Probate Court Form No. 197a Certificate of Marriage STATE OF VERMONT DISTRICT OF ________________ PROBATE COURT CERTIFICATE OF MARRIAGE (Declaration of Intention and Marriage Certificate) _________________________________ Full Name of Groom _________________________________ Residence ( Street & Number ) _________________________________ Town State or County _________________________________ Place of Birth _________________________________ Date of Birth _________________________________ Father=s Full Name _________________________________ Father=s Birthplace _________________________________ Mother=s Maiden Name _________________________________ Mother=s Birthplace ________________________________ Full Name of Bride ________________________________ Residence ( Street & Number ) _________________________________ Town State or County _________________________________ Place of Birth _________________________________ Date of Birth _________________________________ Father=s Full Name _________________________________ Father=s Birthplace _________________________________ Mother=s Maiden Name _________________________________ Mother=s Birthplace I hereby certify that the facts given within are true and correct to the best of my knowledge and belief: Signature of Bride and/ or Groom: _____________________________________ I hereby certify that the within named ________________________ this day applied for a certificate of marriage, made oath to the truth of the facts stated in the foregoing declaration of intention of marriage and have complied with the marriage laws of the State of Vermont. A true copy of the within license and declaration of intention of marriage is duly filed in this office. Date on which license was issued: _________________________________ Signature of Town or City Clerk: __________________________________ Town or City of : _______________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com I hereby certify that the persons above named were joined in marriage by me in accordance with the laws of the State of Vermont at _____________________ this _______ day of ________________20 _____. Attest : ________________________________________________________ Denomination of Clergy : _________________________________________ Title other than clergy : ___________________________________________ Residence : _____________________________________________________ I hereby certify that no evidence of a prior marriage certificate has been presented or found for these registrants and that documentary evidence has been reviewed which substantiated the facts set forth in the foregoing abstract. IN TESTIMONY WHEREOF, I subscribe my name and affix the seal of said Court this __________ day of _____________________ 20_____. ________________________________ Probate Judge District of _______________ DATE OF FILING: ________________________ CLERK=S SIGNATURE: ___________________ TOWN OF : ______________________________ ( SEAL ) IN TESTIMONY WHEREOF, I hereunto affix the seal of said Court and subscribe my name at North Hero, in said District, this _____ day of _______________ 20 _____. ___________________________________ __________________ Probate Judge District of _______________ American LegalNet, Inc. www.FormsWorkFlow.com