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) *
Education - College (0-4 or 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 Postal / Zip Code Country
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? (0-12) *
Education - College (0-4 or 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 Postal / Zip Code Country
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 * - ### - ### ####
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 - ### - ### ####

Application for Marriage License

Application for Marriage License

The questions below refer to Party A

The questions below refer to Party B

A Virginia Marriage license can only be used to perform marriages within the state of Virginia.