This text of Louisiana § 9:223 (Form) is published on Counsel Stack Legal Research, covering Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
§223. Form
A.An application for a marriage license shall be made on a form provided by
Subsection B of this Section.
B.The application form shall be as follows:
Date of Application:
Hour of Application:
GROOM
Last Name
of Groom
First Name of
Groom
Middle/Second
Name of Groom
Address
Is residence inside
city limits?
☐ Yes ☐ No
Parish/County
State
Race
Date of Birth
(month-day-year)
State of Birth
Father's
Name
State of Birth
Mother's
Maiden Name
State of Birth
BRIDE
Last Name
of Bride
First Name of Bride
Middle/Second
Name of Bride
Maiden
Name of
Bride
Address
Is residence inside
city limits?
☐ Yes ☐ No
Parish/County
State
Race
Date of Birth
(month-day-year)
State of Birth
Father's
Name
State of Birth
Mother's
Maiden Name
State of Birth
Covenant
Marriage
Covenant Marriage☐ Yes☐ NoIf yes,
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§223. Form
A. An application for a marriage license shall be made on a form provided by
Subsection B of this Section.
B. The application form shall be as follows:
Date of Application:
Hour of Application:
GROOM
Last Name
of Groom
First Name of
Groom
Middle/Second
Name of Groom
Address
Is residence inside
city limits?
☐ Yes ☐ No
Parish/County
State
Race
Date of Birth
(month-day-year)
State of Birth
Father's
Name
State of Birth
Mother's
Maiden Name
State of Birth
BRIDE
Last Name
of Bride
First Name of Bride
Middle/Second
Name of Bride
Maiden
Name of
Bride
Address
Is residence inside
city limits?
☐ Yes ☐ No
Parish/County
State
Race
Date of Birth
(month-day-year)
State of Birth
Father's
Name
State of Birth
Mother's
Maiden Name
State of Birth
Covenant
Marriage
Covenant Marriage☐ Yes☐ NoIf yes, complete the following:
We, ___________________________ and
_____________________________
do hereby declare our intent to contract a Covenant Marriage and,
accordingly, have executed a declaration of intent attached hereto.
Groom
Has the groom been formerly
married?_________
How many times?________
Are you divorced ________?
Bride
Has the bride been formerly
married?_________
How many times?________
Are you divorced ________?
SSN
Grooms's Social Security Number
Bride's Social Security Number
I ___________________________ (print name of groom) do swear or affirm
that the information contained in this application for marriage is true and
correct. I further swear or affirm that this is my ______ (1 st , 2 nd , etc. number)
marriage but that I am not currently married to anyone else, and that I am free to
marry under the laws of the state of Louisiana. I further understand and
acknowledge that giving any false information or false statement in this
application of marriage shall constitute the crime of filing a false public record in
violation of the Louisiana Criminal Code (R.S. 14:133).
____________________________
Signature of Groom
Sworn to and subscribed before me this ________ day of
__________________, 20___.
___________________ Notary Public/Deputy Clerk/Deputy
Registrar
I ___________________________ (print name of bride) do swear or affirm
that the information contained in this application for marriage is true and
correct. I further swear or affirm that this is my ______ (1 st , 2 nd , etc. number)
marriage but that I am not currently married to anyone else, and that I am free
to marry under the laws of the state of Louisiana. I further understand and
acknowledge that giving any false information or false statement in this
application of marriage shall constitute the crime of filing a false public record in
violation of the Louisiana Criminal Code (R.S. 14:133).
____________________________
Signature of Bride
Sworn to and subscribed before me this ________ day of
__________________, 20___.
___________________ Notary Public/Deputy Clerk/Deputy
Registrar