........... day of.................. [A.D., one thousand nine hundred and...............] (STATE

HERE MONTH AND YEAR)."

(2) A license shall contain:

(I) APPROPRIATE SPACES IN WHICH THE CLERK SHALL ENTER:

1. THE RELATIONSHIP OF THE PARTIES TO BE MARRIED, IF

ANY;

2. AS TO EACH PARTY, THE NAME, AGE, STATE IN WHICH
BORN, RESIDENCE, AND MARITAL STATUS (SINGLE, WIDOWED, OR DIVORCED); AND

3. THE SOCIAL SECURITY NUMBER OF EACH PARTY WHO
VOLUNTARILY DISCLOSES THE NUMBER; AND

(II) a statement that the license is valid only:

[(i)] 1. for 6 months from the EFFECTIVE date [it is issued] AND
TIME STATED ON THE LICENSE; and

[(ii)]2. in the county in which it is issued.

(b) (1) Attached to a license shall be 2 certificate forms that:

(i) read, "I hereby certify that on this............day of [....................,

one thousand nine hundred and] ............. (STATE HERE MONTH AND YEAR), ........

(STATE HERE TIME), at .............. (STATE HERE LOCATION), [............... (state here

name of husband) and ............... (state here name of wife) were by me united in

marriage] in accordance with the license issued by the Clerk of the Circuit Court for

.................(STATE HERE JURISDICTION), I UNITED IN MARRIAGE THE FOLLOWING

INDIVIDUALS:

(STATE HERE NAME OF HUSBAND)

(STATE HERE NAME OF WIFE)";

(II) RESTATE ALL INFORMATION CONCERNING THE INDIVIDUALS
MARRIED THAT IS STATED ON THE MARRIAGE LICENSE; AND

[(ii)](III) provide a space for the signature of the authorized official
who performs the marriage ceremony[; and

(iii) provide spaces for the Social Security numbers of the parties],

(2) Attached to a license, in the case of a Society of Friends marriage
ceremony, shall be 2 certificate forms that:

(i) read, "We hereby certify that on this ..........day of [.........., one

thousand nine hundred and] ...........(STATE HERE MONTH AND YEAR), ........ (STATE

HERE TIME), at ........... (STATE HERE LOCATION), we, ............... (state here name of

husband) and ............... (state here name of wife) were united in marriage in