GREEK ORTHODOX ARCHDIOCESE OF AMERICA

GREEK,ORTHODOX METROPOLIS OF NEW]ERSEY

AFFIDAVIT FOR LICENSE TO MARRY

Name of Parish

Scheduled Date of Wedding

Address

City
vAState Zip Code
Episcopal License Number

FORM MUST BE TYPED

PROSPECTNE GROOM'S INFORMATION ' PROSPECTNE BRIDE'S INFORMATION

1. Full Name 1. Full Name

First Name Middle Initial Last Name First Name Middle Initial Last Name [Maiden]

Name in Greek, Name in Greek

First Name Middle Initial Last Name First Name Middle Initial Last Name

2. Residence 2. Residence
Address - Address

City State Zip Code City State Zip Code

3. Age __ Date of Birth 3. Age __ Date of Birth

4. Place of Birth 4. Place of Birth

City .State Country City State Country

5. Date of Baptism 5. Date of Baptism

Religion at Baptism Religion at Baptism

Date of Chrismation into Orthodoxy Date of Chrismation into Orthodoxy

6. Occupation 6. Occupation
7. Father's Name 7. Father's Name
Father's Place of Birth Father' sPlace of Birth
City State Country City State Country

Father's Religion Father's Religion

-' -
8. Mother's Maiden Name 8. Mother's Maiden Name

Mother's Place of Birth Mother's Place of Birth

City State Country City State Country

Mother's Religion Mother's Religion

9. Have you ever been married? o No o Yes [check below] 9. Have you ever been married? o No o Yes [check below]
0 Orthodox Church 0 Other Faith 0 Civilly 0 Orthodox Church 0 Other Faith 0 Civilly

10. If you were born in a foreign country, at what age did you 10. If you were born in a foreign country, at what age did you
arrive in the United States ? arrive in the United States ?
Date of Arrival Date of Arrival
11. Are you related to the intended bride? Yes No 11. Are you related to the in tended groom? Yes No
By Blood 0 0 By Blood 0 0
By Marriage 0 0 By Marriage 0 0

If the answer to question 9 is "Yes," complete and attach Form 165. If the answer to question 11 is "Yes," then attach particulars.

The undersignedapplicantsfor a Licenseto Marry, deposeandsay, that to the best of their ability, knowledge,and beliefthe abovestatement
respectfullysigned by them is true, and that no legalor religiousimpediment existsas to the right of the applicants to enter into the marriagestate.
"

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~ Signature of Bride
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