Complete the below marriage application information to process your application request more efficiently.
The information entered below will automatically be forwarded to the bedford County Clerk's Office.
Note: You will need to use your marriage license within thirty days of the date issued.
Applicant 1 Personal Information
First Name (Required):
Middle Name (optional):
Last Name (Required):
Original Surname (optional):
Suffix (optional):
OR
Street Address (Required):
City (Required):
State (Required)
Zip (Required)
County Residing (Required):
OR
Phone Number (optional):
Email (Required)
Confirm Email (Required)
Date of Birth (Required):
Birthplace State (Required)
Country (Required):
Gender (Required):
Designation (Required):
Race (Required):
Hispanic Origin (Required):
Applicant 1 Marital History
Have you previously been married? (Required)
Applicant 1 Educational Information
What is the highest grade completed?
Applicant 1 Parental Information
*If name is unknown, please type unknown in that field*
Father / Parent 1
First Name (Required):
Middle Name (optional):
Last Name (Required):
Original Surname (optional):
Suffix (optional):
OR
Birthplace State (Required):
Country (Required):
Mother / Parent 2
First Name (Required):
Middle Name (optional):
Last Name (Required):
Original Surname (optional):
Suffix (optional):
OR
Birthplace State (Required):
Country (Required):
Applicant 2 Personal Information
First Name (Required):
Middle Name (optional):
Last Name (Required):
Original Surname (optional):
Suffix (optional):
OR
Address same as Applicant 1
Street Address (Required):
City (Required):
State (Required)
Zip (Required)
County Residing (Required):
OR
Phone Number (optional):
Email (Required)
Confirm Email (Required)
Date of Birth (Required):
Birthplace State (Required):
Country (Required):
Gender (Required):
Designation (Required):
Race (Required):
Hispanic Origin (Required):
Applicant 2 Marital History
Have you previously been married? (Required)
Applicant 2 Educational Information
What is the highest grade completed?
Applicant 2 Parental Information
*If name is unknown, please type unknown in that field*
Father / Parent 1
First Name (Required):
Middle Name (optional):
Last Name (Required):
Original Surname (optional):
Suffix (optional):
OR
Birthplace State (Required):
Country (Required):
Mother / Parent 2
First Name (Required):
Middle Name (optional):
Last Name (Required):
Original Surname (optional):
Suffix (optional):
OR
Birthplace State (Required):
Country (Required):