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APPLICATION FOR DILLON MARRIAGE CHAPEL

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Chapel Hours: Monday thru Friday 9:00am til 5:00 pm only Saturday and Sunday 1:00pm til 5:00 pm only Telephone #: 843-0774-2671 Fax #: 843-841-2671

P.O. Box 630 Dillon, SC 29536

We the undersigned, apply for a marriage license and certify that we are legally capacitated to marry, our full names and places of address are as follows: Phone Number: ________________________

Groom's Name (First, Middle, Last)			Birthdate (Month/Day/Year)		Age
Birthplace (State)	Race	Present Address (Street or P.O. B ox)
City of Residence		County	State, Zip	No. of this Marriage (1st, 2nd, 3rd, etc.)
Groom's Signature:				Social Security #:
Bride's Name (First, Middle, Last)			Birthdate (Month/Day/Year)		Age
Birthplace (State)	Race	Present Address (Street or P.O. B ox)
City of Residence		County	State, Zip	No. of this Marriage (1st, 2nd, 3rd, etc.)
Bride's Signature:				Social Security #:

****Date_____________ Time________ ( Of Marriage)

**Call 3 or 4 days after sending this application** Thanks Timmy Grimsley Proprietor

Take I-95 South to Exit 193 in South Carolina ****(NOT South of the Border exit)**** At bottom of ramp and stop sign, turn left Going under I-95, go to first stop light Turn right at stop light, about 150-200 yards. The Marriage Chapel will be on the right. A red brick building with 5 white columns on the porch.		The Dillon Marriage Chapel
		Mon - Fri 9-5	Sat & Sun 1-5
		N. Martin Luther King Blvd. P.O. Box 630 Dillon, SC 29536	Phone: 843-774-2671 fAX: 843-841-2671