Application for Marriage License
Application for Marriage License
Commonwealth of Virginia
Have you called the Clerk's Office at (276) 634-4882 and scheduled an appointment?
Before completing this application you must call and make an appointment
*
Have you called the Clerk's Office at (276) 634-4882 and scheduled an appointment?
Before completing this application you must call and make an appointment
Yes
No
Appointment Date given to you by the Clerk's Office
Appointment Date given to you by the Clerk's Office
*
/
MM
/
DD
YYYY
Appointment Time
*
The questions below refer to Party A
Party A
*
Party A
Bride
Spouse
Name
Name
*
First
Middle
Last
Maiden Surname (if different from last)
Date of Birth
Date of Birth
*
/
MM
/
DD
YYYY
Age
*
Place of birth (state or foreign country)
*
Social Security number or DMV number
*
Sex
*
Education - How many years completed? (0-12)
*
0
1
2
3
4
5
6
7
8
9
10
11
12
Education - College (0-4 or 5+)
*
0
1
2
3
4
5+
Number of this marriage (first, second, etc.)
*
Marital Status (if previously married)
Marital Status (if previously married)
Widowed
Divorce
Usual Residence: Street address or Rt. number
Usual Residence: Street address or Rt. number
*
Street Address
Address Line 2
City
State / Province / Region
Select a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal / Zip Code
Country
United States
County
*
Name of parent 1 (first middle last, suffix. Maiden if any)
*
Sex of Parent 1
*
Name of parent 2 (first middle last, suffix. Maiden if any)
*
Sex of Parent 2
*
The questions below refer to Party B
Party B
*
Party B
Groom
Spouse
Name
Name
*
First
Middle
Last
Maiden Surname (if different from last)
Date of Birth
Date of Birth
*
/
MM
/
DD
YYYY
Age
*
Place of birth (state or foreign country)
*
Social Security number or DMV number
*
Sex
*
Education - How many years completed? (0-12)
*
0
1
2
3
4
5
6
7
8
9
10
11
12
Education - College (0-4 or 5+)
*
0
1
2
3
4
5+
Number of this marriage (first, second, etc.)
*
Marital Status (if previously married)
Marital Status (if previously married)
Widowed
Divorce
Usual Residence: Street address or Rt. number
Usual Residence: Street address or Rt. number
*
Street Address
Address Line 2
City
State / Province / Region
Select a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal / Zip Code
Country
United States
County
*
Name of parent 1 (first middle last, suffix. Maiden if any)
*
Sex of Parent 1
*
Name of parent 2 (first middle last, suffix. Maiden if any)
*
Sex of Parent 2
*
A Virginia Marriage license can only be used to perform marriages within the state of Virginia.
Intended Location of Marriage (if known)
The license is valid for 60 days from the date issued.
Intended date of marriage (if known)
The license is valid for 60 days from the date issued.
Intended date of marriage (if known)
/
MM
/
DD
YYYY
Party A's telephone number
Party A's telephone number
*
-
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-
###
####
Party B's telephone number
Party B's telephone number
*
-
###
-
###
####
Minister's name
Minister's name
First
Last
Minister's telephone number
Minister's telephone number
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-
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