(a) A declaration of informal marriage must be signed on a form prescribed by the bureau of vital statistics and provided by the county clerk. Each party to the declaration shall provide the information required in the form.
(b) The declaration form must contain:
(1) a heading entitled “Declaration and Registration of Informal Marriage, ___________ County, Texas”;
(2) spaces for each party’s full name, including the woman’s maiden surname, address, date of birth, place of birth, including city, county, and state, and social security number, if any;
(3) a space for indicating the type of document tendered by each party as proof of age and identity;
(4) printed boxes for each party to check “true” or “false” in response to the following statement: “The other party is not related to me as:
(A) an ancestor or descendant, by blood or adoption;
(B) a brother or sister, of the whole or half blood or by adoption;
(C) a parent’s brother or sister, of the whole or half blood or by adoption;
(D) a son or daughter of a brother or sister, of the whole or half blood or by adoption;
(E) a current or former stepchild or stepparent; or
(F) a son or daughter of a parent’s brother or sister, of the whole or half blood or by adoption.”;
(5) a printed declaration and oath reading: “I SOLEMNLY SWEAR (OR AFFIRM) THAT WE, THE UNDERSIGNED, ARE MARRIED TO EACH OTHER BY VIRTUE OF THE FOLLOWING FACTS: ON OR ABOUT (DATE) WE AGREED TO BE MARRIED, AND AFTER THAT DATE WE LIVED TOGETHER AS HUSBAND AND WIFE AND IN THIS STATE WE REPRESENTED TO OTHERS THAT WE WERE MARRIED. SINCE THE DATE OF MARRIAGE TO THE OTHER PARTY I HAVE NOT BEEN MARRIED TO ANY OTHER PERSON. THIS DECLARATION IS TRUE AND THE INFORMATION IN IT WHICH I HAVE GIVEN IS CORRECT.”;
(6) spaces immediately below the printed declaration and oath for the parties’ signatures; and
(7) a certificate of the county clerk that the parties made the declaration and oath and the place and date it was made.

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