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Get Application For Public Marriage License Ver5 -2 - Sccgov

AST NAME AT BIRTH (IF DIFFERENT THAN 1C) 4. # PREV. MARRIAGES / SRDP (State Registered Domestic Partnership) MIDDLE 1C. CURRENT LAST DATE OF BIRTH - MONTH, DAY, YEAR 2. 3. 5A. LAST MARRIAGE / SRDP ENDED BY: STATE/COUNTRY OF BIRTH 5B. DATE ENDED MM/DD/YYYY DEATH DISSOLUTION ANNULMENT TERM SRDP N/A PERSON 6. ADDRESS 7. CITY 8. STATE/COUNTRY 10A. FULL BIRTH NAME OF FATHER/PARENT 10B. STATE OF BIRTH (IF OUTSIDE U.S. ENTER COUNTRY) 11A. FULL BIRTH NAME OF MOTHER/PARENT 11B.

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