOT be mailed to the Registrar's Office.
When presenting yourselves to the Registrar you must bring the following items with you:
A copy of the prepared application that will be emailed to you after you "Submit" below.
Your Social Security Number (will be kept confidential)
Application Fee of $25.00 in case of not paying while submitting the application
City
Next Steps
Payment Method
Correspondence
State
ZIP
Fees
Phone #