One Day Designation Certificate

Note : * Indicates required fields.
If you wish to pay online, you must enter the applicant’s email address below.

Ceremony details

*City or town:

*Ceremony date:

Applicant

*First name:

Middle name:

*Last name:

*Street address:

Unit No:

*City or town:

*State:

*Country:

*Zip code:

*Phone number:

*Date of birth:

Email address:

Party A (information must be entered as it appears on the marriage intent application issued by the city/town clerk)

*First name:

Middle name:

*Last name:

*Street address:

Unit No:

*City or town:

*State:

*Country:

*Zip code:

Phone number:

*Date of birth:

Party B (information must be entered as it appears on the marriage intent application issued by the city/town clerk)

*First name:

Middle name:

*Last name:

*Street address:

Unit No:

*City or town:

*State:

*Country:

*Zip code:

Phone number:

*Date of birth: