(a) General rule.--No marriage license shall be issued except upon written and verified application made by both of the parties intending to marry.
(b) Contents.--The application shall contain the following:
(1) The full name of the applicants.
(2) The occupation, birthplace, residence and age of the applicants. An applicant intending to marry who is a program participant in the Address Confidentiality Program under Chapter 67 (relating to domestic and sexual violence victim address confidentiality) may use the substitute address designated by the Office of Victim Advocate pursuant to Chapter 67 as the address of their residence.
(3) Whether the marriage contemplated is the first, second or other marriage of an applicant.
(4) A statement that neither of the applicants is afflicted with transmissible disease.
(5) The full name, residence, occupation and birthplace of the parents of each applicant, including the maiden name of the mother of each applicant. An applicant may use the substitute address designated by the Office of Victim Advocate pursuant to Chapter 67 for a parent's residence if:
(i) the applicant is a program participant in the Address Confidentiality Program under Chapter 67 and the applicant resides with the applicant's parents; or
(ii) the applicant's parent is a program participant in the Address Confidentiality Program under Chapter 67.
(6) Any other facts necessary to determine whether a legal impediment to the proposed marriage exists.