(Please type)

No. __________

APPLICATION FOR MARRIAGE LICENSE

We __________________________________ of ____________________________________
                                              (Permanent Residence)
and __________________________________ of ____________________________________
                                              (Permanent Residence)
do hereby apply for and request that a marriage license be granted us to enter into marriage in _________________, Virgin Islands, and we do further respectfully represent that the following statements are true and correct.
MALE: FEMALE:
Full Name  ____________________________ _________________________________
SS No.  ______________________________ _________________________________
Date of Birth  __________________________ _________________________________
Place of Birth  _________________________ _________________________________
Nationality  ___________________________ _________________________________
Usual Residence  _______________________ _________________________________
Previous marital status: ___________________ _________________________________
Related to other Applicant?________________ _________________________________
In what degree?  ________________________ _________________________________
Place of Birth  __________________________ _________________________________
Previous Marital Status ___________________ _________________________________
Related to other Applicant?  _______________ _________________________________
Parents/Guardians:
Present Name  __________________________ _________________________________
Maiden Name:  __________________________ _________________________________
Place of Birth  ___________________________ _________________________________
Signature  ____________________________ _________________________________

  PLEASE CHECK THIS BOX IF YOU ARE REQUESTING EXEMPTION TO THE EIGHT-DAY POSTING REQUIREMENT EXPLAINED IN THE ATTACHED
MARRIAGE INFORMATION FACT SHEET.

 THE COURT, HAVING REVIEWED THIS APPLICATION FOR MARRIAGE LICENSE, DETERMINES THAT SPECIAL CIRCUMSTANCES EXIST TO ISSUE A LICENSE WITHOUT THE POSTING REQUIRED BY TITLE 16 SECTION 38 OF THE VIRGIN ISLANDS CODE.
WE ARE REQUESTING EXEMPTION BECAUSE OF THE FOLLOWING SPECIAL CIRCUMSTANCES:
_________________________________ _________________________________
JUDGE
_________________________________
_________________________________
Subscribed and sworn to by each of the above parties this ________day of  ____________ , ______.
License issued this ________day of   _______________ ,  ______.
Filed this ________day of  _______________ , ______.
Clerk of the Territorial Court
By: ___________________________
          Deputy Clerk