Marriage License Form

BID #: REG-77

ISSUED: 4/1/2019

DUE: TBD

VALUE: TBD

100

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Executive Summary

This document is an application form (REG-77) for a marriage license, remarriage, civil union, or reaffirmation of a civil union in New Jersey. It requires applicants to provide personal information such as names, addresses, dates of birth, and details of previous marriages or civil unions. The form also includes sections for an identifying witness and an oath affirming the accuracy of the provided information. Applicants must provide their Social Security numbers which are kept confidential.

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--- Document: Marriage License Form Document ---
REG-77 
PAGE 1
APR 19
New Jersey Department of Health 
APPLICATION FOR LICENSE 
 MARRIAGE 
 REMARRIAGE 
 CIVIL UNION 
 REAFFIRMATION OF CIVIL UNION 
(PLEASE PRINT OR TYPE) 
DECLARATION OF APPLICANT A 
(Giving false information constitutes perjury.) 
DECLARATION OF APPLICANT B 
(Giving false information constitutes perjury.) 
1. Name (First, Middle, Last)
(List name given at birth or on birth certificate/Maiden name)
1. Name (First, Middle, Last)
(List name given at birth or on birth certificate/Maiden name)
Street Address (Current Legal Residence) (See Note 1) 
County 
Street Address (Current Legal Residence) (See Note 1) 
County 
Municipality of Residence (See Note 4) State 
Zip Code 
Municipality of Residence (See Note 4) State 
Zip Code 
1a. Current Name (if different) 
2. Date of Birth
1a. Current Name (if different) 
2. Date of Birth
3. Birthplace
 Male
 Female
/ Non-Binary
5. Age 
(See Note 2)
3. Birthplace
 Male
 Female
 Undesignated 
/ Non-Binary
5. Age 
(See Note 2)
6. Domestic Status (at this time) (See Notes 3 and 5)
6. Domestic Status (at this time) (See Notes 3 and 5)
Date
Place 
Date
Place 
Single
Single
Widowed 
Widowed 
Divorced 
Divorced 
Annulled 
Annulled 
Current Domestic 
Partner 
Current Domestic 
Partner 
Former Domestic 
Partner 
Former Domestic 
Partner 
Current Civil 
Union Partner 
Current Civil 
Union Partner 
Former Civil 
Union Partner 
Former Civil 
Union Partner 
For Remarriage to the same spouse, or Reaffirmation of Civil Union to the 
same partner, enter date and place of original ceremony: 
For Remarriage to the same spouse, or Reaffirmation of Civil Union to the 
same partner, enter date and place of original ceremony: 
Marriage 
Civil Union 
Date 
 
Place 
Marriage 
Civil Union 
Date 
 
Place 
7a. Enter number of times ever 
Married (if applicable): 
7b. Name of Most Recent Spouse (if any) (List name 
given at birth or on birth certificate/Maiden name): 
7a. Enter number of times ever 
Married (if applicable): 
7b. Name of Most Recent Spouse (if any) (List name 
given at birth or on birth certificate/Maiden name): 
8a. Enter number of times ever 
in a Civil Union 
(if applicable): 
8b. Name of Most Recent Civil Union Partner (if any) 
(List name given at birth or on birth certificate/ 
Maiden name): 
8a. Enter number of times ever 
in a Civil Union 
(if applicable): 
8b. Name of Most Recent Civil Union Partner (if any) 
(List name given at birth or on birth certificate/ 
Maiden name): 
9a. Parent’s Full Name at Birth 
9b. Birthplace 
9a. Parent’s Full Name at Birth 
9b. Birthplace 
10a. Parent’s Full Name at Birth 
10b. Birthplace 
10a. Parent’s Full Name at Birth 
10b. Birthplace 
11. Are you related to Applicant B?
Yes 
No 
If “YES,” how?
11. Are you related to Applicant A?
Yes 
No 
If “YES,” how?
INFORMATION TO BE COMPLETED BY EITHER APPLICANT 
12. In which Incorporated Municipality in New Jersey do you intend for the ceremony 
to be performed? (See Note 4)
13 Intended Date of Ceremony 
14. Telephone Number where either 
applicant can now be reached:
15. Name and mailing address of person who is to perform the ceremony:
16. Mailing Address where you may be reached after the ceremony:
 Undesignated 
4. Sex 
4. Sex 
(See Notes on Page 2) 
Continue with Declaration of Identifying Witness and Oath.


REG-77 
PAGE 2
APR 19 
UPON COMPLETION, APPLICATION IS TO BE RETAINED AS A PERMANENT RECORD. 
DECLARATION OF IDENTIFYING WITNESS 
(Giving false information constitutes perjury) 
1.
Name (First, Middle, Last):
Mailing Address (Street/PO Box):
City:
State: 
Zip Code: 
2.
Have the applicants correctly stated their ages and usual residences?
Yes 
No 
3.
Did the applicants make you aware of any legal impediment to their
marriage / remarriage / civil union / reaffirmation of civil union?
Yes 
No 
If “Yes, “ explain:
OATH OR AFFIRMATION OF APPLICANTS AND IDENTIFYING WITNESS 
NOTE TO REGISTRAR - Applicants and witness should be told that taking a false oath constitutes perjury, which is punishable by a 
maximum fine of $7,500.00.  In any case where application is made by only one applicant to begin the waiting period, the same 
identifying witness must return when the second applicant completes the application.  In such a case the same witness must sign once 
again on the line below that on which he/she signed when appearing with the first applicant. 
We, who have hereunder signed our names, do solemnly swear (or affirm) that we are not currently ruled mentally incompetent; 
the answers given by us in this application for a marriage, remarriage, civil union, or reaffirmation of civil union license are true, 
full and perfect answers to each and all of said questions. 
Signature of Applicant A: 
Date: 
Signature of Applicant B: 
Date: 
Signature of Witness: 
Date: 
Second Signature of 
Witness (if necessary): 
Date: 
Sworn (or affirmed) and subscribed before me at 
this 
 
day of 
,  20 
at 
AM 
PM 
Signature of Registrar: 
REGISTRAR - DO NOT insert place and date of ceremony or file the application until either the completed certificate or copy 
thereof is sent to you.  Follow-up on all licenses for completion. 
License Number: 
Date of Issue: 
Ceremony Performed in (City, Borough, Twp.): 
Date of Ceremony: 
NOTE 1.  This is the permanent home and principal establishment to 
which, when absent, the applicant intends to return. 
NOTE 2.  Both applicants must be a minimum of 18 years of age at the 
time of application. 
NOTE 3.  When a remarriage or reaffirmation of civil union license is 
requested, indicate in Question 6 that the parties are already married 
or joined in a civil union.  It is required that proof of the previous 
marriage or civil union be submitted to you.  Common law marriages, 
which were legal prior to December 1, 1939, must be established by 
affidavit showing the place and date of the common law marriage 
contract.  The place and date of the previous marriage or civil union 
should be stated on both the application and the license.  The seventy-
two hour waiting period is waived.  Consent of parents is required for 
the remarriage or reaffirmation of a civil union of a minor previously 
joined in a marriage or civil union to the same partner in another state. 
NOTE 4.  Municipality of residence is the municipality where applicant 
physically resides, not the mailing address.  If both applicants are 
nonresidents of New Jersey, the application must be made in the 
municipality where the ceremony will be performed.  Registrar should 
mark the license accordingly. 
NOTE 5.  The Registrar’s review of a divorce decree, dissolution of Civil 
Union, or termination of Domestic Partnership, submitted with this 
application, in no way implies the validity of the submitted document. 
Such determination can only be made by a court of law. 
APPLICANTS MUST PROVIDE THEIR SOCIAL SECURITY NUMBERS (N. J. S. 37:1-17) 
Social Security Number of Applicant A 
Social Security Number of Applicant B 
- 
- 
- 
- 
Social Security Numbers shall be kept confidential and may only be released for child support purposes and 
this document shall not be considered a public record pursuant to P. L. 1963, C.73 (C.47:1A-1 et seq.).