Marriage Kiosk

Spouse 1

First Name (Nombre Primero)	Full Middle Name (Segundo)
Full Last Name (Appelido)	Suffix (Sufijo)
Maiden/Given Name (Appelido de soltera)
Race (Race)	Social Security # (Seguro Social)
--Select One-- AFRICAN AMERICAN ALASKAN NATIVE AMERICAN INDIAN ASIAN CAUCASIAN HISPANIC MIDDLE EASTERN OTHER PACIFIC ISLANDER
Street Address (Direccion)	City (Ciudad)
State (Estado)	Zip Code (Codigo Postal)
AGUASCALIENTES (AG-MX) ALABAMA (AL) ALASKA (AK) ALBERTA (AB-CAN) AMERICAN SAMOA (AS) ARIZONA (AZ) ARKANSAS (AR) ARMED FORCES AFRICA (AE-AFR) ARMED FORCES AMERICAS (AA) ARMED FORCES CANADA (AE-CAN) ARMED FORCES EUROPE (AE-EUR) ARMED FORCES MIDDLE EAST (AE-ME) ARMED FORCES OTHERS (AE-OTHER) ARMED FORCES PACIFIC (AP) BAJA CALIFORNIA (BN-MX) BAJA CALIFORNIA SUR (BS-MX) BRITISH COLUMBIA (BC-CAN) CALIFORNIA (CA) CAMPECHE (CM-MX) CHIAPAS (CP-MX) CHIHUAHUA (CH-MX) COAHUILA (CA-MX) COLIMA (CL-MX) COLORADO (CO) CONNECTICUT (CT) DELAWARE (DE) DISTRICT OF COLUMBIA (DC) DISTRITO FEDERAL (DF-MX) DURANGO (DU-MX) FLORIDA (FL) GEORGIA (GA) GUAM (GU) GUANAJUATO (GT-MX) GUERRERO (GR-MX) HAWAII (HI) HIDALGO (HG-MX) IDAHO (ID) ILLINOIS (IL) INDIANA (IN) IOWA (IA) JALISCO (JA-MX) KANSAS (KS) KENTUCKY (KY) LOUISIANA (LA) MAINE (ME) MANITOBA (MB-CANADA) MARYLAND (MD) MASSACHUSETTS (MA) MEXICO (MX-MX) MICHIGAN (MI) MICHOACAN (MC-MX) MINNESOTA (MN) MISSISSIPPI (MS) MISSOURI (MO) MONTANA (MT) MORELOS (MR-MX) NAYARIT (NA-MX) NEBRASKA (NE) NEVADA (NV) NEW BRUNSWICK (NB-CAN) NEW HAMPSHIRE (NH) NEW JERSEY (NJ) NEW MEXICO (NM) NEW YORK (NY) NEWFOUNDLAND (NL-CAN) NORTH CAROLINA (NC) NORTH DAKOTA (ND) NORTHERN MARIANA ISLANDS (MP) NORTHWEST TERRITORY (NT-CAN) NOVA SCOTIA (NS-CAN) NUEVO LEON (NL-MX) NUNAVUT (NU-CAN) OAXACA (OA-MX) OHIO (OH) OKLAHOMA (OK) ONTARIO (ON-CAN) OREGON (OR) PENNSYLVANIA (PA) PRINCE EDWARD ISLAND (PE-CAN) PUEBLA (PU-MX) PUERTO RICO (PR) QUEBEC (QC-CAN) QUERETARO (QE-MX) QUINTANA ROO (QR-MX) RHODE ISLAND (RI) SAN LUIS POTOSI (SL-MX) SASKATCHEWAN (SK-CAN) SINALOA (SI-MX) SONORA (SO-MX) SOUTH CAROLINA (SC) SOUTH DAKOTA (SD) TABASCO (TB-MX) TAMAULIPAS (TM-MX) TENNESSEE (TN) TEXAS (TX) TLAXCALA (TL-MX) UNITED STATES MINOR OUTLYING ISLANDS (UM) UTAH (UT) VERACRUZ (VE-MX) VERMONT (VT) VIRGIN ISLANDS (VI) VIRGINIA (VA) WASHINGTON (WA) WEST VIRGINIA (WV) WISCONSIN (WI) WYOMING (WY) YUCATAN (YU-MX) YUKON TERRITORY (YT-CAN) ZACATECAS (ZA-MX)
County (Condado)	Phone # with Area Code (Teléfono con código de área)
Date of Birth (Fecha de Nacimiento - MM/dd/yyyy)	Birth State (Nacimiento Estado o Pais)
	AGUASCALIENTES (AG-MX) ALABAMA (AL) ALASKA (AK) ALBERTA (AB-CAN) AMERICAN SAMOA (AS) ARIZONA (AZ) ARKANSAS (AR) ARMED FORCES AFRICA (AE-AFR) ARMED FORCES AMERICAS (AA) ARMED FORCES CANADA (AE-CAN) ARMED FORCES EUROPE (AE-EUR) ARMED FORCES MIDDLE EAST (AE-ME) ARMED FORCES OTHERS (AE-OTHER) ARMED FORCES PACIFIC (AP) BAJA CALIFORNIA (BN-MX) BAJA CALIFORNIA SUR (BS-MX) BRITISH COLUMBIA (BC-CAN) CALIFORNIA (CA) CAMPECHE (CM-MX) CHIAPAS (CP-MX) CHIHUAHUA (CH-MX) COAHUILA (CA-MX) COLIMA (CL-MX) COLORADO (CO) CONNECTICUT (CT) DELAWARE (DE) DISTRICT OF COLUMBIA (DC) DISTRITO FEDERAL (DF-MX) DURANGO (DU-MX) FLORIDA (FL) GEORGIA (GA) GUAM (GU) GUANAJUATO (GT-MX) GUERRERO (GR-MX) HAWAII (HI) HIDALGO (HG-MX) IDAHO (ID) ILLINOIS (IL) INDIANA (IN) IOWA (IA) JALISCO (JA-MX) KANSAS (KS) KENTUCKY (KY) LOUISIANA (LA) MAINE (ME) MANITOBA (MB-CANADA) MARYLAND (MD) MASSACHUSETTS (MA) MEXICO (MX-MX) MICHIGAN (MI) MICHOACAN (MC-MX) MINNESOTA (MN) MISSISSIPPI (MS) MISSOURI (MO) MONTANA (MT) MORELOS (MR-MX) NAYARIT (NA-MX) NEBRASKA (NE) NEVADA (NV) NEW BRUNSWICK (NB-CAN) NEW HAMPSHIRE (NH) NEW JERSEY (NJ) NEW MEXICO (NM) NEW YORK (NY) NEWFOUNDLAND (NL-CAN) NORTH CAROLINA (NC) NORTH DAKOTA (ND) NORTHERN MARIANA ISLANDS (MP) NORTHWEST TERRITORY (NT-CAN) NOVA SCOTIA (NS-CAN) NUEVO LEON (NL-MX) NUNAVUT (NU-CAN) OAXACA (OA-MX) OHIO (OH) OKLAHOMA (OK) ONTARIO (ON-CAN) OREGON (OR) PENNSYLVANIA (PA) PRINCE EDWARD ISLAND (PE-CAN) PUEBLA (PU-MX) PUERTO RICO (PR) QUEBEC (QC-CAN) QUERETARO (QE-MX) QUINTANA ROO (QR-MX) RHODE ISLAND (RI) SAN LUIS POTOSI (SL-MX) SASKATCHEWAN (SK-CAN) SINALOA (SI-MX) SONORA (SO-MX) SOUTH CAROLINA (SC) SOUTH DAKOTA (SD) TABASCO (TB-MX) TAMAULIPAS (TM-MX) TENNESSEE (TN) TEXAS (TX) TLAXCALA (TL-MX) UNITED STATES MINOR OUTLYING ISLANDS (UM) UTAH (UT) VERACRUZ (VE-MX) VERMONT (VT) VIRGIN ISLANDS (VI) VIRGINIA (VA) WASHINGTON (WA) WEST VIRGINIA (WV) WISCONSIN (WI) WYOMING (WY) YUCATAN (YU-MX) YUKON TERRITORY (YT-CAN) ZACATECAS (ZA-MX)
Ever Married Before (click box below) (Anteriorment se casó?)	Number of This Marriage (Número de este matrimonio)
Last Marriage Ended Date (Fecha de matrimonio anterior - MM/dd/yyyy)	Reason Marriage Ended (Ultimo Martrimonio Termino Por)
	--Select One-- Annulment Death Divorce