W. Todd Harris
Register of Deeds, Surry County, NC

You must call for an appointment after filling out the application at (336) 401-8150
Complete the application below to apply for a marriage license. When the application is submitted it will be checked to make sure all required fields have been completed. Any problems will be presented to you in red and these problems will need to be corrected and the application will need to be resubmitted. When your application has been successfully submitted, you will receive confirmation and a list of further instructions for obtaining the license at the Surry County Register of Deeds office.
 
Applicant 1 or Groom
First Name
Middle Name
Last Name
Suffix
Last Name At Birth (if different)
Gender (optional)
State
County
City, Town, or Location
Inside City Limits
Yes No
Street and Number
County of Birth
State of Birth
Birth Date (mm/dd/yyyy)
/ /
Parent or Father's Full Name At Birth
State of Birth
Address (if living)
Parent or Mother's Full Name At Birth
State of Birth
Address (if living)
Race (optional)
Number of this marriage
If previously married, last marriage ended by
Date last marriage ended
/
Highest education level completed
Applicant 2 or Bride
First Name
Middle Name
Last Name
Suffix
Last Name At Birth (if different)
Gender (optional)
State
County
City, Town, or Location
Inside City Limits
Yes No
Street and Number
County of Birth
State of Birth
Birth Date (mm/dd/yyyy)
/ /
Parent or Father's Full Name At Birth
State of Birth
Address (if living)
Parent or Mother's Full Name At Birth
State of Birth
Address (if living)
Race (optional)
Number of this marriage
If previously married, last marriage ended by
Date last marriage ended
/
Highest education level completed
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