A marriage license application must use the form provided in Subsection B, and the groom and bride must swear or affirm that the information they provide is true and correct.
§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: Application for Marriage __________________(Parish), State of Louisiana 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 ______ (1st, 2nd, 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 ______ (1st, 2nd, 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 Acts 1987, No. 886, §3, eff. Jan. 1, 1988; Acts 2015, No. 436, §1, eff. Jan. 1, 2016.