Polk County
County Home
Marriage License
Portal
Applicant One
First Name
Middle Name
Last Name
Last name is a required field.
Maiden Name (if applicable)
Address
Address is a required field.
City
A city is a required field.
State
-- Select State --
A state is a required field.
Zip Code
A zip code is a required field.
Phone Number
SSN
A Social Security Number is a required field.
Date of Birth
A date of birth is a required field.
Place of Birth
A place of birth is a required field.
I have not been divorced in the last 30 days.
True
False
You must answer true or false to this question.
I am not presently married.
True
False
You must answer true or false to this question.
I am not presently delinquent in the payment of court ordered child support.
True
False
You must answer true or false to this question.
The other applicant is not presently married.
True
False
You must answer true or false to this question.
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 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 adoption.
True
False
You must answer true or false to this question.
I wish to make a voluntary contribution of $5.00 to promote healthy early childhood by supporting the Texas Home visitation Program administrated by the Office of Early Childhood Coordination of the Health and Human Services.
True
False
You must answer true or false to this question.
Applicant Two
First Name
Middle Name
Last Name
Last name is a required field.
Maiden Name (if applicable)
Address
Address is a required field.
City
A city is a required field.
State
-- Select State --
A state is a required field.
Zip Code
A zip code is a required field.
Phone Number
SSN
A Social Security Number is a required field.
Date of Birth
A date of birth is a required field.
Place of Birth
A place of birth is a required field.
I have not been divorced in the last 30 days.
True
False
You must answer true or false to this question.
I am not presently married.
True
False
You must answer true or false to this question.
I am not presently delinquent in the payment of court-ordered child support.
True
False
You must answer true or false to this question.
The other applicant is not presently married.
True
False
You must answer true or false to this question.
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 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 adoption.
True
False
You must answer true or false to this question.
I wish to make a voluntary contribution of $5.00 to promote healthy early childhood by supporting the Texas Home visitation Program administrated by the Office of Early Childhood Coordination of the Health and Human Services.
True
False
You must answer true or false to this question.
Mail Executed License to...
Applicant One Address
Applicant Two Address
Other Address
Address
Zip Code
City
State
-- Select State --
Submit
Successful Application Submission
×
Your marriage application was successfully received.
You may close this dialog now.