Certificate of Consent
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records
Certificate of Consent
CONSENT
PLACE OF R
County
City;Town
E/GROOM/SPOUSE
This is to certify
, who have hereto subscribed
name, do hereby consent that
(I. we)
(my. our)
(name of minor)
who is
and who is under the age of
years, shall be united in
(my or our child or ward)
marriage to
by any person authorized by law to solemnize marriages in New York State.
Witness my hand this
day of
20
~
~
(Signatures of Parents or Guardians)
~
(Signature of Issuing Clerk or a Notary Public)
This is to certify
, who have hereto subscribed
name, do hereby consent that
(I, we)
(my. our)
(name of minor)
who is
and who is under the age of
years, shall be united in
(my or our child or ward)
marriage to
by any person authorized by law to solemnize marriages in New York State.
Witness my hand this
day of
20
~
~
(Signatures of Parents or Guardians)
~
(Signature of Issuing Clerk or a Notary Public)
DOH-2279 (7/2011) page 1 of 2
If it appears that an applicant is under 18
years of age, documentary proof of age
must be submitted for that person. The
following documents are acceptable:
certified copy of birth certificate, baptismal
record, passport, driver license, life
insurance policy, employment certificate,
school record, immigration record,
naturalization record or court order. No
other type of proof, such as a statement by
the parents, may be accepted.
Please note the following:
. 1) A marriage license may not be issued if
either applicant is under 14 years of age.
2) If either applicant is 14 or 15 years of
age, such applicant(s) must present the
written consent of both parents and a
justice of the Supreme Court or a judge of
the Family Court having jurisdiction over the
town or city in which the application is
made.
3) If either applicant is 16 or 17 years of
age, that applicant must present the written
consent of both parents.
4) If both applicants are 18 years of age or
older, no consents are required.
DOH-2279 (7/2011) page 2 of 2
One parent alone may consent to a minor's
marriage if: (a) the other parent is
deceased; (b) the other parent has been
missing for one year preceding the
application; (c) the parents have been
divorced and the consenting parent was
given full custody of the child; or (d) the
other parent has been judged incompetent.
The clerk may require documentary
proof if any of these exceptions are
declared.
Parents or guardians consenting to the
marriage of a minor must personally appear
and acknowledge their consent before the
town or city clerk or some other authorize d
official, such as a notary public. If the
notarized affidavit is made before an official
outside of the State of New York, it must be
accompanied by a certificate of
authentication.
Court Order
The 24-hour waiting period betwee n
issuance of the license and marriage may
be waived by an order of a Family Court
judge of the county in which either party
under the age of 16 resides.