Online Marriage Application
Applicant Personal Information
Party A:
(check one)		 Bride Groom Spouse
Name:
First Middle Last
Maiden Surname: (if different)
Street Address:
City:
State, Zip:
,
County Residing:
Select a VA county or fill in one.
   Or   
 
Date of Birth:
Age:
Birthplace State/Country:
State or Country
 
Social Security #:
Gender:

Applicant Marital Information
Which marriage is this?
Last Marriage Ended Reason:

Applicant Educational Information
What is the highest grade completed?
Elementary/High School College

Applicant Parental Information
Father's Full Name:
Gender of Parent:
Mother's Full MAIDEN Name:
Gender of Parent:
* If Name is not known, please type UNKNOWN in that field *
Applicant Personal Information
Party B:
(check one)		 Bride Groom Spouse
Name:
First Middle Last
Maiden Surname (if different):
Street Address:
Address same as spouse
City:
State, Zip:
,
County Residing:
Select a VA county or fill in one.
   Or   
 
Date of Birth:
Age:
Birthplace State/Country:
State or Country
 
Social Security #:
Gender:

Applicant Marital Information
Which marriage is this?
Last Marriage Ended Reason:

Applicant Educational Information
What is the highest grade completed?
Elementary College

Applicant Parental Information
Father's Full Name:
Gender of Parent:
Mother's Full MAIDEN Name:
Gender of Parent:
* If Name is not known, please type UNKNOWN in that field *