The Marriage License Application Sample (Form H105.167, Rev. 08/22) is the application two people complete to request a Bucks County marriage license from the Clerk of Orphans' Court; the Bucks County Register of Wills lists it among its marriage license forms. It collects the details of both applicants, their parents and the planned ceremony, and ends with a sworn statement signed by both. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the county publishes the original at buckscounty.gov.
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What is H105.167?
The Marriage License Application Sample is the Bucks County form on which two people give the facts needed for a marriage license and swear them true when they apply to the Clerk of Orphans' Court to marry.
The PDF is numbered H105.167 (Rev. 08/22) and printed under the title MARRIAGE LICENSE APPLICATION. It must be typed or printed in permanent black ink. It is built in two columns, one for Applicant A and one for Applicant B, and runs in this order:
- Lines 1 to 4: the county issuing the license, where the marriage will take place, the date of marriage and the person performing the ceremony.
- Lines 5 to 8: names, residence, birthplace, date of birth, sex (M/F/X), age at last birthday and any previous marriage.
- Lines 9 and 10: transmissible disease, education and usual occupation.
- Lines 11 to 18: the names, birthplaces, residences and occupations of Parent A and Parent B for each applicant.
- Lines 19 to 21: yes-or-no questions on mental capacity or guardianship, alcohol or drugs, and the prohibited degree of consanguinity.
- Signatures of both applicants, then line 22, which is for the local official.
The Bucks County Register of Wills site shows this form on its Forms page next to the Name Change Affidavit, the PA Marriage Law for officiants and the Petition For Amendment of Marriage Record. Those are separate documents; this one is the application itself.
Who needs to file H105.167?
Two people who intend to marry and are applying for a Bucks County marriage license complete this application together. The form is written for Applicant A and Applicant B, and both must sign the sworn statement at the bottom.
Each applicant answers for himself or herself on lines 5 to 10 and 19 to 21, and gives information about two parents (Parent A and Parent B) on lines 11 to 18, using the label Father, Mother or Parent. The applicants also name the person who will perform the ceremony on line 4.
Line 22 is not for applicants: it records the date the license was issued, the date it was filed by the local official, and that official's signature and title.
The form itself prints no eligibility rules beyond the questions it asks. The county's Register of Wills pages titled Requirements & Restrictions, Common-Law Marriage and Waiver of Waiting Period are the places to check how your situation is treated.
When to file H105.167
Complete the application before the marriage, because it is an application to the Clerk of Orphans' Court to marry and it asks for the planned date of marriage (line 3) and the person who will perform the ceremony (line 4). No deadline or validity period is printed on the form.
The Bucks County Register of Wills site has separate pages titled Applying for a Marriage License, License Fees, Requirements & Restrictions and Waiver of Waiting Period under Marriage Licenses and Certificates. Check them for timing rules that apply to your date of marriage before you finalize line 3.
How to fill out H105.167
Use permanent black ink
The form is headed TYPE/PRINT IN PERMANENT BLACK INK. Enter every answer by typing, or print in black ink if you complete a paper copy.
Enter license and ceremony details
Line 1: the county issuing the license. Line 2a and 2b: the city, borough or township and the county where you will marry. Line 3: the date of marriage (Month, Day, Year).
Name the person performing the ceremony
Line 4a: the name of the person performing the ceremony. Line 4b: that person's title. Line 4c: street, city or town, state and ZIP code.
Enter both applicants' names
Lines 5a and 5b for Applicant A, and 5c and 5d for Applicant B: first, middle and last name, and a maiden surname if different.
Enter residence information
Lines 6a to 6c for Applicant A and 6d to 6f for Applicant B: city, borough or township, county and state of residence.
Enter birth information
Lines 7a to 7d for Applicant A and 7e to 7h for Applicant B: birthplace (state or foreign country), date of birth (Month, Day, Year), sex (M/F/X) and age at last birthday.
Report any previous marriage
Lines 8a to 8c for Applicant A and 8d to 8f for Applicant B: the number of this marriage (first, second, etc.), and if previously married, how the last marriage ended and the date.
Answer health and education lines
Line 9: mark NO or YES for transmissible disease, and enter only the highest grade completed, elementary/secondary (0-12) or college (1-4 or 5+). Line 10: usual occupation.
Enter the parents' information
For each applicant, complete the Parent A block (lines 11 to 14) and the Parent B block (lines 15 to 18): name, label (Father/Mother/Parent), maiden surname if applicable, birthplace, residence and usual occupation.
Answer the yes-or-no questions
Lines 19 to 21 ask each applicant about unsound mind or guardianship, being under the influence of alcohol or drugs, and whether both applicants are outside the prohibited degree of consanguinity.
Leave line 22 for the local official
Line 22 (date license issued, date filed by local official, and the official's signature and title) is completed by the local official, not by you.
Review, sign and download the PDF
Both applicants sign the sworn statement above line 22. Check that each answer is in the right applicant's column, then download or print the completed PDF from FillingPDF.
How to submit H105.167
The form names no submission channel, address or fee: it states only that the applicants make application to the Clerk of Orphans' Court. Follow the Bucks County Register of Wills / Clerk of Orphans' Court instructions for how and where to present it.
- County pages: the Register of Wills section Marriage Licenses and Certificates includes pages titled Applying for a Marriage License, License Fees, Requirements & Restrictions and Officiants. Start from the county Forms page.
- Signatures: both applicants sign the sworn statement above line 22.
- Line 22: leave it blank. The local official completes the date issued, the date filed and the signature and title.
If a fee applies, the county's License Fees page is where to check the amount and how it is paid. FillingPDF lets you fill out and download the PDF; submission follows the county's channels above.
Common mistakes to avoid
- Filling the form in anything other than permanent black ink; the form says to type or print in permanent black ink.
- Writing anything on line 22, which is reserved for the local official's date issued, date filed, signature and title.
- Submitting the sworn statement signed by only one applicant; the form has a signature line for Applicant A and one for Applicant B.
- Entering the sex on lines 7c and 7g in a format other than the M/F/X choices printed on the form.
- Writing the full education history on line 9 instead of only the highest grade completed, in elementary/secondary (0-12) or college (1-4 or 5+).
- Leaving the previous-marriage lines 8a to 8f blank when an applicant was married before: they ask for the number of the marriage, how the last one ended (death, divorce, annulment) and the date.
- Skipping the yes-or-no questions on lines 19 to 21 for either applicant.
- Entering Applicant A's information in Applicant B's column, since lines 5 to 18 are split into two separate columns.
Frequently asked questions
How do I get a Bucks County marriage license?
You apply to the Clerk of Orphans' Court, and this form, H105.167, is the application. The county's Register of Wills site has pages titled Applying for a Marriage License, License Fees and Requirements & Restrictions; check them for the steps, fees and in-person details, which the form itself does not print.
What is Form H105.167?
Form H105.167 (Rev. 08/22) is the Bucks County Marriage License Application, listed on the county's Forms page as Marriage License Application Sample. Both applicants give personal, parent and ceremony details and sign a sworn statement that the facts are true to the best of their knowledge and belief.
Can I fill out the Bucks County marriage license application online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service, not connected to Bucks County, and does not file the application; follow the county's own instructions to apply.
Do both people have to sign the application?
Yes. The form has a signature line for Applicant A and one for Applicant B under a statement in which both swear the facts are true and correct to the best of their knowledge and belief and apply to the Clerk of Orphans' Court to marry.
What do I write on line 22?
Nothing. Line 22 holds the date the license was issued, the date it was filed by the local official, and that official's signature and title. It is completed by the local official, so applicants leave it blank.
What ink do I use on the form?
The form is headed TYPE/PRINT IN PERMANENT BLACK INK. Type your answers, or print them in permanent black ink if you complete a paper copy.
What do I enter if one of us was married before?
Use lines 8a to 8c (Applicant A) or 8d to 8f (Applicant B): the number of this marriage (first, second, etc.), whether the last marriage ended by death, divorce or annulment, and the date it ended in Month, Day, Year.
Is there a fee or a waiting period for a Bucks County marriage license?
The form does not print either. The county's Register of Wills site has separate pages titled License Fees and Waiver of Waiting Period under Marriage Licenses and Certificates; check them for the current requirements.
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