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DipAttamenton Kontnbusion yan Adu~n~~S. MOYLAN,LLGovernor iThenteGubebiadot

REVENUE AND TAXATIONARTEMIO B.ILAGAP4. Dkec*oe

DEPARTMENT OF
GOVERNMENT OF GUAM

Gubetnamenton Guhhan

MARRIAGE APPLICATIONTO BE COMPLETED BY MALE APPLICANTTO BE COMPLETED BY FEMALE APPLICANTGROOM’SNAME IN FULL (Ffrs’t, Mkidle Last)

BRIDE’S NAMEIN FULL (Fir4 Middle, Last)

AGE

AGE

DATE OF BIRTH

BIRTHPLACE

CITIZENSHIPDATE OF BIRTH

BIRTHPLACE

CITIZENSHIPSSN:

SSN:Resident Alien C)

NAT:___________________

No4mrni~rant ()Passport:___________________

Resident Alien ()NAT:__________________

Non4nirnigrant C)

Passport:

PRESENT LOCAL RESIDENCE ADDRESSPRESENT LOCAL RESIDENCE ADDRESSTRADE OR OCCUPATIONTRADE OR OCCUPATIONSINGLE()WIDOWED()

NO.OFTHISMARRIAGESINGLE()WIDOWED()

NO.OFTHISMARRIAGEDIVORCED
ANNULLED
WHERE CONTRACTED (State ofLastMarriage)

WHERE CONTRACTED (State ofLastMarriage)

LAST MARRIAGE ENDED

LAST MARRIAGE ENDED / MAIDEN NAME (Ifpreviously married)

RACE (Chamorro, Cascasian, Fihpino, etc.)

RACE (Chomorro, Cancasion, Fil~pino, etc.)

FATHER’S NAME (infidl Livingor Deceased)

FATHER’S NAME(in fidi, Livingor Deceased)

FATHER’S BIRTHPLACE

FATHER’S BIRTHPLACE

MOTHER’S NAME (infulL Living orDeceased)

MOTHER’S NAME (infull, Living orDeceased)

MOTHER’S MAIDEN NAME

MOTHER’S MAIDEN NAME

MOTHER’S BIRTHPLACE

MOTHER’S BIRTHPLACEEDUCATION THRUHIGH SCHOOL
1 2 3 4 5 6 7 5 9 10 11 12
COLLEGE

DEGREEEDUCATION THRUHIGH SCHOOL

DEGREE

1 2 3 4 5WE HEREBY CERTIFY THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT TO THE BEST OF OUR
KNOWLEDGE AND BELIEF.
SIGNATURE IN FULL OF MALE APPLICANTSIGNATURE IN FULL OF FEMALE APPLICANTPost Office Box 23607, Guam Main Facility, Guam 98921 • Tel. I Telifon: (871) 475-1801/178549 • Fax I Faks: (071) 472-2843

REQUIREMENTS
PURSUANT TO SECTION 3201, TITLE 19, GUAM CODE ANNOTATED, ThE FOLLOWING MUST BE
COMPLIED WITH BEFORE ThE ISSUANCE OF ANY MARRIAGE LICENSE:
1. BOTH APPLICANTS must be present atthe time of submission ofthis application..

2. BIRTH CERTIFICATES: Both applicants must present their Certified Original (seal copy) of BirthCertificates issued by the Office of Vital Statistics or Registrar. Baptismal or hospital certificates are
not accepbi~le~ Birth certificates in foreign languages must be translated by an official translator.
3. ADOPTION: If either applicant was adopted, adoption papers must be presented.
4. NATURALIZED CiTiZENS: If either applicant is a naturalized citizen, the naturalization certificate must
be presented.
5. FOREIGN COUNTRY: if either applicant was born abroad (in a foreign country) to U.S. Citizens I
Parents, be it on military installations I other, a Department of State, Certification of Birth Abroad (FormFS-545) must be presented.
8. ALlEN: lf either applicant is of foreign descent (non-US), it is mandatory thathe or she present
their Certified (seal copy) birth certificate or family register, duly translated into English, andtheir respective country’s current passport. Affidavits are required from aliens (whetherresident alien or non-immigrant alien). The affidavits must be a written statement containing
your correct full name, date and place of birth, place of residence, parents complete names(living or deceased) and whether or not you have been previously married. This affidavit must
be notarized.
7. PREVIOUS MARRIAGE:

In case of termination of a previous marriage by divorce, death orannulment, the appicant must furnish an Original Certified Seal Copy of the final divorce decree, deathcertificate, or annulment document. Please note: The furnished copy will be kept on file with theDepartment Photo or Xeroxcopies are NOT ACCEPTABLE.

8. RETENTION OF MAIDEN NAME: if a female applicant desires to maintain her maiden name aftermaniage, she must prepare and attach an affidavit in triplicate stating that she elects to keep hermaiden name after marriage and the reason, if any.
HYPHENATION: No hyphenation may be used for last name after marriage (ULLOA-CRUZ) until acourt order has been obtained and filed at Office of Vital Statistics, Public Health.
9. FEE: A fee of Fifteen Dollars ($15.00) is required upon filing ofthis application and is not refundable if
the license is not issued or used.
10. WAITING PERIOD: No license shall be issued/released until after the expiration of five (5) days after
the filing of the application. Such a waiting period may be waived through affidavit for (3000 CAUSESHOWN. An additional fee of Ten Dollars ($10.00) will be assessed forthe waiver, if approved.
11. MINORS: Applicants under the age of eighteen (18) must obtain a Court OrderlPetitionlConsentto
marry and must be accompanied by a parent or guardian giving consent upon filing this application.