(c) The License and Certificate of Non-Clergy Marriage entered into pursuant to Section 307 of the Family Code shall contain as nearly as can be ascertained the following:

1. (1) The personal data of each party married, including the date of birth, full given name at birth or by court order, birthplace, mailing address, names and birthplaces of each party’s parents, last names at birth of each party’s parents, the number of previous marriages, marital status, the name used prior to the intended marriage by each party at the time of the marriage license application, if the name is different from the name given at birth or by court order, and the new name, if any, selected by each party for intended use upon solemnization of the marriage.
2. (2) The license to marry.
3. (3) The county and date of issuance of the license.
4. (4) The marriage license number.

5. (5) The certification of the parties entering into the marriage, that shall show the following:

   1. (A) The fact, time, and place of entering into the marriage.
   2. (B) The printed name, signature, and mailing address of two witnesses to the marriage ceremony.
   3. (C) The religious society or denomination of the parties married, and that the marriage was entered into in accordance with the rules and customs of that religious society or denomination.
6. (6) The signatures of the parties married.
7. (7) Any other items that the State Registrar shall designate.