310-409-7236
Creating Beautiful Wedding Memories. . .
         One Love Story at a Time!
Creating Beautiful Wedding Memories. . .
       One Love Story at a Time!

Rev. Lorelei Starbuck
Bride Application
Los Angeles Officiant, southern california beach weddings, wedding california, clergy, officiant, officiants, reverend, reverends, nondenomanational, denomanational, religious non religious, metaphysical, new thought,christian
Applicant 1First Name
*Please fill in every box.

*Do not leave one blank.

*If it does not apply to  
you type N/A in box.

*Please check your work  
carefully.

*Make sure all  
information is correct,
free of mis-spellings.

**Your license will be  
created from this
application. Errors can
not be made on original
license.

**Mistakes require a new
license to be issued at an
additional cost of 70.00

Call Rev. Lorelei if you
have questions filling this
out!

310-409-7236
Middle  Name
Last Name
Maiden Name
Date of Birth
State of Birth
Number of Marriages
Last Marriage ended in:
Divorce/Anullment/Death
Date Marriage Ended
Father's Full name
Father's State of Birth
Mother's full Maiden name
Mothers State of Birth
Couples Address
City, County, State
Zip Code
Phone Number
Email Address
Mailing Addres if Different
I attest that all the information supplied above is true and correct to the best of my knowledge and
that I have read the requirements for a confidential marriage license and that I am eligible to apply
for a Confidential Marriage License.   By my initials below I agree to be bound by the terms and
conditions of this application and hold the Notary harmless for any and all mistakes made by me.
Initials
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