Civil Union License Application

Upon submitting this online civil union license application, you will receive a Confirmation Number that is valid for 14 days.

Please fill in all the information in the fields below

* required fields

Partner A Information
Name & Birth Information
First Name Required
Last Name Required
Date of Birth Required
MM/DD/YYYY Format Required
Birth City Required
Birth Place Required
Last Name On Birth Cert Required
Gender Is Required

If applicant does not have a social security number, please enter 000000000

SSN Required
XXXXXXXXX Format Required
Address
Address Required
City Required
Country Required
Vital Statistics
Phone Number Required
XXX-XXX-XXXX Format Required
Email Is Required
Enter A Valid Email Address

Select the highest grade completed.

Marriage History
Number of this Marriage/Civil Union Required
MM/DD/YYYY Format Required
Partner A Parents Information

If a parent(s) is deceased, please fill out the name and type "deceased" in the address field.

If a parent(s) information is unknown, please type "unknown" in the unknown fields.

Parent's First Name Required
Parent's Last Name Required
Parent's Address Required
Parent's Last Name on Birth Certificate Required
Parent's Place of Birth Required
Parent's First Name Required
Parent's Last Name Required
Parent's Address Required
Parent's Last Name on Birth Certificate Required
Parent's Place of Birth Required
Partner B Information
Name & Birth Information
First Name Required
Last Name Required
Date of Birth Required
MM/DD/YYYY Format Required
Birth City Required
Birth Place Required
Last Name on Birth Cert Required
Gender Required

If applicant does not have a social security number, please enter 000000000

SSN Required
XXXXXXXXX Format Required
Address
Address Required
City Required
Country Required
Vital Statistics
Phone Number Required
XXX-XXX-XXXX Format Required
Email Required
Must Be A Valid Email

Select the highest grade completed.

Marriage History
Number of this Marriage/Civil Union Required
MM/DD/YYYY Format Required
Partner B Parents Information

If a parent(s) is deceased, please fill out the name and type "deceased" in the address field.

If a parent(s) information is unknown, please type "unknown" in the unknown fields.

Parent's First Name Required
Parent's Last Name Required
Parent's Address Required
Parent's Last Name on Birth Cert Required
Parent's Place of Birth Required
Parent's First Name Required
Parent's Last Name Required
Parent's Address Required
Parent's Last Name on Birth Cert Required
Parent's Place of Birth Required
Partner A & Partner B Relationship

Please review your information and make sure it is correct and click Submit button below