CONSENT TO MINOR’S MARRIAGE

(To Be Completed By Hand – Do NOT Type)

STATE OF NEBRASKA            )

                                                    ) ss.

COUNTY OF ______________)

                        I, ____________________________________, being first duly sworn, on oath, depose and say that I am the __________________________ and have legal and actual custody of _____________________________ and do give my consent to ______ marriage to ________________________________________, age _____ years, and request the issuance of a marriage license to them.

____________________________________

                                                                        Father/Mother/Guardian

                        Subscribed in my presence and sworn to before me this __________ day of ____________________, 20___.

                        (SEAL)

                                                                        ____________________________________

                                                                        Notary Public