N.Y. Dom. Rel. Law § 14
The town or city clerk of each and every town or city in this state is hereby empowered to issue marriage licenses to any parties applying for the same who may be entitled under the laws of this state to apply therefor and to contract matrimony, authorizing the marriage of such parties, which license shall be substantially in the following form:
State of New York County of ................ City or town of ..........
Know all men by this certificate that any person authorized by law to perform marriage ceremonies within the state of New York to whom this may come, he not knowing any lawful impediment thereto, is hereby authorized and empowered to solemnize the rites of matrimony between ............. of ........... in the county of ............. and state of New York and .................. of ................... in the county of ............. and state of New York and to certify the same to the said parties or either of them under his hand and seal in his ministerial or official capacity and thereupon he is required to return his certificate in the form hereto annexed. The statements endorsed hereon or annexed hereto, by me subscribed, contain a full and true abstract of all of the facts concerning such parties disclosed by their affidavits or verified statements presented to me upon the application for this license. This certificate is to be returned addressed to the undersigned at ..................., ............................, .................
(Street) (City, Town, Village) (State)
In testimony whereof, I have hereunto set my hand and affixed the seal of said town or city at .......... this ....... day of ........ nineteen ........, at........m. Seal.
The form of the certificate annexed to said license and therein referred to shall be as follows:
I, .... a ....., residing at ......... in the county of ........ and state of New York do hereby certify that I did on this ......... day of .... in the year, nineteen ......... at .....m, at ....... in the county of .......... and the state of New York, solemnize the rites of matrimony between .... of ..... in the county of ........... and state of New York, and .... of ..... in the county of ............. and state of New York in the presence of ..... and ..... as witness, and the license therefor is hereto annexed.
Witness my hand ...... in the county of ....... this ....... day of ....., nineteen .....
In the presence of
..............
..............
..............
There shall be endorsed upon the license or annexed thereto at the end thereof, subscribed by the clerk, an abstract of the facts concerning the parties as disclosed in their affidavits or verified statements at the time of the application for the license made in conformity to the provisions of section fifteen of this chapter.
There shall also be stated upon the license the exact period during which the marriage may be solemnized.
The license issued, including the abstract of facts, and the certificate duly signed by the person who shall have solemnized the marriage therein authorized, shall be returned by him, and where the marriage is solemnized by a written contract, the judge before whom acknowledgment is made shall forward such contract and marriage license to the office of the town or city clerk who issued the license within five days succeeding the date of the solemnizing of the marriage therein authorized and any person or persons who shall wilfully neglect to make such return within the time above required shall be deemed guilty of a misdemeanor and upon conviction thereof shall be punished by a fine of not less than twenty-five dollars or more than fifty dollars for each and every offense.
When a marriage is solemnized by a city, town or village justice outside of the territorial jurisdiction in which such justice was elected or appointed, as provided in subdivision six of section eleven of this chapter, there shall be affixed to such license prior to filing, the official or common seal of the court or of the municipality in which such justice was elected or appointed.
N.Y. Dom. Rel.Law § 14