New York Laws
Article 3 - Solemnization, Proof and Effect of Marriage
14 - Town and City Clerks to Issue Marriage Licenses; Form.

§ 14. Town and city clerks to issue marriage licenses; form. The town
or city clerk of each and every town or city in this state is hereby
empowered to issue marriage licenses to any parties applying for the
same who may be entitled under the laws of this state to apply therefor
and to contract matrimony, authorizing the marriage of such parties,
which license shall be substantially in the following form:

State of New York
County of ................
City or town of ..........

Know all men by this certificate that any person authorized by law to
perform marriage ceremonies within the state of New York to whom this
may come, he not knowing any lawful impediment thereto, is hereby
authorized and empowered to solemnize the rites of matrimony between
............. of ........... in the county of ............. and state of
New York and .................. of ................... in the county of
............. and state of New York and to certify the same to the said
parties or either of them under his hand and seal in his ministerial or
official capacity and thereupon he is required to return his certificate
in the form hereto annexed. The statements endorsed hereon or annexed
hereto, by me subscribed, contain a full and true abstract of all of the
facts concerning such parties disclosed by their affidavits or verified
statements presented to me upon the application for this license. This
certificate is to be returned addressed to the undersigned at
..................., ............................, .................

(Street) (City, Town, Village) (State)

In testimony whereof, I have hereunto set my hand and affixed the seal
of said town or city at .......... this ....... day of ........
nineteen ........, at........m. Seal.

The form of the certificate annexed to said license and therein
referred to shall be as follows:

I, .... a ....., residing at ......... in the county of ........ and
state of New York do hereby certify that I did on this ......... day of
.... in the year, nineteen ......... at .....m, at ....... in the county
of .......... and the state of New York, solemnize the rites of
matrimony between .... of ..... in the county of ........... and state
of New York, and .... of ..... in the county of ............. and state
of New York in the presence of ..... and ..... as witness, and the
license therefor is hereto annexed.

Witness my hand ...... in the county of ....... this ....... day of
....., nineteen .....

In the presence of

...............

...............

...............

There shall be endorsed upon the license or annexed thereto at the end
thereof, subscribed by the clerk, an abstract of the facts concerning
the parties as disclosed in their affidavits or verified statements at
the time of the application for the license made in conformity to the
provisions of section fifteen of this chapter.

There shall also be stated upon the license the exact period during
which the marriage may be solemnized.

The license issued, including the abstract of facts, and the
certificate duly signed by the person who shall have solemnized the
marriage therein authorized, shall be returned by him, and where the
marriage is solemnized by a written contract, the judge before whom
acknowledgment is made shall forward such contract and marriage license
to the office of the town or city clerk who issued the license within
five days succeeding the date of the solemnizing of the marriage therein
authorized and any person or persons who shall wilfully neglect to make
such return within the time above required shall be deemed guilty of a
misdemeanor and upon conviction thereof shall be punished by a fine of
not less than twenty-five dollars or more than fifty dollars for each
and every offense.

When a marriage is solemnized by a city, town or village justice
outside of the territorial jurisdiction in which such justice was
elected or appointed, as provided in subdivision six of section eleven
of this chapter, there shall be affixed to such license prior to filing,
the official or common seal of the court or of the municipality in which
such justice was elected or appointed.