CONSENT TO MINOR’S MARRIAGE

(TO BE COMPLETE 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_______________________________

(father, mother, guardian)

have legal and actual custody of _____________________________________________

and do give my consent to _____________ marriage to ___________________________

(his, her)

aged _______ years, and request the issuance of a marriage license to them.

________________________________________________

Subscribed in my presence and sworn to before me this

________ day of ______________________, 2004.

______________________________________________

(Notary Public)

(SEAL)