Clark County Clerk’s Office Box 551604 Las Vegas, NV 89155-1604 Rev 01/15/2020

Office of the Clark

County Clerk

Lynn Marie Goya County Clerk

Carl Bates

Assistant County Clerk

Note: All requests for the Marriage License/Affidavit (application to get married) containing the couple’s social security numbers require a notarized statement from either party on the marriage license authorizing this office to provide a copy. Licenses/Affidavits issued prior to 1998 may not include the social security number.

STATE OF ___________________________ SS: COUNTY OF _________________________ I, ________________________________________________, authorize the Clark County Clerk’s Office to provide an unredacted certified copy of my Marriage License/Affidavit containing the social security numbers. Marriage License/Affidavit # (if known): _____________________________________________ Date Issued (to the best of your knowledge): _________________________________________ Party 1’s Full Name: _____________________________________________________________ Party 2’s Full Name: _____________________________________________________________ ___________________________________________ Signature of Applicant Signed and sworn to (or affirmed) before me on this _______ day of ______________________, 20_____, by _________________________________________. (Printed name of individual whose signature is being notarized)

____________________________________________ Signature of Notarial Officer