Marriage by Proxy

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Bride's Full Name

First, Middle, Last

Bride's Date of Birth

Month, Day, Year

Bride's Most Recent
Street Address

Bride's County
of Residence

Bride's Phone Number.
Include area
code; also include
country code if outside of
the U.S.A.

Bride's E-Mail Address

Bride's Mother's Full Name

First, Middle, Last

Bride's Father's Full Name

First, Middle, Last

Is this the Bride's first
marriage?

Yes/No

Have the bride and
groom met in the
same physical
location?

Yes/No

Groom's Full Name

First, Middle, Last

Please check here if U.S. Military
(active or honorably discharged)

S&B Professional Services, Sam Geller, Barbara Geller, marriage by proxy, S&B Professional Services, Sam Geller, Barbara Geller, marriage by proxy,S&B Professional Services, Sam Geller,
Barbara Geller, marriage by proxy,S&B Professional Services, Sam Geller, Barbara Geller, marriage by proxy,S&B Professional Services, Sam Geller, Barbara Geller, marriage by proxy,