Application for Marriage License, Denton County, Texas

Warning: The penalty for knowingly making a false statement can be 2-10 years in prison and a fine of up to $10,000. (HSC,Sec.195.003)

Groom Information
JUAN
PABLO
COSSIO
Name:__________________________________________________________________________________
First

Middle

Last

2522E TRINITY MILLS , 1107

CARROLLTON
TX
75006
Usual Address:___________________________________________________________________________
Street Name and Number

City

214-674-0115
Phone #:_______________________

State

Zip

MONCLOVA_21@HOTMAIL.COM
E-mail Address:__________________________________

974-77-1127
Social Security #:________________________________
7/9/1983
27
Date of Birth:________________________
Age:_______
MONCLOVA
COAHUILA
MX
Place of Birth:____________________________________________________________________________
City

County

I have not been divorced within the last 30 days.

True______

State

False______

I am not presently married and the other applicant is not presently married.

True______

I am not presently delinquent in the payment of court-ordered child support.

True_____False______

False______

The other applicant is not related to me as: an ancestor or descendant by blood or adoption; a brother or sister, of the whole or
by half blood or by adoption; a parents brother or sister of the whole or half blood or by adoption; a son or daughter of a brother
or sister of the whole or half blood or by adoption; a current or former stepchild or stepparent; a son or daughter of a parents
False____
brother or sister, of the whole or half blood or by adoption. True____

_______________________________________________________________________________________
Bride Information
DARIELA
MARIBEL
RIVADENEYRA
RODRIGUEZ
Name:__________________________________________________________________________________
First

Current Last

Middle

Maiden

2522E TRINITY MILLS , 1107

CARROLLTON
TX
75006
Usual Address:___________________________________________________________________________
Street Name and Number

214-674-3931
Phone #:_______________________

City

State

Zip

DARIELA580@HOTMAIL.COM
E-mail Address:__________________________________

645-38-6829
Social Security #:________________________________

8/19/1987
23
Date of Birth:________________________
Age:_______
PIEDRAS NEGRAS
COAHUILA
MX
Place of Birth:____________________________________________________________________________
City

I have not been divorced within the last 30 days.

County

True______

State

False______

I am not presently married and the other applicant is not presently married.

True______

I am not presently delinquent in the payment of court-ordered child support.

True_____False______

False______

The other applicant is not related to me as: an ancestor or descendant by blood or adoption; a brother or sister, of the whole or
by half blood or by adoption; a parents brother or sister of the whole or half blood or by adoption; a son or daughter of a brother
or sister of the whole or half blood or by adoption; a current or former stepchild or stepparent; a son or daughter of a parents
False____
brother or sister, of the whole or half blood or by adoption. True____
Date of Marriage:_________________________County of Marriage:________________________