San Andreas Judicial Branch
Marriage License Application
"EQUAL JUSTICE UNDER LAW"
Party A
- Name: [Thomas Wagner]
Occupation: [EMT-A]
Date of Birth: [23/APR/1996]
Location of Birth: [Indianapolis, Indiana]
Current Mailing Address: [3 Alta Street APT 60]
Contact Information: [250-6496]
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: [Thomas Lugo]
Label for Marriage Certificate: [Groom]
Proof of Identification: **Attached Document**
Signature:
[Thomas Wagner]
Party B
- Name: [Emerson Lugo]
Occupation: [PO-II]
Date of Birth: [21/SEP/1980]
Location of Birth: [Missouri City, Texas]
Current Mailing Address: [3 Alta Street APT 60]
Contact Information: [467-6512]
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: [Emerson Lugo]
Label for Marriage Certificate: [Bride]
Proof of Identification: **Attached Document**
Signature:
[Emerson Lugo]