CLERK OF THE COURT
SUPERIOR COURT OF ARIZONA
MOHAVE COUNTY
POST OFFICE BOX 7000
KINGMAN, ARIZONA 86402

Virlynn Tinnell
Clerk

Phone (928) 753-0713
Fax (928) 753-0781

MARRIAGE LICENSE BY MAIL APPLICATION FORM

Please Print: Information must be clear and accurate as it will appear on your marriage license.

MALE: (All information must be provided per A.R.S. §25-121)

Legal Name: _____________________________________________________________________________

First

Middle

Last
Current Address: _____________________________________________________________________________

Street Address

 

  _____________________________________________________________________________

City

State

Zip Code
  _____________________________________________________________________________

Age

Date of Birth

Social Security Number
OR

 

(  ) I do not have a social security number

FEMALE: (All information must be provided per A.R.S. §25-121)

Legal Name: _____________________________________________________________________________

First

Middle

Last
Current Address: _____________________________________________________________________________

Street Address

 

  _____________________________________________________________________________

City

State

Zip Code
  _____________________________________________________________________________

Age

Date of Birth

Social Security Number
OR

 

(  ) I do not have a social security number

Please provide the address where you may be contacted after your wedding:
 
Name: ______________________________________________________________________

Street Address: _______________________________________________________________

City, State, Zip Code: __________________________________________________________