2023 New York Laws › DOM - Domestic Relations › Article 3 - Solemnization, Proof and Effect of Marriage › 14 - Town and City Clerks to Issue Marriage Licenses; Form.

§  14. Town and city clerks to issue marriage licenses; form. The town
  or city clerk of each and every town or city in  this  state  is  hereby
  empowered  to  issue  marriage  licenses to any parties applying for the
  same who may be entitled under the laws of this state to apply  therefor
  and  to  contract  matrimony,  authorizing the marriage of such parties,
  which license shall be substantially in the following form:
 
  State of New York
  County of ................
  City or town of ..........
Know all men by this certificate that any person authorized by law  to
  perform  marriage  ceremonies  within the state of New York to whom this
  may come, he not  knowing  any  lawful  impediment  thereto,  is  hereby
  authorized  and  empowered  to  solemnize the rites of matrimony between
  ............. of ........... in the county of ............. and state of
  New York and ..................  of ................... in the county of
  ............. and state of New York and to certify the same to the  said
  parties  or either of them under his hand and seal in his ministerial or
  official capacity and thereupon he is required to return his certificate
  in the form hereto annexed. The statements endorsed  hereon  or  annexed
  hereto, by me subscribed, contain a full and true abstract of all of the
  facts concerning  such parties disclosed by their affidavits or verified
  statements  presented to me upon the application for this license.  This
  certificate  is   to   be   returned   addressed to the  undersigned  at
  ...................,   ............................,   .................
(Street)          (City, Town, Village)              (State)
In testimony whereof, I have hereunto set my hand and affixed the seal
  of said town  or  city  at  ..........  this  .......  day  of  ........
  nineteen ........, at........m. Seal.
The  form  of  the  certificate  annexed  to  said license and therein
  referred to shall be as follows:
 
  I, .... a ....., residing at ......... in the  county  of  ........  and
  state  of New York do hereby certify that I did on this ......... day of
  .... in the year, nineteen ......... at .....m, at ....... in the county
  of .......... and  the  state  of  New  York,  solemnize  the  rites  of
  matrimony  between  .... of ..... in the county of ........... and state
  of New York, and .... of ..... in the county of ............. and  state
  of  New  York  in  the  presence  of ..... and ..... as witness, and the
  license therefor is hereto annexed.
Witness my hand ...... in the county of ....... this  .......  day  of
  ....., nineteen .....
In the presence of
...............
...............
...............
There shall be endorsed upon the license or annexed thereto at the end
  thereof,  subscribed  by  the clerk, an abstract of the facts concerning
  the parties as disclosed in their affidavits or verified  statements  at
  the  time  of  the application for the license made in conformity to the
  provisions of section fifteen of this chapter.
There shall also be stated upon the license the  exact  period  during
  which the marriage may be solemnized.
The   license  issued,  including  the  abstract  of  facts,  and  the
  certificate duly signed by the person  who  shall  have  solemnized  the
  marriage  therein  authorized,  shall  be returned by him, and where the
  marriage is solemnized by a written  contract,  the  judge  before  whom
  acknowledgment  is made shall forward such contract and marriage license
  to the office of the town or city clerk who issued  the  license  within
  five days succeeding the date of the solemnizing of the marriage therein
  authorized  and any person or persons who shall wilfully neglect to make
  such return within the time above required shall be deemed guilty  of  a
  misdemeanor  and  upon conviction thereof shall be punished by a fine of
  not less than twenty-five dollars or more than fifty  dollars  for  each
  and every offense.
When  a  marriage  is  solemnized  by  a city, town or village justice
  outside of the  territorial  jurisdiction  in  which  such  justice  was
  elected  or  appointed, as provided in subdivision six of section eleven
  of this chapter, there shall be affixed to such license prior to filing,
  the official or common seal of the court or of the municipality in which
  such justice was elected or appointed.