Marriage License Form:

Complete this form and return it, along with your payment and a self-addressed stamped envelope to: Circuit Court Clerk's Office - Marriage License Dept. P.O. Box 1248 Wise, VA 24293-1248. Along with $3.00 to obtain a certified copy. Methods of payment are: money orders, certified checks, personal checks written on a LOCAL (Wise County) bank only payable to J. Jack Kennedy, Jr., Clerk of the Circuit Court.

Print this form:

License Number:________________

How many copies? _________ X $3.00/copy= ___________(amount enclosed)

Name of Groom:________________

Name of Bride:_________________

Date of Marriage:_______________

Daytime Phone:________________

OFFICE USE ONLY:

Date Received:_______

Date Mailed Out:______