Territorial Court application

     (Typed/Printed Copies, Please)
     Number _________
     
     We ___________________ of ______________________ (Permanent Residence)
     And ___________________ of ______________________
      (Permanent Residence)
     
     do hereby apply for and request that a marriage license be granted us to enter into marriage in ____________, Virgin Islands, and we do further respectfully represent that the following statements are true and correct:
     
     MALE :
     
     Full Name ______________________ _______________________
     
     Social Security No. ________________ ______________________
     
     Date of Birth ____________________ ______________________
     
     Place of Birth ___________________ ______________________
     
     Nationality ______________________ ______________________
     
     Usual Residence __________________ ______________________
     
     Parents:
      Present Name___________________ ______________________
      Maiden Name___________________ ______________________
      Place of Birth ___________________ ______________________
     
     Previous Marital Status ______________ ______________________
     
     Related to other applicant? ____________ ______________________
     In what degree? ___________________ ______________________
     
     Signature ________________________ ______________________
     
     FEMALE:
     
     Full Name ______________________ _______________________
     
     Social Security No. ________________ ______________________
     
     Date of Birth ____________________ ______________________
     
     Place of Birth ___________________ ______________________
     
     Nationality ______________________ ______________________
     
     Usual Residence __________________ ______________________
     
     Parents:
      Present Name___________________ ______________________
      Maiden Name___________________ ______________________
      Place of Birth ___________________ ______________________
     
     Previous Marital Status ______________ ______________________
     
     Related to other applicant? ____________ ______________________
     In what degree? ___________________ ______________________
     
     Signature ________________________ ______________________
     
     Subscribed and sworn to by each of the above parties this _____ day of ______, ____
     
     License issued this ______ day of __________, _____
     
     Filed this _____ day of __________, _____
     
     Clerk of the Territorial Court
     
      By: _________________
      Deputy Clerk