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Marriage Certificate - Birch, Midori A_3/17/1997�W � o �/%-�-�a �e.mn...ne.se> • g�ATEOPINDIANA � Na �wwew.mwa . x.�u v.e.. �auenv � a����.�a. ApPLICATION FOR MARRIAGE LICENSE Fv� m.eu.. �w t �m ', Gibson County �o � � � $ v���.�b� ��E FEMALE �' �' O Medleal Fseminatlon RepoR Dated Atedlcal Examinatlon RepoR eted � Name of Phyelclen Neme o( Phyeiclan f'«'°`� � ALL GULBTIONB tlUBi 86 ANBWERED.IC ]I-14! pn�crlbE'F�lu �t�Nm<vl-WGw��t D�vm W� bmm<� e1 � Ilnen b m�rql� uf falw �l�bm�e4 nOn�elallee er pn4vx �Y�II b IInM 1n �v) �um eo� �.ewGlvi tb� CuvEnE Goll�n 1tS00.0a1". MALE APPLICANC uu�un� �� / � � %9A' �c� l �l�x muv«fl(� �)_ P«.r. � y mc� ��t✓ �RO� ItL' � ll+"f"++'� Err+-�-..� ! o �Pn�loa� M� W Bbtv�: N�ve MurIM O Oft Lu� Mvrl�p EndM BT w.�e o OM1Ort�C' weeulmmt0 D�b al EirtE artlLleE Gp O BIrW GK � JvE1cIJ Ocre� �l,- i _ 0 ow.r (ev��ryl _— �"�'�+_ _ .. __.___.__--__.._ I. An �ou eo� ot E�o yvu �or bee WfvE{N b b o( vawveG m1oE9 If �evrt 1�'ya� ; Eu IEe Wjudlt�tlov Eean remaved9 �. 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Are yau roQU1�sd ey �uy wurt oreer or araen No O YaL�- b rvppon We ��on Gepvtl�et cE1lEnnv 1( �nv�r b'f�i .1� b nQU1rtE l��t 1Lb ApPllotloe E�.cwmp.vleE Oy uU�t�cbq Prool tE�l )ou �re 19eempllww wllE �vY roarl oeEer or ortlen luu�d f0f tEVlr rvpporl �/ !. Pul� v�me a( ILLEer _.�.--�]- �} - - ��- -.' • . ..._....._. Re�1E1ec� Of 1uElf (If Exl�b � rta[[) -/-��°' � � 91rtEpl�c� al M1tpv I81�1� or lonlin Countq� --... _.... _._ ................ u. rm�m.ia:ne.�•o��nom.. OY!?"�'"- �.�__..�.� ��.—..__._._._'_'_. . ._.__/ _. .. Re�1E�oce of matEer p( d�ceueE w�fa�l -r!!--.T�_= � �-'-_......... ,}1y J�. �= �r� -._ BIMpl�ce el motEer (Bl�b or tonlge romtql -._! �`- '" ---..---._...._. B��t�dlMl��� IG a�ed.����Ue�Nwm.Jeni�rm �a � � �� � �..t� cw� ��� ,.. a n.c s�� � — N� Addrs� eae.�,s.ew.�eao�e,.y.. P a.r i <+l�..iu f) 'h � c�..� e� �n. cm.ae co-��� ceen COlIDEHfOPPARLM9.PARPNfONC11APD1AN ' 11� W� p��my d Nb �pp11uM belW) dr� mmro� br NY m�rrl�p if wd� ane p�emt �kd. �4N IMS �lMb eml�r W� m�m1 W N� elle� D��m! vv�ss��n ee.e.a�nu.n.. t.. Com11 S e�ne.e.na..o.�me.b..m.w� a.>a �v— �� !. Lbt t4� NII Pn�m�e� o( �n� EepevEent cElltlnv. � (/�.(/�/ -__.__-./,A G,�..--O[v?�t..__...�.�_`.-`�r J_..__.-___-_. ---��^--�-T--�°--�^-�° _-=- r. w�. yo� r.am.sa e> .vy m�n om.� o. o.a.r. w�upport �M �Eav Aepeotlen! eElldmn4 No Ys� ❑ il m��er b"Ye� : 11 b nQU1nG lE�t tEU ADVl�ollov 0� �campmleG Ly utl�(wbr9 prao( tE.[ �oe �n lu eompllmn �ItE �vl �orl oN�r er artlm IerveE far t�etr �uDport. !. Full n�me o11uMr _ � ��//'� I ftv�IEence ol l�l�er pt Gec���eG �a �t�u� I.G�C%� - Blrtl�pl4't al btMr �Bt�t� O� (or�l(n countq) —. �� • u. Fui� m.iaev n.m. ot muteo! "! �/"0 "------.p—�—,�-- fte�lemceatmomerlltaecauad�o�u�e) _'_" -'-n---�--�j��------'-" BIIt�p1Y! �I IIIOIE!( (sl�t� O! IOft�sC COVOI!]) -_{,-- -'�—�-� !/ S��te d I�d� yyy ,n 1: I�d e�vd n t Ne INam.�lev {Irm 7L1�o-.- ( � � wou�.iae � �.�. .�a .n...« CeuNY �� ' g,.� �'—T`" n c-.,��m. k.. �ae�e. n� � sae.am.a ud ..a.� do.. m. ui a.r d{�— �s �� c�� ee w. cm.e. c�ie cwn COTS EM OF PANENIS. PARLYI OR GUARDIAN Ws N� pveN�. W Nb yp�luvt heraEY f�v� mvem br N� mmlqe �f ml> aM Oveex �I�m. �1�fe hcb .11rA neda tA� m�+mt o11L� aNer pnmt unnaasnry 5�.�.a�bi.�� /.:. r..e�,e. d _ 1 s�e.��m.e.�a..o.�mem..m.0 e•s^� �'— — C..� CONPLET6 IF MAHRIAGE LICENSE I9SUED BY ORD6R OF COUftT. A merrlege Ilceneehevingbeen re(u�ed to the ebove nemed partlee, the C,q���y. Court by wrltten ortler IesaM eM Ned ._ .euthoriza end dtreets LhebeuancedamarrlegelkemetoNeebwenamedparllm. REl'UAN OF MAfiR1AGE LICENSE AND MARRIAGE CERTIFICATB BE IT RfiA7EAfBEREO, then vu Tled in my oJ(ce a the �� daY ^/-i Be U L - livena iuued 6y fht C�rprk �oy/ fhe Gi6ron Cir<uit Court o/ Ci6eon Counfy, /ndiana, � 19SLL� auNoriti the% ini�toeKAnahm6andaldn�i/e � ,,,_ . . . �'. �/ �led in my o//et to-miC fhat on ont fAomand tine hu�drd a '• �� SWIe o/ fidianq C'M � I A��L-^-��"''�'�� -C^�^b. Stale o/ ax( Brid JJ1L. '�- � °� �".�`�y County.5taleo) mae 6y me united in marriage u aufhorized by a marria8� �cense iuued /or lhaf purpax by fhe C��rk a/ fhe Ci6ran Circuil Court o/ Cibton Couny. Dald Ni� �� �� 't°7 a1-LY1-� 19� Sr%�7 ' / U CC. p//icia( DmiBnatlon �L6 � < L � . � ro