San Andreas Judicial Branch
Marriage License Application
"EQUAL JUSTICE UNDER LAW"
Party A
- Name: [Corey Cougzy]
Occupation: [Unlemployed]
Date of Birth: [16/SEP/1998]
Location of Birth: [Ireland]
Current Mailing Address: [10 Fudge Ln]
Contact Information: [423-2316]
Previous Marital Status: [Single]
Number of This Marriage: [First]
Last Marriage Ended By: [N/A]
Date Last Marriage Ended: [N/A]
Legal name to be taken after marriage: [Corey Cougzy]
Label for Marriage Certificate: [Groom]
Proof of Identification: **Attached Document**
Signature: Corey Cougzy
[Firstname Lastname]
Party B
- Name: [Miaelize Rose]
Occupation: [Unemplyed]
Date of Birth: [02/SEP/2001]
Location of Birth: [Brooklyn, NY, USA]
Current Mailing Address: [10 Fudge Ln]
Contact Information: [4206]
Previous Marital Status: [Single]
Number of This Marriage: [First]
Last Marriage Ended By: [N/A]
Date Last Marriage Ended: [N/A]
Legal name to be taken after marriage: [Miaelize Cougzy]
Label for Marriage Certificate: [Bride]
Proof of Identification: **Attached Document**
Signature:MiaElize Rose
[Firstname Lastname]






