ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, address and telephone #): FOR COURT USE ONLY STATE BAR NO: ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF MARIN 3501 Civic Center Drive P.O. Box 4988 San Rafael, CA 94913-4988 IN THE MATTER OF THE PETITION OF: and TO ESTABLISH THE FACT OF MARRIAGE: CASE NUMBER: PETITION TO ESTABLISH FACT OF MARRIAGE 1. Petitioner is a beneficially interested person, entitled under section 103450 of the California Health and Safety Code, to judicial establishment of the fact, time and place of the marriage of (name of individual(s)): ____________________________________________________________________________________ Petitioner's beneficial interest in the matter herein is based on the following facts and circumstances (state relationship, if any, and other facts and circumstances giving rise to or affecting a beneficial interest ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ (Attach additional sheets if necessary) 2. A certified copy of the record of marriage of (name of individual(s))_____________________________ and ________________________________ is not registered. 3. On (date) _______________________________________, the marriage of (name of individual(s)) _________________________________ and _______________________________ occurred in County of ________________________________ State of ____________________________. 4. (name of individual(s)) ________________________and____________________, now reside at (town) _____________________ County of _______________________ State of ______________________. CV019WB (Rev. 7/07) PETITION TO ESTABLISH FACT OF MARRIAGE Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Wherefore petitioner prays that a time and place be fixed for the hearing of the petition and that on the hearing of this petition the Court make an order determining that the marriage did in fact occur at the time and place by the proofs adduced at said hearing. (Your name) ________________________________________________, being duly sworn, deposes and says: That he/she is the petitioner named in the foregoing petition; that he/she has read the foregoing petition and knows the contents thereof; that the same is true of his/her own knowledge except as to the matters which are therein stated upon his/her information or belief, and as to those matters that he/she believes it to be true. Date: __________________________________ _______________________________________________ SIGNATURE AFFIDAVIT OF MARRIAGE I, ___________________________________________________________ , declare that I am a citizen of the United States, ________ years of age, and reside at I further declare under penalty of perjury that the marriage of _________________________and took place on ____________________________ and they now reside at ____________________________________. A certified copy of the record of the marriage is not obtainable because: Executed on (date) ___________________________________ at (place) . SIGNATURE This affidavit must be notarized or signed before a clerk of the court. Subscribed and sworn before me this ________________ day of ________________________ Address _______________________________________ KIM TURNER Court Executive Officer By DEPUTY CV019WB (Rev. 7/07) PETITION TO ESTABLISH FACT OF MARRIAGE Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com