1. Full name of husband ___________________________________________________________
  2. Full name of the father of husband ________________________________________________
  3. Full name of mother of husband __________________________________________________
  4. Occupation of husband __________________________________________________________
  5. Residence of husband ___________________________________________________________
  6. Birthplace of husband ___________________________________________________________
  7. Full name of wife previous to marriage _____________________________________________
  8. Full name of father of wife _______________________________________________________
  9. Full name of mother of wife ______________________________________________________
  10. Birthplace of wife _______________________________________________________________
  11. Time when marriage was contracted _______________________________________________
  12. The place, town or township, and county ___________________________________________
  13. The color of the parties __________________________________________________________
  14. By what ceremony contracted _____________________________________________________
  15. Names of subscribing witnesses __________________________________________________
  16. __________________________________________________

  17. Additional circumstances ________________________________________________________


Certificate Dated __________________________________________________________________

Name ____________________________ Title ________________________________________

Residence ___________________________________

Volume ______________ Page _______________ Date Recorded_____________________

Transcribed by ____________________________________________________________________






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