THE CITY OF NEW YORK, OFFICE OF THE CITY CLERK
MARRIAGE LICENSE BUREAU
APPLICATION FOR THE CORRECTION
OF
A MARRIAGE RECORD
(Pursuant to § 14-a(5) of the Domestic Relations Law)
STATE OF NEW YORK)
CITY OF NEW YORK ) SS.: PRINT OR TYPE ALL INFORMATION CLEARLY
________________________________________ _________________________________________
Full name of Bride/Groom/Spouse A Full name of Bride/Groom/Spouse B
WE NOW LIVE AT _________________________________________________________________________________
House number and street address City State Zip Code
TELEPHONE #: (__________)__________________________________
We obtained a marriage license in the borough of
________________________________________and our ceremony was performed on
__________________________________
Date of ceremony
at: _____________________________________________________________________________________________________________________
Name and address where ceremony was performed
LIST BELOW THE INCORRECT INFORMATION THAT NOW APPEARS
ON YOUR MARRIAGE RECORD:
(1) ____________________________________________
(2) ____________________________________________
(3) ____________________________________________
(4) ____________________________________________
LIST BELOW THE CORRECT INFORMATION THAT SHOULD
APPEAR ON YOUR MARRIAGE RECORD:
(1) ____________________________________________
(2) ____________________________________________
(3) ____________________________________________
(4) ____________________________________________
WE BELIEVE THAT THE ERROR(S) WAS (WERE) MADE BECAUSE:
(1) ________________________________________________________________________________________________________________
(2) ________________________________________________________________________________________________________________
(3) ________________________________________________________________________________________________________________
(4) ________________________________________________________________________________________________________________
EXPLAIN IN DETAIL ALL FACTS; ATTACH ADDITIONAL PAGES AS NECESSARY
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
WE SUBMIT THE FOLLOWING DOCUMENT(S) AS EVIDENCE IN SUPPORT OF OUR APPLICATION. NOTE: IF YOU ARE SUBMITTING YOUR
APPLICATION IN PERSON YOU MUST SUBMIT ORIGINAL OR CERTIFIED DOCUMENTARY EVIDENCE WITH THIS FORM. DOCUMENTS WILL
BE RETURNED TO YOU AFTER USE.
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
BEING SUBSCRIBED AND SEVERALLY SWORN TO ME
THIS __________ DAY OF ________________, 20 _________
_____________________________________________________
Notary Public or Commissioner Of Deeds
FOR MAIL APPLICATIONS ONLY
X ________________________________________________________
Signature of Bride/Groom/Spouse A
X ________________________________________________________
Signature of Bride/Groom/Spouse B
X ________________________________________________________
Signature of witnessing clerk
FOR OFFICE USE ONLY: _______________________________________________________________________________________________________
If you are applying by mail, please send copies of the original documents certified as true copies of the originals.
DO NOT SEND THE ACTUAL DOCUMENTS EXCEPT FOR THE ORIGINAL MARRIAGE CERTIFICATE.
FORM CC2008 4/6/2017
YEAR _____________________
CASE# ____________________