Texas Form Vs 180 1 – Fill Out and Use This PDF

VS-180.1 Rev. 06/2015

DECLARATION AND REGISTRATION OF INFORMAL MARRIAGE, __________________COUNTY, TEXAS

The form and content of this application is prescribed by section 2.004 of the Texas Family Code.

WARNING: IT IS A FELONY TO FALSIFY INFORMATION ON THIS DOCUMENT. THE PENALTY FOR KNOW INGLY MAKING A FALSE STATEMENT ON THIS FORM OR FOR SIGNING A FORM WHICH CONTAINS A FALSE STATEMENT IS 2 TO 10 YEARS IMPRISONMENT AND A FINE OF UP TO $10,000. (HEALTH AND SAFETY CODE, CHAPTER 195, SEC. 195.003)

	First Name			Middle Name		Current Last Name					Suffix
One	Woman’s Maiden Name (If Applicable)							Telephone Number
Applicant
	Street Address				City				State	Zip
	Date of Birth		Place of Birth (including city, county and state)				Social Security Number

I am not related to the other applicant as: □ TRUE □ FALSE

an ancestor or descendant, by blood or adoption;

a brother or sister, of the whole or half blood or by adoption;

a parent's 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; or

a son or daughter of a parent's brother or sister, of the whole or half blood or by adoption;

I solemnly swear (or affirm) that we, the undersigned, are married to each other by virtue of the following facts: on or about

____________________ we agreed to be married, and after that date we lived together as a married couple and in this state

represented to others that we were married. Since the date of marriage to the other party I have not been married to any other person. This declaration is true and the information in it which I have given is correct.

Applicant’s Signature and Date Signed

	First Name			Middle Name		Current Last Name					Suffix
Two	Woman’s Maiden Name (If Applicable)							Telephone Number
Applicant
	Street Address				City				State	Zip
	Date of Birth		Place of Birth (including city, county and state)				Social Security Number

I am not related to the other applicant as: □ TRUE □ FALSE

an ancestor or descendant, by blood or adoption;

a brother or sister, of the whole or half blood or by adoption;

a parent's 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; or

a son or daughter of a parent's brother or sister, of the whole or half blood or by adoption;

I solemnly swear (or affirm) that we, the undersigned, are married to each other by virtue of the following facts: on or about

____________________ we agreed to be married, and after that date we lived together as a married couple and in this state

represented to others that we were married. Since the date of marriage to the other party I have not been married to any other person. This declaration is true and the information in it which I have given is correct.

Applicant’s Signature and Date Signed

For County Clerk Office Use Only

Subscribed and sworn to before me on ________________________, 20_____ at _______________am/pm

______________________________________ County Clerk ___________________County, Texas

	By ___________________________________ Deputy
	Applicant One Identification Type (ID & Age)___________________________________	License Number _______________________
	Applicant Two Identification Type (ID & Age)___________________________________	Volume _______________ Page _______________