La. Stat. tit. 9 § 273.1
_____________________________________________________________
(Insert names of the prospective spouses)
who after being duly sworn by me, Notary, deposed and stated that:
Affiants acknowledge that they have received premarital counseling from a priest, minister, rabbi, clerk of the Religious Society of Friends, any clergyman of any religious sect, or a professional marriage counselor, which marriage counseling included:
A discussion of the seriousness of Covenant Marriage;
Communication of the fact that a Covenant Marriage is a commitment for life;
The obligation of a Covenant Marriage to take reasonable efforts to preserve the marriage if marital difficulties arise, and
That the affiants both read the pamphlet entitled "The Covenant Marriage Act" developed and promulgated by the office of the attorney general, which provides a full explanation of a Covenant Marriage, including the obligation to seek marital counseling in times of marital difficulties and the exclusive grounds for legally terminating a Covenant Marriage by divorce or divorce after a judgment of separation from bed or board.
_________________________
(Name of prospective spouse)
_________________________
(Name of prospective spouse)
SWORN TO AND SUBSCRIBED BEFORE ME THIS _____ DAY OF ____________, ________.
________________________________
NOTARY PUBLIC
ATTESTATION
The undersigned does hereby attest that the affiants did receive counseling from me as to the nature and purpose of marriage, which included a discussion of the seriousness of Covenant Marriage, communication of the fact that a Covenant Marriage is for life, and the obligation of a Covenant Marriage to take reasonable efforts to preserve the marriage if marital difficulties arise.
_______________________________
Counselor
La. R.S. § 9:273.1