La. Admin. Code tit. 48 § V-12309

Current through Register Vol. 50, No. 9, September 20, 2024

Section V-12309 - Certificate of Marriage Preparation

A. The marriage license/certificate shall be prepared in duplicate for those issued in Orleans parish (PHS-5) and in triplicate for those issued in other parishes (PHS-5). At the point of license issue, the original and souvenir copy shall be provided to the bride and groom. Upon completion of the certificate, distribution instructions appearing on the lower right are to be followed. At least one of the applicants shall be a resident of the parish in which the license is purchased.

B. Section-Groom. This section as well as all information pertaining to the bride and groom shall be prepared on the basis of the applicants' birth certificate and/ or statements.

1. Last Name of Groom. Enter the last name of the groom.

2. First Name. Enter the first name of the groom.

3. Second Name. Enter the second name of the groom.

4. Usual Residence. Enter the street address, rural route and city and state.

5. Is Residence Inside City Limits? Check the appropriate block.

6. Parish. Enter the parish of residence.

7. State. Enter the state of residence.

8. Race of Color. Enter the race or color as it appears on the applicant's birth certificate. In cases wherein race does not appear on the birth certificate or a waiver was presented as permitted by R. S. 9:242, the statement of the applicant shall be accepted.

9. Date of Birth. Enter the date of birth as it appears on the applicant's birth certificate or as it is provided by the applicant if a waiver pursuant to R. S. 9:242 is presented. Enter the applicant's age in years.

10. State of Birth. Enter the information as shown on the birth certificate. If birth occurred outside the United State, enter the name of the country.

11. Father-Name. The name of the father shall be the husband of the mother of the groom, otherwise, a father's name shall not be entered. If a father's name is to be entered, complete this item as it appears on the applicant's birth certificate or accept the statement of the applicant.

12. State of Birth. If a father's name is entered in Item 9, enter the state of birth, or if outside the United States, the name of the country of birth.

13. Mother-Maiden Name. Enter the maiden name of mother.

14. State of Birth. This section shall be completed per instructions outlined in the previous section.

C. Section-Bride. This section shall be completed per instructions outlined in the previous section.

D. Section-Place of Issue of CertificateParish. City or Town 3. Date of Issue Enter the month, day and year of issuance in numerals.

E. Section-Marriage Certification

1. Shall be completed by the officiate certifying that he/she officiated at the marriage ceremony of the bride and groom whose names appear on the license. The officiant shall ensure that all the essential signatures are affixed before the officiant signs in Item 34.

2. Signature of Witness. The signature of one of the witnesses shall appear in this item.

3. Signature of Groom. The signature of the groom shall appear in this item.

4. Signature of Witness The signature of one of the witnesses shall appear in this item.

5. Signature of Bride The signature of the bride shall appear in this item.

6. Signature of Witness This item shall be left blank; see Act 817, 1984 Regular Session.

7. Signature and Title of Officiant. Enter the signature of the person completing the certification in Item 28 and indicate his/her title.

8. Local Recording Officer's Signature. Enter the signature of the parish recording officer authorized to issue the license. Stamps or facsimilies are permissible.

9. Enter the title of the person whose signature appears in Item 35.

E. Section-Confidential Information Groom and Bride Enter the following information on the groom and bride:

1. Number of this marriage

2. If previously married-If the applicant was previously married, the applicant shall provide a certified copy of a judgment of divorce or a certified copy of a death certificate, whichever is applicable.

3. Date-If the applicant was previously married, enter the date the marriage was dissolved.

4. Education-Circle the highest grade completed.

5. If the bride had been married before, enter the full name of the previous husband.

F. Reverse Side of Form

1. Applicant's Affidavit

a. This section shall be completed by the licensing official and signed by the applicant and the licensing official or his designee. Officiant's Authorization.

b. This section shall be completed and signed by the licensing official or his designee.

La. Admin. Code tit. 48, § V-12309

Promulgated by the Department of Health and Human Resources, Office of Preventive and Public Health Services, LR 13:246 (April 1987).

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:32 et seq.