N.C. Gen. Stat. § 51-8.2

________, [applicant] appearing before the undersigned notary and being duly sworn, says that: 1. I, ________, [applicant’s name] am applying for a license in ________ County, North Carolina, to marry ________ [name of other applicant] in North Carolina within the next 60 days and I am authorized under G.S. 51-8.2 to complete this Affidavit in Lieu of Personal Appearance for Marriage License Application. I attach: (1) documentation that I am over 18 years of age as required in county of issuance; and (2) documentation of divorce as required by county of issuance. 2. I submit the following information in applying for a marriage license: Name: ___________________________________________________________________ First Middle Last Residence: ______________________________________________________________ State County City or Town ________________________________________________________________________ Street and Number Inside City Limits (Yes or No): _________________________________________ Birthplace: _____________________________________________________________ County & State or Country Birth Date: ____________________________ Age: ________ Father: _________________________________________________________________ Name State of Birth ________________________________________________________________________ Address (if living) or Deceased Mother: _________________________________________________________________ Name State of Birth ________________________________________________________________________ Address (if living) or Deceased Race (Optional): ________________________________________________________ Number of this marriage: 1st, 2nd, etc. _________________________________ Last Marriage Ended by: _________________________________________________ Death, Divorce, Annulment Date Marriage Ended: ____________________________________________________ Specify Highest Grade Completed in School (Optional): ___________________ Social Security # ____________________________ (If applicant does not have Social Security number, attach affidavit of ineligibility) I hereby make application to the Register of Deeds for a Marriage License and solemnly swear that all of the statements contained in the above application are true and I further make oath that there is no legal impediment to such marriage. ____________________________ Signature of Applicant Sworn to (or affirmed) and subscribed before me this ____ day of ________, ________. ________________________ [Seal] Notary Public My commission expires: ________ ____________________________________ [Notary’s typed or printed name].