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Office of the Registrar General

MARRIAGE LICENCE APPLICATION Marriage Act - Form 3

Marriage Licence No.

APPLICANT

JOINT APPLICANT

LAST NAME

FIRST AND MIDDLE NAMES

WIDOWED

DIVORCED

MONTH

YEAR

NEVER MARRIED

COURT FILE NUMBER

CITY DIVORCE GRANTED IN

PROVINCE (IF OUTSIDE CANADA, COUNTRY)

AGE

DATE OF BIRTH

DAY

MARITAL STATUS

IF DIVORCED IN CANADA, please provide the court file number

RELIGIOUS DENOMINATION

AGE AND DATE OF BIRTH

PLACE OF BIRTH

NEVER MARRIED

WIDOWED

COURT FILE NUMBER

CITY DIVORCE GRANTED IN

AGE

DATE OF BIRTH

DAY

MONTH

PROVINCE (IF OUTSIDE CANADA, COUNTRY)

DIVORCED

YEAR

LAST NAME

LAST NAME

FATHER'S NAME

FIRST (NAMES)

(Last, First)

FIRST (NAMES)

MOTHER'S MAIDEN NAME

LAST NAME

(Last name before marriage, First)

FIRST (NAMES)

LAST NAME

FIRST (NAMES)

FATHER'S PLACE

PROVINCE (IF OUTSIDE CANADA, COUNTRY)

OF BIRTH MOTHER'S PLACE

PROVINCE (IF OUTSIDE CANADA, COUNTRY)

PROVINCE (IF OUTSIDE CANADA, COUNTRY)

PROVINCE (IF OUTSIDE CANADA, COUNTRY)

OF BIRTH

STREET NAME AND NUMBER

APT

STREET NAME AND NUMBER

APT

CITY OR TOWN

PROVINCE

PRESENT RESIDENCE OR POSTAL ADDRESS

CITY OR TOWN

PROVINCE

POSTAL CODE

TELEPHONE NUMBER

POSTAL CODE

TELEPHONE NUMBER

STREET NAME AND NUMBER

APT

STREET NAME AND NUMBER

APT

CITY OR TOWN

POSTAL CODE

PROVINCE

TELEPHONE NUMBER

PERMANENT HOME ADDRESS IF DIFFERENT FROM ABOVE

CITY OR TOWN

POSTAL CODE

PROVINCE

TELEPHONE NUMBER

INTENDED PLACE OF MARRIAGE

CITY, TOWN, VILLAGE

COUNTY OR DISTRICT

INTENDED DATE OF MARRIAGE

I DECLARE THAT THE ABOVE INFORMATION IS CORRECT:

I DECLARE THAT THE ABOVE INFORMATION IS CORRECT:

SIGNATURE OF APPLICANT

SIGNATURE OF JOINT APPLICANT

DATE

DATE

Personal Information contained on this form is collected under the authority of the Marriage Act, R.S.O. 1990, c. M. 3 and will be used to determine whether to issue the marriage licence, to register and record the marriage, provide certified copies, extracts, certificates, search notices, photocopies and for statistical, research, medical, law enforcement, adoption and adoption disclosure purposes. Questions about this collection should be directed to: The Deputy Registrar General, Office of the Registrar General, PO Box 4600, Thunder Bay, ON P7B 6L8. Telephone 1 800 461-2156 or 416 325-8305.

11018 (2009/04)

© Queen’s Printer for Ontario, 2009

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