San Andreas Judicial Branch
Marriage License Application
"HERE FOR YOU | SAFE FOR YOU"
Party A
- Name: Galileo Czapiewski
Occupation: Correctional officer
Date of Birth: 07/FEB/1999
Location of Birth: San Rafael CA
Current Mailing Address: [email protected]
Contact Information: 2027328
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: Galileo Czapiewski
Label for Marriage Certificate: Groom
Proof of Identification: **Attached Document**
Signature:
Party B
- Name: Chase Carter
Occupation: Correctional officer
Date of Birth: 10/July/1990
Location of Birth: United States
Current Mailing Address: [email protected]
Contact Information: 2212144
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: Chase Czapiewski
Label for Marriage Certificate: Bride
Proof of Identification: **Attached Document**
Signature:
Party C
- Name: John Tegans
Occupation: Correctional officer
Date of Birth: 26/MAR/1998
Location of Birth: Miami
Current Mailing Address: [email protected]
Contact Information: 5417182
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: John Czapiewski
Label for Marriage Certificate: Groom
Proof of Identification: **Attached Document**
Signature:
Party D
- Name: Jim Hart
Occupation: Correctional officer
Date of Birth: 21/09/2000
Location of Birth: England
Current Mailing Address: [email protected]
Contact Information: 499-1465
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: Jim Czapiewski
Label for Marriage Certificate: bride
Proof of Identification: **Attached Document**
Signature: