California Form Vs116 PDF Details

The California VS116 form is a critical document for individuals seeking to legally declare their marriage in the state of California, especially when a formal marriage record does not exist for a solemnized marriage. This form covers detailed personal information for both parties involved, including their names (both current and at birth), dates of birth, previous marital status, and details about their parents. It also mandates the declaration of their marriage under penalty of perjury, asserting the truthfulness of the information provided and confirming the occurrence of the marriage ceremony in California. Furthermore, the form includes a section for changing middle and/or last names post-marriage, offering a structured way for individuals to legally adopt new names through their marriage declaration. It emphasizes the requirement of dark ink for legibility, insists on accuracy without alterations, and outlines the procedural steps for the document’s submission to the appropriate county recorder. In essence, this form serves as both a declaration and a permanent legal acknowledgment of a marriage, facilitating the rights and recognitions afforded to marital unions within the state. Moreover, it underscores the significance of this declaration by highlighting the penalties for perjury and the public nature of the declared marriage. By doing so, it not only ensures the proper legal acknowledgment of a marriage but also provides a way for couples to officially record their union, reflecting its importance within California’s legal and social framework.

QuestionAnswer
Form NameCalifornia Form Vs116
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names25B, 32B, vs116 form, CALIFORNIA

Form Preview Example

Groom Bride

FIRST PERSON DATA

LICENSE AND CERTIFICATE OF

DECLARATION OF MARRIAGE

 

MUST BE LEGIBLE – MAKE NO ERASURES, WHITEOUTS, OR OTHER ALTERATIONS

 

 

 

STATE FILE NUMBER

USE DARK INK ONLY

 

 

 

LOCAL REGISTRATION NUMBER

 

1A. FIRST NAME

 

 

1B. MIDDLE

 

 

 

 

 

 

 

 

1C. CURRENT LAST

 

 

1D. LAST NAME AT BIRTH (IF DIFFERENT THAN 1C)

 

 

 

 

 

 

 

 

 

2. DATE OF BIRTH (MM/DD/CCYY)

3. STATE/COUNTRY OF BIRTH

4. #PREV. MARRIAGES/SRDP

5A. LAST MARRIAGE/SRDP ENDED BY:

 

5B. DATE ENDED (MM/DD/CCYY)

 

 

 

 

 

DEATH DISSO ANNULMENT TERM SRDP

N/A

 

6. ADDRESS

 

7. CITY

 

8. STATE/COUNTRY

 

9. ZIP CODE

 

 

 

 

 

 

 

 

 

10A. FULL BIRTH NAME OF FATHER/PARENT

 

 

10B. STATE OF BIRTH (IF OUTSIDE U.S. ENTER COUNTRY)

 

 

 

 

 

 

11A. FULL BIRTH NAME OF MOTHER/PARENT

 

 

11B. STATE OF BIRTH (IF OUTSIDE U.S. ENTER COUNTRY)

 

12A. FIRST NAME

 

 

12B. MIDDLE

 

 

 

Groom Bride

SECOND PERSON DATA

AFFIDAVIT

12C. CURRENT LAST

 

 

12D. LAST NAME AT BIRTH (IF DIFFERENT THAN 12C)

 

 

 

 

 

 

 

 

13. DATE OF BIRTH (MM/DD/CCYY)

14. STATE/COUNTRY OF BIRTH

15. # PREV. MARRIAGES/SRDP

16A. LAST MARRIAGE/SRDP ENDED BY:

 

16B. DATE ENDED (MM/DD/CCYY)

 

 

 

 

DEATH

DISSO ANNULMENT TERM SRDP

N/A

 

 

 

 

 

 

 

 

 

17. ADDRESS

 

18. CITY

 

19. STATE/COUNTRY

 

20. ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

21A. FULL BIRTH NAME OF FATHER/PARENT

 

 

 

21B. STATE OF BIRTH (IF OUTSIDE U.S. ENTER COUNTRY)

 

 

 

 

 

 

 

 

22A. FULL BIRTH NAME OF MOTHER/PARENT

 

 

 

22B. STATE OF BIRTH (IF OUTSIDE U.S. ENTER COUNTRY)

WE, THE UNDERSIGNED, DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT TO THE BEST OF OUR KNOWLEDGE AND BELIEF. WE FURTHER DECLARE THAT WE ARE PRESENTLY MARRIED TO EACH OTHER, THAT A CALIFORNIA MARRIAGE LICENSE WAS OBTAINED PRIOR TO THE CEREMONY, AND THAT THE CEREMONY OCCURRED IN CALIFORNIA. WE ACKNOWLEDGE RECEIPT OF THE INFORMATION REQUIRED BY FAMILY CODE SECTION 358 AND HEREBY APPLY FOR A LICENSE AND CERTIFICATE OF DECLARATION OF MARRIAGE.

23. SIGNATURE OF PERSON LISTED IN FIELDS 1A-1D

24. SIGNATURE OF PERSON LISTED IN FIELDS 12A-12D

 

LICENSE TO MARRY

CERTIFICATION

OF MARRIAGE

TO THE MARRIAGE

REQUIRED)

WITNESSES

(TWO

I, THE UNDERSIGNED, DO HEREBY CERTIFY THAT THE ABOVE-NAMED PARTIES HAVE PERSONALLY APPEARED BEFORE ME AND PROVED TO ME ON THE BASIS OF SATISFACTORY EVIDENCE TO BE THE PERSONS CLAIMED, HAVE DECLARED THAT THEY MEET ALL THE REQUIREMENTS OF THE LAW, AND HAVE PAID THE FEES PRESCRIBED BY LAW. THESE REQUIREMENTS HAVING BEEN MET, I HEREBY ISSUE THE LICENSE AND CERTIFICATE OF DECLARATION OF MARRIAGE.

25A. ISSUE DATE (MM/DD/CCYY)

25B. EXPIRES AFTER (MM/DD/CCYY)

25C. NAME OF COUNTY CLERK

25D. SIGNATURE OF CLERK OR DEPUTY CLERK

 

 

 

BY

25E. MARRIAGE LICENSE NUMBER

25F. COUNTY OF ISSUE

25G. RETURN COMPLETED MARRIAGE LICENSE TO (INCLUDE ADDRESS):

WE, THE ABOVE-NAMED PARTIES, DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA, THAT WE WERE JOINED IN MARRIAGE IN ACCORDANCE WITH THE LAWS OF THE STATE OF CALIFORNIA AS INDICATED BELOW.

26A. DATE OF MARRIAGE (MM/DD/CCYY)

26B. CITY/TOWN OF MARRIAGE

26C. COUNTY OF MARRIAGE

 

 

 

 

27. SIGNATURE OF PERSON LISTED IN FIELDS 1A-1D

 

 

28. SIGNATURE OF PERSON LISTED IN FIELDS 12A-12D

 

 

 

 

WE, THE UNDERSIGNED, DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA, THAT WE WERE PHYSICALLY PRESENT AT THE MARRIAGE CEREMONY OF THE ABOVE-NAMED PARTIES, THAT WE WITNESSED THE ABOVE-NAMED PERSONS COMPLETE THE MARRIAGE CEREMONY, THAT THE CEREMONY OCCURRED IN CALIFORNIA, AND THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT TO THE BEST OF OUR KNOWLEDGE AND BELIEF.

29A. SIGNATURE OF WITNESS

29B. NAME OF PERSON WITNESSING MARRIAGE (TYPE OR PRINT CLEARLY)

 

 

 

 

29C. ADDRESS, CITY, STATE/COUNTRY, AND ZIP CODE

 

 

 

 

 

30A. SIGNATURE OF WITNESS

30B. NAME OF PERSON WITNESSING MARRIAGE (TYPE OR PRINT CLEARLY)

 

 

 

 

30C. ADDRESS, CITY, STATE/COUNTRY, AND ZIP CODE

 

 

NEW NAMES (IF ANY)

NEW MIDDLE AND LAST NAME OF PERSON LISTED IN 1A-1D (IF ANY) FOR USE UPON SOLEMNIZATION OF THE MARRIAGE (SEE REVERSE FOR INFORMATION)

31A. FIRST – MUST BE SAME AS 1A

31B. MIDDLE

31C. LAST

 

NEW MIDDLE AND LAST NAME OF PERSON LISTED IN 12A-12D (IF ANY) FOR USE UPON SOLEMNIZATION OF THE MARRIAGE (SEE REVERSE FOR INFORMATION)

32A. FIRST – MUST BE SAME AS 12A

32B. MIDDLE

32C. LAST

LOCAL

33A. NAME OF LOCAL REGISTRAR

33B. SIGNATURE OF CLERK OR DEPUTY CLERK

33C. DATE ACCEPTED FOR REGISTRATION

 

 

 

REGISTRAR

 

BY

 

 

 

 

STATE OF CALIFORNIA, DEPARTMENT OF PUBLIC HEALTH, OFFICE OF VITAL RECORDS

VS-116 (01/01/2010)

INSTRUCTIONS AND INFORMATION

Refunds CANNOT be given after a marriage license is issued.

You will not be notified that your license has been registered. You do not automatically receive a certified copy. You must request and pay for a certified copy from the local registrar of marriages (County Recorder) in the county where the license was issued.

SRDP = State Registered Domestic Partnership as registered with the Secretary of State. Pursuant to Family Code, Section 298.5(c), no person who has filed a Declaration of Domestic Partnership may enter a marriage with someone other than their registered domestic partner unless the most recent domestic partnership has been terminated or a final judgment of dissolution or nullity has been entered, or the domestic partnership terminated due to death of one of the domestic partners.

“New Name(s)”—Law applying to middle and last names (items 31B, 31C, 32B, and 32C) OPTIONAL: Pursuant to Family Code Section 306.5, at the time of application for a marriage license, one or both parties to the marriage may elect to change the middle or last names, or both, by which that party wishes to be known after solemnization of the marriage by entering that information on the marriage license application. Parties may adopt any of the following middle names: the current last name of either spouse; the last name of either spouse given at birth; a hyphenated combination of the current middle name and the current last name of the person or spouse; a hyphenated combination of the current middle name and the last name given at birth of the person or spouse. Parties may adopt any of the following last names: the current last name of the other spouse; the last name of either spouse given at birth; a name combining into a single last name all or a segment of the current last name or last name of either spouse given at birth; a hyphenated combination of last names. NOTE: The first name of the parties may not be changed on the marriage license. An amendment to the new name fields may only be issued to correct clerical errors, and that amendment must be signed by one of the parties to the marriage and the county clerk or his or her deputy.

PURCHASE OF A LICENSE

All persons must purchase a License and Certificate of Declaration of Marriage from the County Clerk in the parties’ county of residence in order to declare a California marriage which has been solemnized, but for which no official record exists (Family Code Section 425).

To Persons Declaring Their Marriage

The License and Certificate of Declaration of Marriage expires 90 days after date of issue in Item 25A and cannot be used after the “Expiration Date” shown in Item 25B. A declared marriage is a public record. If you are declaring a marriage that originally used a Confidential Marriage License, using this License and Certificate of Declaration of Marriage would then make it a public record.

1.Complete the marriage license using DARK INK ONLY.

2.Enter date and place of marriage in Items 26A, 26B, and 26C.

3.Sign your names in Items 27 and 28.

4.Have two witnesses to the marriage sign Items 29A and 30A and complete Items 29B, 29C, 30B and 30C.

The completed LICENSE AND CERTIFICATE OF DECLARATION OF MARRIAGE must be returned within 10 days of completion by either of the parties declaring the marriage to be registered by the local registrar of marriages (County Recorder) of the county where the license was issued at the address in box 25G. It can be mailed or delivered in person.

PRIVACY NOTIFICATION

Civil Code Section 1798 et seq. requires each state agency to provide this notice to individuals completing this form. The information is being requested by: State of California, Department of Public Health, Office of Vital Records, MS 5103, P.O. Box 997410, Sacramento, CA 95899- 7410, Telephone (916) 445-2684.

The information requested on this certificate is authorized and required by Division 102 of the Health and Safety Code, and related provisions within the Civil Code, Code of Civil Procedure, Family Code, and Government Code.

The completion of all items requested on this form is mandatory. Health and Safety Code Section 103775 provides that, “Every person, except a parent informant for a certificate of live birth, who is responsible for supplying information who refuses or fails to furnish correctly any information in his or her possession which is required by this division, or furnishes false information affecting any certificate or record required by this division, is guilty of a misdemeanor.”

The principal purpose for this record is:

1.To establish a permanent record that is legally recognized as prima facie evidence of the facts stated therein for each marriage occurring in the State of California.

2.To provide individuals with certified copies from the records to serve their personal needs, such as securing passports and applying for social security or death benefits.

3.To provide information to health authorities and other qualified persons with a valid educational or scientific interest, for demographic and epidemiological studies for health and social purposes.

4.This information is also provided to the National Center for Health Statistics for compiling national statistical reports.

This record shall be open for examination during regularly scheduled office hours, except when access is specifically prohibited by statute or regulations.

For Official Use Only

STATE OF CALIFORNIA, DEPARTMENT OF PUBLIC HEALTH, OFFICE OF VITAL RECORDS

VS-116 (01/01/2010)

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