Applicant Information

Marriage Counseling: Yes No		Are the applicants related to each other by blood or adoption?
		No Yes Explain Relationship:
	First Applicant		Second Applicant
First:		First:
Middle:		Middle:
Last:		Last:
Phone:		Phone:
Residence: U.S. or Other	U.S. Other	Residence: U.S. or Other	U.S. Other
Address:		Address:
City:		City:
County: State: ALABAMA ALASKA ALL EUROPE ARIZONA ARKANSAS ARMED FORCES AMERICA ARMED FORCES PACIFIC CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING Zip: - Country:		County: State: ALABAMA ALASKA ALL EUROPE ARIZONA ARKANSAS ARMED FORCES AMERICA ARMED FORCES PACIFIC CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING Zip: - Country:
	Birth Information:		Birth Information:
Birth Date: Age:		Birth Date: Age:
State or Foreign Country:		State or Foreign Country:
Gender:	Male   Female	Gender:	Male Female
First Applicant has been Previously Married: Yes No		Second Applicant has been Previously Married: Yes No
First Applicant's Previous Married Information: Number of Previous Marriages: First: Middle: Last: City/State Terminated: County Terminated: How Ended? Death Divorce Annulment Clear Date Ended:		Second Applicant's Previous Married Information Number of Previous Marriages: First: Middle: Last: City/State Terminated: County Terminated: How Ended? Death Divorce Annulment Clear Date Ended:

Applicant Additional Information

First Applicant's Name After Marriage		Does one or both of the parties have a felony conviction of a crime committed under Minnesota law or the law of another state or federal jurisdiction? YesNo
First:		Check here if First Applicant is a felon
Middle:		Jurisdiction(s):
Last:
Second Applicant's Name After Marriage
First:		Check here if Second Applicant is a felon
Middle:		Jurisdiction(s):
Last:
Residence After	U.S. Other
Address:
City:
State:	ALABAMA ALASKA ALL EUROPE ARIZONA ARKANSAS ARMED FORCES AMERICA ARMED FORCES PACIFIC CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING
Zip:	-
Country: