Application Number ____ML___________ LAKE COUNTY PROBATE COURT JUDE TED KLAMMER MARRIAGE APPLICATION GROOM In light of the events of 9-11, this Court is taking additional steps to ensure your security as well as the security of the citizens of Lake County, Ohio. This application incorporates revisions in the Ohio Constitution and statutory law, and to protect your privacy interests. The following are the general rules: A male of at least 18 years of age and a female of at least 16 years of age, not nearer of kin than second cousins, and not having a husband or wife living may be joined in marriage. A marriage may only be entered into by one man and one woman. Further, a marriage between persons of the same biological sex is against the Ohio Constitution and the laws of this state. There are some additional requirements if you are under the age of 21. In order to help ensure there are no legal impediments to the approval of this application, please provide and fill out all of the following information: Name: _________________________________________________________________ Last First Middle Telephone Number (daytime): __________________________________ Have You Ever Been Known By Any Other Name? (list all) ______________________________________________________ Social Security No. (optional): ________________________ or Green Card/Passport/Visa/Work Authorization No.: _____________________________ (Must be presented to the clerk) Date of Birth: __________ Place of Birth:____________________________________ (City , State) Present Address: ________________________________________________________ Address City State Zip Prior 2 Addresses: ________________________________________________________ Address City State Zip ________________________________________________________ Address Occupation: City ________________________ State Zip Years/Months Employed: ________ Father’s Full Name: _______________________________________________________ Deceased? _____ Yes _____ No Date of Death: _________________ Mother’s Full Maiden Name: _______________________________________________ Deceased? _____ Yes _____ No Date of Death: _________________ -1– Rev. 12/04/09 American LegalNet, Inc. www.FormsWorkFlow.com Application Number ____ML___________ Are You Involved or Have You Ever Been Involved in Deportation Proceeding(s)? _____Yes _____No Case No. _____________________________________ Have You Ever Been Adjudged Incompetent? _____ Yes _____ No If Yes, By What Court? ________________________________________________ Number of Prior Marriages: _____ Terminated By _____Death _____Divorce If Divorced, Where Were You Divorced? _____________________________________ Date Divorced: ___________ (Must provide a certified copy of most recent divorce and copies of any prior divorces) Case No. _____________________________________ Former Spouse’s Full Name: ______________________________________________ Minor Children 17 or Under (list all with names and ages) From Prior Marriages: _______________________________________________________________________ __________________________________________________________ _____________ Name of Person Solemnizing Marriage: _______________________________________ I, __________________________________, do solemnly swear or affirm that the above information is true, that I am not under the influence of any intoxicating liquor or narcotic drugs, and that I am not nearer of kin than second cousins to the bride, and there is no legal impediment to our marriage. ____________________________________ Groom’s Signature (To Be Signed In Front of Clerk) ________________________________________________________________________ na Sworn to before me and signed in my presence, this __________ day of _____________________, 20________. __________________________________ Deputy clerk -2– Rev. 12/04/09 American LegalNet, Inc. www.FormsWorkFlow.com