Phs T 004 Form PDF Details

Are you in the process of filing for a tax return? If so, then you’ve likely heard about the PHS T 004 form. This legally mandated form is required for all advanced payment transactions and can be used for a variety of different situations. Regardless of why you need it, understanding the specifics behind this form is key to ensuring everything goes as smoothly as possible during your tax-filing endeavors. In this blog post, we'll walk you through each and every step involved with filling out and submitting your very own PHS T 004 form!

QuestionAnswer
Form NamePhs T 004 Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesvi marriage license, sample notarized forms for st thomas virgin islands, 11a, 14b

Form Preview Example

NO. _____

(Please Type)

 

 

APPLICATION FOR MARRIAGE LICENSE

We

 

 

of

 

 

 

 

 

(Permanent Residence)

and

 

 

of

 

 

 

 

 

(Permanent Residence)

do hereby apply for and request that a marriage license be granted us to enter into marriage in

,Virgin Islands, and we do further respectfully represent that the following statements are true and correct:

MALE

Full Name

SS No.

Date of Birth

Place of Birth

Nationality

Usual Residence

Parents:

Present Name

Maiden Name

Place of Birth

Previous Marital Status

Related to other Applicant?

In what degree?

Please check this box if you are requesting exemption to the eight day posting requirement explained in the attached marriage information fact sheet.

We are requesting exemption because of the following special circumstances:

FEMALE

The court, having reviewed this application for marriage license, determines that special circumstances exist to issue a license without the posting required by title 16 section 38 of the Virgin Islands Code.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

JUDGE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Subscribed and sworn to by each of the parties this

 

 

 

day of

 

 

 

,

.

License issued this

 

 

 

day of

 

 

 

 

 

 

,

 

.

 

 

Filed this

 

 

day of

 

 

,

 

 

 

 

 

.

 

 

 

Clerk of the Territorial Court

By:

Deputy Clerk

Requirements when Applying For A Marriage License in the U.S. Virgin Islands.

1.MARRIAGE APPLICATION FORM TO BE COMPLETED BY APPLICANTS (TYPE)

a.Full name, age at last birthday

b.Social Security Number

c.Date of Birth

d.Nationality; Usual Residence

e.Name of Parents (present/maiden place of birth)

f.Previous Martial Status (widowed, divorced, marriage annulled)

After completion, please return the application to the Court. Applications must be typed. Any application that is not typed will be retuned to the applicants. If applicants have been divorced, it is required that a certified copy of their divorce decree be filed along with the application. Applicants should attach a letter with the application detailing:

a.Date of Visit

b.Length of Stay

c.Date of preference if desirous of having the marriage performed by a judge

2.POSTING OF APPLICATION

Virgin Islands law requires that “[b] efore any marriage license is issued, the application for such license shall be posted for public examination in the Office of the

Clerk of the Court for eight (8) days.” The law contains an exception, however, for “special cases.” If you will not be present in the Virgin Islands for eight (8) days preceding your marriage ceremony, you may be exempted from the posting requirement under the

“special cases” exemption. Thus, applicants presenting these or similar circumstances may be granted a marriage license without having to comply with the posting requirement. If you need an exemption from the eight-day posting requirement, check the appropriate box on the application form and include a brief explanation of your reason for the request in the space provided.

3.EXAMINATION OF APPLICANTS FOR MARRIAGE LICENSE

Before a Marriage License can be issued, applicants are required to personally appear before the Clerk of the Court, or her designee, to be examined under oath.

a.Some form of identification is required.

b.No physical examination or blood test is required.

The Clerk will then notarize your application. Please do not have application notarized prior to appearing before the Court.

4.FEES

All fees are to be paid by certified check, money order or by cash when paying in person. The fee for filing a Marriage Application is $50.00 which is “non-refundable” and the fee for the Marriage

License is also $50.00. If the marriage is to be performed by the Judge of the Territorial Court, there is an additional fee of $200.00 for the marriage ceremony. Marriages are performed Monday through Friday, except holidays. A date and time will be scheduled by the Court upon arrival. The Court cannot make arrangements for churches. Applicants will have to write directly to the denomination of their choice if they wish to be married by a clergy.

OFFICE HOURS

Office hours are 8:00 a.m. through 5:00 p.m. Monday through Friday. The Court is also open on Saturday between the hours of 10:00 a.m. to 12:00 p.m. Additionally, by pre-arrangement, and upon payment of a $150.00 surcharge per couple, the Court will be available on Sundays and specific holidays between 9:30 a.m. and 10:30 a.m. The Court will not be open for any business on:

New Year’s Day

Independence Day

Good Friday

Labor Day

Carnival Saturday

Thanksgiving Day

Memorial Day

Christmas Day

ATTIRE

Although your attire may be casual, wearing apparels such as slippers and shorts are not permitted when appearing before the Court.

Enclosed is a brochure on the Virgin Islands that provides you with important information. We look forward to hearing from you, and welcome you to our beautiful United States Virgin Islands.

Virgin Islands Holidays

Title 1, Chapter 1, § 171

Virgin Islands Code

New Year’s Day (January 1)

Three Kings Day (January 6)

Martin Luther King, Jr. Day

(January)

Presidents Day (February)

Transfer Day (March 31)

Holy Thursday (March/April)

Good Friday (March/April)

Easter Monday (March/April)

Carnival Friday (April/May)

Carnival Saturday (April/May)

Memorial Day (May)

VI Emancipation Day (July 3)

Independence Day (July 4)

Labor Day (September)

Columbus Day/

Puerto Rico Virgin

Islands Friendship Day (October)

D. Hamilton Jackson Day (November 1)

Election Day (November)

Veterans’ Day (November 11)

Thanksgiving Day (November)

Christmas Day (December 25)

Christmas 2nd Day/

Boxing Day (December 26)

TERRITORIAL COURT

OF THE

VIRGIN ISLANDS

OFFICIAL PUBLICATION

OF THE

TERRITORIAL COURT

OF THE

VIRGIN ISLANDS

MARRIAGE INFORMATION

FACT SHEET

POST OFFICE BOX 70

ST. THOMAS, U.S.V.I. 00804

(340) 774-6680

DEPARTMENT OF HEALTH AND HUMAN S — PUBLIC HEALTH SERVICE — NATIONAL CENTER FOR HEALTH STATISTICS 1989 REVISION

TYPE/PRINT

IN

PERMANENT

BLACK INK

FOR

INSTRUCTIONS

SEE

HANDBOOK

GROOM

BRIDE

SIGNATURES

LICENSE TO

MARRY

CERMONY

LOCALLOCAL

OFFICIAL

OFFICIAL

VIRGIN ISLANDS OF THE UNITED STATES

LICENSE AND CERTIFICATE OF MARRIAGE

 

 

LICENSE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STATE FILE NUMBER

1. GROOM’S NAME (First, Middle, Last)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. AGE LAST BIRTHDAY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3a.

RESIDENCE – CITY TOWN OR LOCATION

 

 

 

 

 

 

 

 

 

 

 

3b. COUNTY OR ISLAND

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3c. STATE

 

4a. BIRTHPLACE (State or foreign Country)

 

4b. DATE OF BIRTH (Month, Day, Year)

 

5. SOC SEC NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6a.

FATHER’S NAME (First, Middle, Last)

 

6b.

BIRTHPLACE (State

 

 

7a. MOTHER’S NAME (First, Middle,

 

 

 

7b. BIRTHPLACE (State or

 

 

 

 

 

 

or Foreign Country)

 

 

 

Maiden Surname)

 

 

 

 

 

Foreign Country)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8a.

BRIDE’S NAME (First, Middle, Last)

 

 

 

 

 

 

 

8b. MAIDEN SURNAME (if different)

 

9. AGE LAST BIRTHDAY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10a. RESIDENCE – CITY, TOWN OR LOCATION

 

 

 

 

 

 

 

 

 

 

 

10b. COUNTY OR ISLAND

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10c. STATE

 

11a. BIRTHPLACE (State OR foreign Country)

 

11b. DATE OF BIRTH (month, Day, Year)

 

12. SOC SEC NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13a. FATHER’S NAME (First, Middle, Last)

 

13b.

 

BIRTHPLACE (State

 

 

14a. MOTHER’S NAME (First, Middle,

 

 

 

14b. BIRTHPLACE (State or

 

 

 

 

 

 

or Foreign Country)

 

 

 

maiden Surname)

 

 

 

 

 

Foreign Country)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WE HEREBY CERTIFY THAT THE INFORMATION PROVIDED IS CORRECT TO THE BEST OF OUR KNOWLEDGE AND BELIEF

 

 

AND THAT WE ARE FREE TO MARRY UNDER THE LAWS OF THIS STATE.

 

 

15.

GROOM’S SIGNATURE

 

 

 

 

 

 

 

 

 

16. BRIDE’S SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This License Authorizes the Marriage in This State of the Parties Named Above by Any

 

17. EXPIRATION DATE (Month, Day, Year)

Person Duty Authorized to Perform a Marriage Ceremony Under the Laws of the

 

 

 

 

 

 

 

 

State of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18.

SUBSCRIBED TO AND SWORN TO BEFORE

 

19. SIGNATURE of ISSUING OFFICIAL

 

 

20. TITLE OF ISSUING OFFICIAL

 

ME ON: (Month, Day, Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21.

I CERTIFY THAT THE ABOVE NAME PERSONS

 

 

22a. WHERE MARRIED—CITY, TOWN OR LOCATION

22b. ISLAND

 

WERE MARRIED ON: (Month, Day, Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

23a. SIGNATURE OF PERSON PERFORMING CEREMONY

 

23b. NAME (Typed/Print)

 

 

 

 

 

23c. TITLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

23c. ADDRESS OF PERSON PERFORMING CEREMONY (Street and Number or Rural Route Number, City or Town, State, Zip Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24a. SIGNATURE OF WITNESS TO CEREMONY

 

 

 

 

 

 

 

 

24b. SIGNATURE OF WITNESS TO CEREMONY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25.

SIGNATURE OF COURT REGISTRATION OFFICIAL

 

 

 

 

 

 

 

 

 

 

 

 

26. DATE FILED BY COURT (Month, Day, Year)

 

CLERK OF THE TERRITORIAL COURT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONFIDENTIAL INFORMATION. THE INFORMATION BELOW WILL NOT APPEAR ON CERTIFIED COPIES OF THE RECORD.

 

 

 

 

28. IF PREVIOUSLY MARRIED. LAST MARRIAGE

 

30. EDUCATION

 

 

 

 

27. NUMBER OF THIS

ENDED

29. RACE—American Indian, Black,

(Specify only highest grade completion)

 

 

 

 

 

 

 

 

 

MARRIAGE –

 

 

 

 

 

 

 

 

 

 

By Death, Divorce, Disposition

 

 

White, etc. (Specify below)

 

 

 

 

 

 

 

First, Second, etc.

 

Date (Month, Day, Year)

Elementary/Secondary

College

 

 

 

or Annulment (Specify below)

 

 

(0-12)

 

 

1-4 or 5

 

 

 

(Specify below)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GROOM

 

27a.

28a.

 

28b.

29a.

30a.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BRIDE

 

27b.

28c.

 

28d.

29b.

30b.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHS-T-004 REV 1/89

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1. The efore necessitates particular details to be typed in. Ensure the following fields are finalized:

Stage # 1 for filling out marriage form usa pdf

2. When this array of blank fields is completed, go on to enter the suitable details in these - Date of Birth, Place of Birth, Nationality, Usual Residence, Parents, Present Name, Maiden Name, Place of Birth, Previous Marital Status, Related to other Applicant, In what degree, cid Please check this box if you, and The court having reviewed this.

marriage form usa pdf writing process shown (stage 2)

3. The following part should be fairly easy, cid Please check this box if you, Subscribed and sworn to by each of, day of, day of, JUDGE, day of, Clerk of the Territorial Court, and Deputy Clerk - all these fields must be filled out here.

Completing segment 3 in marriage form usa pdf

4. The next part will require your attention in the subsequent areas: N O I S I V E R, S C I T S I T A T S H T L A E H R, BLACK INK, FOR, INSTRUCTIONS, LICENSE NUMBER, STATE FILE NUMBER, SEE, HANDBOOK, GROOMS NAME First Middle Last, a RESIDENCE CITY TOWN OR LOCATION, AGE LAST BIRTHDAY, b COUNTY OR ISLAND, GROOM, and GROOM. Remember to type in all needed information to go onward.

marriage form usa pdf writing process clarified (stage 4)

5. The document must be wrapped up by filling out this part. Below one can find a full list of fields that need appropriate information for your document usage to be faultless: S C I T S I T A T S H T L A E H R, a SIGNATURE OF PERSON PERFORMING, b NAME TypedPrint, c TITLE, cid, CERMONY, CEREMONY, c ADDRESS OF PERSON PERFORMING, a SIGNATURE OF WITNESS TO CEREMONY, b SIGNATURE OF WITNESS TO CEREMONY, cid, Local cid LOCAL OFFICIAL Official, SIGNATURE OF COURT REGISTRATION, cid CLERK OF THE TERRITORIAL COURT, and cid.

Stage no. 5 for completing marriage form usa pdf

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