CONSENT TO MINOR

CONSENT TO MINOR'S MARRIAGE

(TO BE COMPLETE BY HAND - DO NOT TYPE)

STATE OF NEBRASKA )

) ss.

COUNTY OF DAKOTA)

I, being first _____________________________________ duly Sworn, on oath,

Name of father, mother or guardian

depose and say that I am the _______________________ and have legal and actual

(father, mother, guardian)

custody of ____________________________________ and do give my consent to

(Name of minor)

____________ marriage to ____________________________________ aged

(his, her)

_______ years, and ____________________________________________ request

(Name of potential spouse)

the issuance of a marriage license to them.

Subscribed in my presence and sworn to before me this _____day of 20___.

(Notary Public)

(SEAL)