Marriage Certificate - Briner, Pauline H_11/2/19921
i
�i
I
;
rm.werne.en
.,y.�. sm se.a a
.�,.�...w„e,
aKm-�.�
�� �h���
��-
��. �
�,��. v��-
STATE OF INDIANA . _
APPLICATION FOR MARRIAGE LICENSE F+�a _
GIBSON C
IC71-7•9-1. Furnithinglelaelnlormetionuponepplyinglorllcense.
A person who knowingly furnishes faise inlormetion to a clerk ol the
circu(t court when Ihe person ap0�ies lor e marriage license unGer I C
91-7-3 commits a Class D lelony.
BVN
ISUb n
�� ,� g
pU�4-3_� 6
Pf o r� �
OUNTY o� o Appllc�ntion
Female Applicanl50> No O Yes �
II No, Medical Ecamination or Report Da�ed
Name ol Physician
MALE APPLILANT . I _ FEMALE A7FLICAM
$�Y
pmiw� M��IW SI�Nf: Nn�r N��neE O OP No.01 F/��Iwf 1.4�Npn _- �
L�W�M.prEMeeB' OnN� OMVae❑ �nnolmmiO O�le� /�po
O�b M GiM nN W Gy. BiM GN�IGU p O V�SOe[ilY)
_���in�r�� / , i�
1. /.e� you no. a Mn pu e�er Gem �aryO:N to M ol un�oune MM� Na� vu ❑
11�nfw�1�}'�:��fN�WryE1ca00nEn^rerMVlO� Ney0 Yn0
}. �f�ypu�M�IMb1�11�T�l��ppl4�nitlo��/N�n�KpnO[Wfn� NO`µ\Y6f0
]. /il�ypuM�YM����ImIN�M�M�n�kMOYCETlr�Oa] NO({ Y[fO
�. Mpvro�WnlMNllwr�[eel�ryKO1KONq� No�` Yn❑
5. U�INefAMmuWmYDep�nG�nICN�em.
6. I�I iNnurvol�pp4Gn1'�ItlM� ' .
�11 bopfl0. WI bOOYrt �uMb QMI�
M.berc� ol �.�m� 1'�� ewuue..o �ui
BvI�Wn o11�N�r (Stm a Ia�qn covmry/lJ
�p� fy� m�q�n nwe al �pp4anl'1 meNlr ..1� �- Q �� � n�
pi.aoo�ee.�.iuoo�..o.nnuw.hl y�� .[LC[.i _
HeYUmC�olme1na1110NbflO.ntl�b) ��„". ¢
&Mp1�uWmoN�r�51�I�M�Wn4^�W^WI "'�'�
♦CKNOWLEOGMENi
1¢�ro�lwi� wl l n�re na�inE N1orm�ibn rpuC�nO a�nqvouf mmmuN<�de Eue�a�a
unv�n.u�h�rmuNnM.w�b�WN��nuib��11 Iatne.nmmuuusu�lo5bcaun�e
vm�M�� 0�fnm[I ryt4rwn�l. �� �� �
Sbn�iw�e��aNc�m�7 .�y ���o Dne �qY
tm.eo.. �oneu•i n.. oWa�.a m nmN�q er ann or.nnn•non or .qoatm� m me •EO.�
61nOdKqm�M Oeum� ol rtYpqu� bWL.
e�n. e� eoun one
Sbboll�Elen� 1 ��`*�������^'^�miNemlormnanpivm
Counry d Olpam 1°' �x i'�oo�k+tmn ia vue �na conmt.
S�qneOp}�L.���L �
N��AJOra� �f o
Subt �M f�pn le MlerY� 4� ��<tY 01 � 19L��
��-�� /�-�+^� - -- C4M1 el IM a1Nen GrNll fcW
CANSENT Oi GARENiS, F�FENi, OR GU�R�IIN
W�. W WIMI� M W� �ON4nl �frfCYG^� �f�n11M INf m�lv��.11 wJy en! W�ln� ii9�f.
�lal� IaCU �ticl+m�1� W<mfMl OI IM dl��r parMl vnntteiury
s�.�.auaw�. i .,
Cwnry o� 1
{�N[I . .� 1O•
MONIf �� �
$vpWiyM �M �wpn b'Lelau m� We _ Cry 01 I9_
Gert
wm•
D�1� W 01M
e101M (SUU a
PnNVUfY.�MtlSYWC NMtM�rtIMO OR NO.OIP�MdnWrtl�On�_
Lu1N�rt1�0�EnEeEBY: d+N� Wwrt�O MnWnrntO O�le GD
DaIeGWMr�rl�iMtry: OBiMCm�f�ul� QD fSnGry�
�����
i. e.. ya� �o. o� n... �o�.... en�.al�ev.a io e. oi ��.wm M�at r+o� r.� o
11 �mqr b"Yef.' On IM �G�u?ctlbn Cwn pmOrtO� No O Yq O
3. An YW nI�IN 10 ON rtub �ppY[�nl CMV INn ncOnO <NiNI NO.�]' Yat ❑
0. �rcyWno�unOb��fln0uerc�olmtl[a�0lkMnnqA Nom,,,[[[ TnO
1. 1i�ypuro�unE��N�Nflverceol��vrtoticErtql Noµl Yn❑
1
5. LhINehAnlmnOl�nYCt:OnOMICGOCem
e. � 1.1 r�niu�eoi.odkNn�.uxr '
111 �COpIM.11il baT�n P�rtnl� ONyI /) '
'RtliO�nceolhN�t(IIEMJUUAO�41�1 ^'J"'l f
6�nnq¢• ol4uw� Ism� w lor•p� cwninl i`+^-� -
(p� FA m�i0m n�m� W �pofic�nYSnoNer �
(11 �OOpleU. bl W op1M PtMU ONy)
HniemceMmomerpiaaoua.ao��ne� ��^=='" Q'
B�nnoba o� momrr ISUie ar �mqn o vnvyl �.
•LI(NOWlEOGMENT
1�[Ynv.le09� �n�l l n�r� ��c�ME lnlarmtlbn rpuEhq OupVOUf cOmmvnk�Gb Ebuan
1��1 m qrv�lly InmM�bE. �Mi Iryl e11M te+� �I�o 1or N� �1ru� W I u�nef AIO$ pcy WrM
�,.,�. a.��,n „�.�.r/ �
9�o.�w� e� bo�i�m � /d!/IL�E � Diie !/-d-9-`-�
TIf! �EO�e �p0��[�nl ��f OE�NICE le vl�Ilyl^y Ey 0�11� OI ��IIrm�11M Of f1pn�Nl� 10 N� �M�!
�[Ynp�IMpm�n� bc�uf� ol ��Yqiwf Mlylf.
Cl�r� ol (�'qlll D�le
Sb�e oi �n0l�n� 1 i�wrtumm+mn me imomu�mn o�nn
Coun7 al Qimvn /�1'i y� ���ni� �pp�k�iron b vw �iW wrncL
sy�n N � /�' ,6%Y�iJ-ri —
N�w AEdru�
SuOacrlEM n) C•�w^b�'o'erMl�N.f �,� 1O�YOI ' f9 4��
��KI f�s'�-� - pp'1 o11�I OlEton G4[NI Ca6i
fANSENI OF P/.RENiS. P�RENL.OR GU�FDIAN
We. UN D�ronlf ol Nia �pp4[�K �erl�Y Cir� conan� 10� IMf manb��.11 ONy mt p�Rnt fiSmJ•
�[�M1 I�clf ��i[� maY� N� [Onunl a11M oVNr p�l<nl uMKeaLIy
$Oleolln0i�n� 1 as
�Mr a 1
F�U.e� IO �
Po�Mr ID •
SuE3CnUM �nE fwpn 100lICr! me Nb � 0iy O�
19_
CMh
COMPIETE IF MARflIACE IICENSE ISSUED BY OHOEP OF COURT. A marriage license �aving Deen reluse0 lo lhe ebove namad parties. Ihe
Caunry Coun. by wdlten orOer iuued
and IileO in aulhorizez en0 directs Ihe ismance ol.a marria9e license lo the above named panies.
RETURN OF RIARRIAGE LICENSE A\D MARRIAGE CERTiFICATS
f cerGfy thet Ihere wee filed in my affice e marriege licenae isau���(((� ���6yyy��fhe Clerk o.��f 1>the �C' uit Court of. Gi6son County, fndiane,
� �� O� ��/�C...r and
dated eutharizing [he mnmege of y.
���� �e%'�9a � ���� . � � ;
! further rer ify that Lhe fol , win�murnage certificate wea filed in my o i: ' r-
1. ,/J _ — (nam Y. erfifY'thet on _eZ(dete), at in
County, Indian of ounty,
� (stele). and of CounOA
r. .
� (state) were marned 6y me es euthonzed under e mn+riege license Lhat was issued 6y the Clerk oA [he
Cilcuit Court Gi6s n Countv, Ind' e dafcd.���1'�—�r %�99�
Signed 65': � . � %i�fA,a.7�dii . (omtiel d7esignetion)
Filed end orded in ecrordanre with the lawe of the Slate of (ndiane on �t�/J/' �p�°��defe). "
Signed !� �"���'�---��" ""'_"`� Clerk
enu eirn � wiaar
Ci6son Circui! Court
1