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Marriage License Worksheet
ASCENSION PARISH CLERK OF COURT
Please complete the following information which is required to process your marriage license. PLEASE
PRINT. The license is valid in any parish in the State of Louisiana only.
Groom Information:
Last Name
First Name
Street Address
Middle Name
City/Town
Is Residence Inside City
Limits?
[ ] YES
Race
Date of Birth (mm/dd/yyyy)
State of Birth (If not
State
[ ] NO
State of Birth (If not in US Name Country)
Father – Full Name
Parish/County
Social Security Number
Mother – Full Name & Maiden Name
State of Birth (If not in
in US Name Country)
US Name Country)
Bride Information:
Last Name
First Name
Street Address
Middle Name
City/Town
Is Residence Inside City
Limits?
[ ] YES
Race
Date of Birth (mm/dd/yyyy)
State of Birth (If not in
Parish/County
State
[ ] NO
State of Birth (If not in US Name Country)
Father – Full Name
Maiden Name (If different)
Social Security Number
Mother – Full Name & Maiden Name
State of Birth (If not in
US Name Country)
US Name Country)
Groom:
Number of This Marriage
1st, 2nd…(Specify)
If Previously Married
Last Marriage Ended By:
Check One
Date Ended
Month
Year
Education – Circle Highest Grade Completed
Elementary
High School
College
0, 1, 2, 3, 4,
5, 6, 7, or 8
Death
Divorce
Annulment
1, 2, 3, or 4
1, 2, 3, 4, or 5
Bride:
Number of This Marriage
1st, 2nd…(Specify)
If Previously Married
Last Marriage Ended By:
Check One
Date Ended
Month
Year
Death
Divorce
Annulment
Education – Circle Highest Grade Completed
Elementary
High School
College
0, 1, 2, 3, 4,
5, 6, 7, or 8
1, 2, 3, or 4
1, 2, 3, 4, or 5
3
4
3
Are the two of you related by blood or Adoptive Relationship?
Yes
No
***Note*** A certified copy of your marriage license will be mailed to you. Please provide us with the address where you
would like your certified copy to be mailed.
Mailing address after marriage: ___________________________________________________
___________________________________________________
Contact phone # for Bride/Groom: ________________________________________________
Wedding date: ____________________________________ (License is only valid for 30 days)
Print Form