In the name of Allah, the most Beneficent, the most Merciful

MCC Religious Affairs Committee Application for M arriage Services

Please read the following instructions before fi lling in the application:

Groom Bride

Name: Age: Name: Age:

Address: (Streat Number & Name)

Phone No. (City & ZlpCodo)

Residential Status: Marital Status: (Check One) (Check One)

US Citizen D Single D

US Immigrant D Divorced Don: Other Widower Don:

Muslim By Birth: Yes D No D

If "No", accepted Islam on:

Signature:

Venue: (Location of Marriage)

Address: (Street Number & Name)

Phone No. (City & ZlpCodo)

Day: Date: Date:

Marriage License No.

Date:

(AH) Time: !AD)

Issued on

By County, State of (County Name)

Witness #1

Name:

Address: (St r a et Number & Name)

Tel#: (Cfly & ZipCode)

Signature: Date:

Marriage Officiant:,.. - �c;

I .c..:, 1 Date marriage license malled to County: ��

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MCC marriage certificate#: Date issued to party: -

Address: (Street Number & Name)

Phone No. (City & ZlpCoda)

Residential Status: Marital Status: (Check One) (Check One)

US Citizen D Single D

US Immigrant D Divorced Don: Other Widow Don:

Muslim By Birth: Yes D No D

If "No", accepted Islam on:

Signature: Date:

Name of Father /Wali:

Phone No.

Father /Wali Consented: Yes D No

If "No", please explain:

Mahr as agreed: Now Later

Witness #2

Name:

Address: (SI re e I Number & Name)

Tel#: (City & ZipCode)

Signature: Date:

Service Charges: $ Receipt# Date: - (Chock/CuN

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Chairman/ Co-Chairman

Muslim Community Center 4380 N. Elston Ave. Chicaao, IL. 60641 • Ph.(773)725-9047 • Fax(773)725-1616• www.mccchic a a o.ora

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1.You must obtain a marriage license from the county in which marriage will be performed. 2.We cannot perform the Nikah without a marriage license and we cannot perform the Nikah onthe same day of issue of the license. 3. Identification of groom, bride and witnesses must be presented at the time of Nikah. 4. Service Charges: $200 If Performed at MCC/MEC -- $400 If performed at any other facility