SSA-3

Marriage Certification

Download and Print the SSA-3

SOCIAL SECURITY ADMINISTRATION
MARRIAGE CERTIFICATION
Form Approved OMB No. 0960-0009 - TOE 120/420

SEE PAPERWORK/PRIVACY ACT NOTICE ON REVERSE.

PRINT NAME OF WAGE EARNER OR SELF-EMPLOYED PERSON

SOCIAL SECURITY NUMBER

I am the spouse of the person named below, who has applied for insurance benefits under Title II of the Social Security Act, as presently amended.
NAME OF SPOUSE (First Name) - (Maiden Name, if applicable) - (Last Name)

1. Indicate whether your present marriage was performed by:
Clergyman or Authorized Public Official - Other (Explain)

2. Were you married before your present marriage?
Yes
(If ''yes'', give the following information about each of your previous marriages.)
No

PREVIOUS - MARRIAGE - TO WHOM MARRIED - WHEN (Month, Day, Year) - WHERE (City and State) - HOW MARRIAGE ENDED - WHEN (Month, Day, Year) - WHERE (City and State) - MARRIAGE PERFORMED BY:
Clergyman or Public Official - Other (Explain in "REMARKS")

SPOUSE'S DATE OF BIRTH (or age) - GIVE DATE OF DEATH IF SPOUSE IS DECEASED

And much more...