Full name of groom_______________________________________________________
Full maiden name of bride__________________________________________________
(Please list any other name bride may have used)
Month, day, and year of marriage_____________________________________________
For what purpose is this record to be used?_____________________________________
If this is not your marriage record, how are you related to the persons listed on the record?__________________________________________________________________
WARNING: Section 71-649, Nebraska Revised Statutes: It is a felony to obtain, possess, use, sell, furnish, or attempt to obtain any vital record for purpose of deception.