PARTY B PARTY A Signature ofNotaryPublicor DeputyClerkofCourt______NotaryID______Sworn toandsubscribedbefore methis______dayof______,20_____. Signature ofPartyB______false publicrecordinviolationoftheLouisianaCriminalCode(R.S.14:133). the StateofLouisiana.Ifurtherunderstandandacknowledgethatgivingany falseinformationorstatementinthisapplicationformarriageshallconstitutethecrimeoffilinga correct. Ifurtherswearoraffirmthatthisismy______(1st,2nd,etc.number) marriagebutthatIamnotcurrentlymarriedtoanyoneelse,andfreemarryunderthelawsof I ______(printnameofgroom/bride/spouse) doswearoraffirmthattheinformationcontainedinthisapplicationformarriageistrueand Signature ofNotaryPublicorDeputyClerkCourt______NotaryID______Sworn toandsubscribedbeforemethis______day of ______,20_____. Signature ofPartyA______false publicrecordinviolationoftheLouisianaCriminalCode(R.S.14:133). the StateofLouisiana.Ifurtherunderstandandacknowledgethatgivinganyfalseinformationorstatementinthisapplicationformarriageshall constitute thecrimeoffilinga correct. Ifurtherswearoraffirmthatthisismy______(1st,2nd,etc.number)marriagebutamnotcurrentlymarriedtoanyoneelse,and freetomarryunderthelawsof I ______(printnameofgroom/bride/spouse)doswearoraffirmthattheinformationcontainedinthisapplication formarriageistrueand License Number CONFIDENTIAL Covenant Marriage PARTY B: BRIDE GROOM SPOUSE PARTY A: GROOM BRIDE SPOUSE Father/Parent's Name(beforefirstmarriage) Mother/Parent's Name(beforefirstmarriage) Race City Father/Parent's Name(beforefirstmarriage) Mother/Parent's Name(beforefirstmarriage) Race City PartyB PartyA Last Name Last Name Residence Address Last NameBeforeFirstMarriage(ifdifferentthancurrentlegallastname) Residence Address Last NameBeforeFirstMarriage(ifdifferentthancurrentlegallastname) Mailing Address AFTERMarriage: Covenant Marriageand,accordingly,haveexecutedadeclarationofintentattachedhereto. We, ______and______doherebydeclareourintent tocontracta Is thisaCovenantMarriage? PartyA PartyB Sex: Sex: (If none,attachstatement) Social SecurityNumber (If none,attachstatement) Social SecurityNumber Formerly Married? Highest EducationCompleted: Highest EducationCompleted: Formerly Married? Male Male Yes Yes

Female YES Female No No Date ofBirth Date ofBirth Parish/County Parish/County Application forMarriageLicense Number ofPreviousMarriages? Suffix Suffix Number ofPreviousMarriages? NO Check ifconsanguineousoradoptiverelationship State ofLouisiana (If YES,completebelow): First Name First Name Keep Confidential? Keep Confidential? Place ofBirth(city,state,country) PlaceofBirth(city,state,country) Father/Parent's Birthplace(city,state,country) Mother/Parent's Birthplace(city,state,country) Father/Parent's Birthplace(city,state,country) Mother/Parent's Birthplace(city,state,country)

State State Reason LastMarriageEnded Currently Divorced? Reason LastMarriageEnded Currently Divorced? Phone Number Phone Number Yes Yes Middle Name Middle Name No No Application Time of Application Date of ZIP ZIP Date LastMarriageEnded(mm/dd/yy Date LastMarriageEnded(mm/dd/yy) Divorce Divorce Death Death Rev 11/15 Annulment Annulment )