Marriage by Proxy in the United States

INSTRUCTIONS FOR COMPLETING FORMS

Fill in requested information on all forms. Please type in all information on screen then print the forms, sign where indicated and have them Notarized.

Once complete all original forms must be mailed to Fresh Pond Associates at the address on the bottom of this page.

 
Marriage Application:

The marriage application is a separate form and can be accessed by clicking on the link above or below.

Answer all questions completely. All boxes must be filled in, if a question is not applicable, please put N/A.

Sections: 1, 3 and 5 - LEAVE BLANK, these are for court use.

Section 2: Type: This field is prefilled, leave as: Flathead (This is the county where your marriage will take place)

Sections 5a and 16a: Type full name, not initials, if no middle name then put (nmn) and include Sr. Jr. or other suffix, if applicable.

Section 16: Self-explanatory

Sections 6a, 6b, 6c, and 17a, 17b, and 17c: Type your permanent address. If CANNOT be an APO address.

Sections 7 and 18: Type City and County (or Parish) and State (or Commonwealth). If you were not born within the US, then at a minimum type State and Province (or other division) and Country.

Sections 8a, 8b, 17a and 19b: Self-explanatory

Sections 9a, 10a, 20a, and 21a: Type in their full names, no initials. If no middle name then put (nmn). NOTE that the mother's name is her MAIDEN name, not her married name.

Sections 9b, 10b, 20b, and 21b: Type the complete street addresses including zip codes.

Sections 9c, 10c, 20c, and 21c: Self-explanatory

Sections 11, 12, 22, and 23: These refer to the bride and groom and are self-explanatory

Sections 13a and 24a: Type in the number of years you completed, such as 11. If you have a GED then put in 12. Leave blank if you completed any college. DO NOT CIRCLE any numbers.

Sections 13b and 24b: Type in the number of years you completed, such as 3. If you have more than a bachelors degree type 5+/ DO NOT CIRCLE any numbers.

Sections 14 and 28: Type the number representing what number marriage this is for you.

Sections 15a, 15b, 15c, 15d, 26a, 26c and 26d: If this if your first marriage leave the boxes that apply to you blank. If this is more than your second marriage, use another blank piece of paper to provide the information for each and every marriage terminated by divorce, death or annulment; prior spouse's full name (no initials) (maiden name for prior wife) county and state where divorced, death of annulment took place; date of divorce, death or annulment.

Sections 27, 28, 29, 30, 31a and 31b: LEAVE BLANK

Section 32a: Are the bride and groom related in any way, such as cousins, type YES or NO.

Sections32b: If 32a is NO, then leave this blank, if YES state what relationship.

Section 33a: Type YES or NO to answer if you have ever applied for a marriage license with this person that was denied or rejected.

Section 33b: If 33a is NO, LEAVE BLANK. If if was YES, then type in the reason for rejection and the date of rejection.

Section 34: Type in YES or NO as to whether either of you are intoxicated or under the influence of drugs at the time you are completing this application.

Sections 35a, 35b and 35c: Type in the address you and your spouse will be residing at after your marriage. Be sure to type the full address including street and number, town or location, state and zip code, and your phone number including area code.

Sections 36a and 36b: Once you have typed the entire application and printed it out, both bride and groom must sign here. ORIGINAL SIGNATURES ONLY, no photocopies or fax copies allowed.

Sections 37, 38 and 39: LEAVE BLANK, for court use.

All dates should be typed in full detail (ie: January 1, 1985), not in a shortened format (ie: 01/01/85).

Husband’s Proxy sheet:

Line 1. Type husband’s full legal name.

Line 3.Type wife’s full legal name

Line 5. Leave blank

Line 6. Leave blank

Line 10. Type date on which you are signing before a notary public

Line 11. Type month and year on which you are signing before a notary public

Line 12. Husband signs his name in ink.

Line 13. Husband e-mail address.

Line 14. Witness signs his or her name. This can be notary public or another person.

Line 15. Notary Public prints or types or rubber stamps his or her name.

Line 16. Notary public prints or types his jurisdiction (county and state, or country)

Line 19. Notary public signs his/her name in ink.

Line 20. Notary public prints the date his authority expires and affixes his seal or stamp.

Wife’s Proxy sheet: 

Line 1. Type wife’s full legal name.

Line 3. Type husband’s full legal name

Line 5. Leave blank

Line 6 Leave blank

Line 10. Type date on which you are signing before a notary public

Line 11. Type month and year on which you are signing before a notary public

Line 12. Wife signs her name in ink.

Line 13. Wife's e-mail address.

Line 14. Witness signs his or her name. This can be notary public or another person.

Line 15. Notary Public prints or types or rubber stamps his or her name.

Line 16. Notary public prints or types his jurisdiction (county and state, or country)

Line 19. Notary public signs his/her name in ink.

Line 20. Notary public prints the date his authority expires and affixes his seal or stamp.

Informed Consent/Waiver of Requirement of Blood Test for Rubella Immunity

Place a check in the box to the right of the request of waiver. (To do this position your cursor over the box and left click with your mouse).

Wife must sign and print her name.

Husband must sign and print his name

Signature of Clerk of District Court: LEAVE BLANK, this will be signed when your application is received.

All forms must then be returned to us, including.

[ ]    Marriage Application
[ ]    Husband’s Proxy
[ ]    Wife’s Proxy
[ ]    Informed Consent/Waiver of Requirement of Blood Test for Rubella Immunity.
[ ]    Official Document photo copy for each, husband and wife. (Birth Certificate, Driver’s License or Passport information page, but it must show date of birth.)

Upon receipt of the above forms, your marriage application will be sent, by courier, to the attorneys handling your proxy marriage and a wedding date (within approximately one week) will be scheduled. As soon as your marriage is complete a copy of your marriage certificate will be e-mailed to you and the original marriage certificate will also be sent to you by mail.

 

To securely pay via credit card complete these forms, print them out and fax them to us at 1-877-756-1466 OR call 978-443-8387

These forms must filled in online, printed out, signed and Notarized, and then mailed to Fresh Pond Associates

Marriage Application:

Click here to go to the Marriage Application sheet. 
Fill this out online, then print it out and both bride and groom must sign it. Mail it along with the Husband's Proxy, Wife's Proxy, copies of required documents and the Credit Card Authorization (if not paying on-line) to Fresh Pond Associates.

This form is in Adobe Acrobat pdf format. If you do not have the Acrobat reader click on the button below to download the Acrobat reader.

 

 

Husband’s Proxy

1.) I , being of full legal age and in full

2.) mental capacity and desiring to enter into a marriage to

3.) ,

4.) and being unable to be present at the solemnization of such marriage, do hereby

5.) authorize and appoint of

6.)

7.) to act as my proxy, and authorize him to execute all documents on my behalf, and

8.) to take all oaths on my behalf, the same as I could do were I able to be present, to

9.) achieve said marriage.

10.) IN WITNESS WHEREOF I have hereunto set my hand and seal this day

11.) of , 200 .

12.)

13.)Husband's E-mail Address: 

14.)
         Witness to signature

 

15.) I, , being an officer qualified to take oaths by the

16.) State/County/Country of do hereby

17.) acknowledge that the foregoing instrument was signed and sworn to before me, the

18.) day and date above written.

19.)

20.) My commission expires

 

Wife(s) Proxy

1.) I , being of full legal age and in full

2.) mental capacity and desiring to enter into a marriage to

3.) ,

4.) and being unable to be present at the solemnization of such marriage, do hereby

5.) authorize and appoint of

6.)

7.) to act as my proxy, and authorize him to execute all documents on my behalf, and

8.) to take all oaths on my behalf, the same as I could do were I able to be present, to

9.) achieve said marriage.

10.) IN WITNESS WHEREOF I have hereunto set my hand and seal this day

11.) of , 200 .

12.)

13.) Wife's E-mail Address:

14.)
       Witness to signature

 

15.) I, , being an officer qualified to take oaths by the

16.) State/County/Country of do hereby

17.) acknowledge that the foregoing instrument was signed and sworn to before me, the

18.) day and date above written.

19.)

20.) My commission expires

 

INFORMED CONSENT/WAIVER OF REQUIREMENTS OF BLOOD TEST FOR RUBELLA IMMUNITY

Important Information About the Need for Rubella Immunity

Infection of a pregnant woman with the rubella virus in early pregnancy can be catastrophic to the unborn child. Infection may lead to fetal death, spontaneous abortion, or premature delivery. If the fetus survives the infection, the virus may affect any or all of its vital organs, and may cause a variety of congenital defects. Up to 85% of infants whose mothers are infected with the rubella virus in the first three months of pregnancy may suffer significant health effects.

It is important that a woman be sure of her rubella immunity status prior to becoming pregnant because rubella immunizations are not recommended for pregnant woman. While a woman might believe that she has had rubella in the past, and that she is now immune, many illnesses that cause a rash may mimic a rubella infection, so she may have been diagnosed with rubella when she was not actually infected with the rubella virus. A woman might also know or believe that she was immunized for rubella, but not everyone who is immunized  has a sufficient immune response fro the immunization to confer lifelong immunity.

The only way to be certain of rubella immunity is to have a blood test to confirm the presence of rubella antibodies. The results of the blood test will allow you to make appropriate decisions, in consultation with your physician, regarding your rubella immunity status and possible need for rubella immunization prior to becoming pregnant.

Applicants may obtain additional information regarding rubella and rubella immunity testing at their local county health department or the Montana Department of Public Health & Human services Immunization Program. (408) 444-5580

Reference:

Epidemiology and Prevention of Vaccine-Preventable Diseases, 10th Editions, January 2007. Edited by William Atkinson, Jennifer Hamborski, Lynne McIntyre and Charles Wolfe, Chapter 12.

R We request a waiver of the requirement for medical certification of blood testing for rubella immunity (or medical exemption therefrom). We have read an understand the information provided regarding the importance of rubella immunity testing, and we accept full responsibility for any consequences that might arise from our failure to obtain a blood test for rubella immunity prior to marriage.

We attest that we are the applicants for a marriage license for which this certification/informed consent is required. By our signatures, we attest that we have both seen the results of the serological test for rubella immunity or are medically exempt, or that we both have been informed of the importance of rubella immunity testing but request a waiver of the requirement for the premarital testing as stated above.

 

________________________________                   

Signature of Female Applicant                                      Name Printed

 

________________________________                   

Signature of Male Applicant                                          Name Printed

 

________________________________                    ___________________________________

Signature of Clerk of District Court                               Date Recieved

 

 

Fresh Pond Associates
Divorce Fast

Credit card authorization

This applies to you only if you are paying by credit card

If you would prefer to use our Secure Online Credit Card payment system,
please click the button below.

Opens in a new window.

If you paid using our online system you do not need to fill out the following section.

This must be signed by the person whose credit card has been used, whether yourself or some other person:

To: Fresh Pond Associates, I/we have authorized you to charge the sum of $ to my credit card.
Credit card # Exp. date(MM/YY) , security code

Billing Address for Credit Card: (Street Address, City, Zip Code):

For a marriage for

Signature of credit card holder:

Printed Name:

E-mail Address: _____________________________________

To securely pay via credit card complete these forms, print them out and fax them to us at 1-877-756-1466 OR call 978-443-8387

 

United States Proxy Marriage - $900: