CERTIFICATE OF RECEIPT OF NOTICE
I, do hereby certify that, on the
day of , notice was duly entered in my Marriage Notice Book of the marriage intended between
the parties therein named and described, delivered under the hand of , one of the parties (that is to
say):—
Names Condition Rank or
profession
Age Dwelling
place
Length of
residence
Church,
chapel or
place of
worship in
which the
marriage is
to be
solemnized
District in which
the other party
resides, when the
parties dwell in
different districts
James
Smith. Widower. Carpenter.
of full age. 16, Clive
Sreet.
23 days. Free Church of Scotland Church,
Calcutta. Martha Green. Spinster.
………
Minor. 20, Hastings
Street. More than a
month.
and that the declaration 1
[or oath], required by section 17 or 41 of the Indian Christian Marriage Act,
1872 (15 of 1872), has been duly made by the said (James Smith).
Date of notice entered
Date of Certificate given
Witness my hand, this
The issue of this certificate has not been prohibited by any person
authorized to forbid the issue thereof.
day of seventy-two.
(Signed)
This certificate will be void, unless the marriage is solemnized on or before the day of
[The italics in the Schedule are to be filled up, as the case may be, and the blank division thereof is
only to be filled up when one of the parties lives in another district].