Dinwiddie County
J. Barrett Chappell, Jr. - County Clerk
Requestor’s Info
Please enter this information about yourself.
Requestor Name
Requestor Phone
Requestor Email
Marriage License Application
PARTY A
indicates mandatory fields for the application to be processed
Bride
Groom
Spouse
First Name
Middle Name
Last Name
Suffix
Jr.
Sr.
II
III
IV
Last Name At Birth (if different)
Sex
Male
Female
Social Security Number
Street Address or Route Number
City or Town of Residence
Zipcode
County/City
State (or Foreign Country)
Place of Birth (State)
Birth Date
Age
Education - Elementary or Secondary (0-12)
Elementary 1
Elementary 2
Elementary 3
Elementary 4
Elementary 5
Elementary 6
Elementary 7
Elementary 8
High School 1
High School 2
High School 3
High School 4
College
College 1
College 2
College 3
College 4
College 5+
Number of this marriage
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Eighth
Ninth
Tenth
Eleventh
Twelfth
Other
If previously married, Marital Status
Widowed
Divorced
Parent First
Parent Middle
Parent Last
Suffix
Jr.
Sr.
II
III
IV
Parent Maiden (if applicable)
Sex
Male
Female
Parent First
Parent Middle
Parent Last
Suffix
Jr.
Sr.
II
III
IV
Parent Maiden (if applicable)
Sex
Male
Female
Marriage License Application
PARTY B
indicates mandatory fields for the application to be processed
Use Same Address as Party A
Bride
Groom
Spouse
First Name
Middle Name
Last Name
Suffix
Jr.
Sr.
II
III
IV
Last Name At Birth (if different)
Sex
Male
Female
Social Security Number
Street Address or Route Number
City or Town of Residence
Zipcode
County/City
State (or Foreign Country)
Place of Birth (State)
Birth Date
Age
Education - Elementary or Secondary (0-12)
Elementary 1
Elementary 2
Elementary 3
Elementary 4
Elementary 5
Elementary 6
Elementary 7
Elementary 8
High School 1
High School 2
High School 3
High School 4
College
College 1
College 2
College 3
College 4
College 5+
Number of this marriage
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Eighth
Ninth
Tenth
Eleventh
Twelfth
Other
If previously married, Marital Status
Widowed
Divorced
Parent First
Parent Middle
Parent Last
Suffix
Jr.
Sr.
II
III
IV
Parent Maiden (if applicable)
Sex
Male
Female
Parent First
Parent Middle
Parent Last
Suffix
Jr.
Sr.
II
III
IV
Parent Maiden (if applicable)
Sex
Male
Female
Submit Application
