Marriage Certificate - Crecelius, Amy J_10/13/1998_ Q
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r«�+r�..�.m.ae. � • STATE OF INDIANA � No.
- � -' i�ew. sw. eeve m
""�'�'°"""°"'" -'� APPLICATION FOR MARRIAGE LICENSE File
m����„ �-
GIBSON COUNTY q � �s
Date of Application
.-IC31-7-9-1.�Fuml�hinglelaeinlormatlonuponepplyinglorlleense. FemaleApplicant50>NO ❑ Ves ❑
i;4personwhoknowinglylurnishesfalseinformationtoaclerkollhe IfNO,MeCicalExaminationorReportDated 7-as-9z
: circuitcourtwhenihepersonappliestoramarriagelicenseunderlC e
.^31r7-3 commits a Class D felony. Name of Physician
MALE APPLICANT
wm. /� ,�vp.� ��ecie � �.v q�.
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' D�1101 BI�� MAnI� D!Y sear
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` R�u ot Binn ISl�le or �oni9n cwntryl T� )
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RW�npa�a a StreeiorgR. Ciry Coun Sute T,,
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PnNwf �.I�tl��l Sliluf: Nmr MLnM O OR No. ol irtMet Mern�qea �p_
L�etMVn�p�EnUeOBy: Oe�inp Diwrte� m+nWmema Date oI /993
o�te ol oinn nriGea oY- � Binn Cmwcne�Omer ISPrcrtvl
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L bay0unaworMrayWM�Own�ai�9��oWOlunfounEminci No'� ro0
II �Npr if "Yef.' Ms OL �CjWiu4On Dpen remOVECI No (�i YH O
]. Are'pu r�la�t0lo I�e femal� �ppliGnt clofer ln�n XcpW coufin� No� YO O
]. Art you noM unCer I�e inib�nce ol �n alco�o4c Oennqe? no �y.� ve� O
�. Af[ YOY 110w Y(IEl1 N! IIIfNlnC1 OI � n�tC0lif 0 NOiy Y!f ❑
5. Lisltnelullnimoo/lp/ YeeDenoenlcniWren.
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6. �qFUlln�meolapp4unl'fhlner
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AOiIOC�CCOIIiI�[I�IIEKG�l�0.30f�1�l) �•
&nnobu ol M1mar �S41e w lorei9^ �ounvy� S.✓
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(�ia��_
Revamce oi momer li� a�nuea. �o mtel ./ •C•
Binno�ew ol moma �Sbu or loniqn covmry� I,✓
�CKNOWLEDGMENT
I¢k�p.IMy� ��n 1 Nre recei.W inlorm�uon re9arEin9 Oan9erw> communiu0le Oisuuf
1��4�� S�m/Ily 1!lnfR+OtC. �n0 � Iif� 011�! In� vUf 10/ �M riNf lM� [ause] AID$ ��COm�lE
sfqn.mn ouoo��um
Dne
Tne �OOVUOOLCmt nu o0iecleC to v�rilyln9 �Y onn or allirmalion o� si9mlure lo ine apove
�Uno+leEqmml pecame o� rtllqiom eeli�le.
UeM1 01 Courl One
Su:eollnEhn� 1 �e�+sar4�ermmnmem�ormationqiren
C<unN ol GlDaan 1 U' /� �n iM �od�cnan ie �me �n0 mrtep.
s,s�� �.li,�„ �i).l�.un�Q,�i�
New AUOresa �p
Sueuripee ana arwn �o ee�yp n� u+ie —fL a�y o� . �9 �
!/ /Jn V
A. �.e��Y AZ..` Iert ot u:e GlDSOn ClrcWt Cowt
CONSENT Oi P�RENTS. �AqENT, OR GU�RDIAH
We.�inr p�nnb ol Nn �pOYUm. nereOY pire comenl lo� ini� marria9e.11 an1Y �e wrmt siqm.
�tlle ��Cit wflic� m�Y� Oq CMfent ol Ipe atNr Wrenl unnKeiLry
S�neollnci�m �
Caunryol � fe'.
qmm
Motner
SueurieW �na �.om m pela� m� ini�
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aaYOi t9_
Cier1
FEMALE APPLICANT
nem�
One o� Bmn
Placeol8innl5laborloreiqncovnlry) _�
�vi�`no �aa� Stroei o� R.R. Qty, _ � Counry � �pe
F�L� � n� oa. N
PnvlWf MpNlSbtus: Never ManieE� pq No. ol Pnrlpyf Mvrl�gaa
Levivarri�qeEna�a9y: 0<un O Divo¢e C Mnulmml ❑ Due
one oi e�nn ve.niea ey: o Binn Gniicae�'omo �5peciry�
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Are yoe mv ot nave yw erb pwn �e�uegeE ip Ds Of vnwunE mi,q? No�G Yn O
u�n�.er h'yn: nae me aa'ryoiuwn wm removwt Np � Y�f 0
AeeyovrtlrteElo��emtl!lOp��e�nl[IOH���anticonUCOUfint No�' Yn0
Ar! yw mw unEa IOe Inlluenn ol �n �ko�ollc Eev�nq�P N0�' Yn �
♦1! yW n0� und!! t11[ i(111ulM! OI � 11l/COLC QNp? NO � Y�f Q
LiflNflullNmlSO1�nY41p��OCn�C1�ilOMn. NO
I�1 :un n�me ol aoo�icanYe bmar
QI aaootlC. lis� Naoolive vuentf Onh) .
�(�MW pMC O� �][Ilp! (11 UNllflO. f0 f�llC�
e�+dace ol Iamer (SUie or lorepn coumry� �
1�1 Fy0 RyiCln I4�T! OI �OO�Klf1h mO1Ml /�M
(n.aop�ea.iiauaoo�mav�womy) ///
Ry W�f.C! 01 rtp�l��f (i( CK��YE. fO fl]IO
BirtOplace ol mot�m �Sbte 0� �o�ei9� rouniry� '��
�CKNOWLEDGMENT
i ec�no.�ea9e mu 1 nave receive0 �miormation ro9amin9 mnqmou� comrt�.vniuG� aiu�ra
I��I ln ae� W IIy V�nfTippC. i0E � �ifl al 10� 1lSI Si�ef.10'� N,,f(�muf Nal caufn AID$ I�COUVq
immunea��KUncy�rna���.L�'\� ��l-�%i��ll' Q-p�15
Sign�Wr� ot eoW�um Date
T�e apOV! �OO��un� 1us oOjecttE �o vbllying py w�� or
ec4nOW1lOqmenlDecevuol« IipiousDelieh.
CIefY 0� COV�1
or srymmre b �ne �owr
OIIG
SbuollnGUna ) I�.uri�mmma�meimormatron9^en
CounHOlGl�aon /� 1 �' inMfaoo�cationiewe�oammct
Sipnea /� w „w✓ �T� (�
Ner ACCres� " p.�
SvOmrIME �na�o m to Cetort "gInu � OaY ol 19 /?
L/ /Tl (i
-/�¢aE �sr hezn� cw� o� Ne cioea� circ�u can
CONSENT Of PGRENTS. PRRENT, OR GU�F�IAN �
We. tM wnnb ol INS aOGliunl MnDy 9ire coment lor Inif muria9e.II oN/ on� wrml fpns.
f(ne t¢p w�kp mate Ine confan� ol Ne olne� partnt unna[Oaary
SlaleallnCiana �
Counryal � ss.
Frtner ID �
MONM 10 �
SuOfcnDeE en0 iwm �a Oelore me ��if _ Oay ol f9_
Gen
COMPLETE IF MARRIAGE LICENSE ISSUED BY OHOER OF COUHT. A marriage license having Deen relusetl to the aDOVe name0 parlie5, l�e
Caunry Coun, by wriiten orEer i55ued
anE liled in authorizes ena Airecis t�e Issuance ol a marriage license to tne aDOVe namea panies.
RETURN OF hfARRIAGE LICENSE AND MARRIAGE CERTIFICATE
I certify It et there wes Sled in my office e marriage license issued 6y the Clerk of [he Circuit Court of Gibson County, Indiana,
dated Y�s , authonzing the marriage of �-1 ����-f- ci��� �/11�i' Q�C E..� � and
/. n , 1 /_ 0 0. _ . �—�—
I
I,
mamage cert�cate4vas filed in my
- (na�ne), certify that on
County, Indiana,
(state), and d- ��-�
(state) were mamed b me as euthorized under a
Circuit Court Gi6 ounty nd�eo dated � .
Signed by: 6�
Filed and recorded in eccordence with the lews of the State ot Indiana on
_. . �. . .
qy-� (datc), et in
� of � County,
af �-�� � County,
license that wes issued by the Clerk of the
designation)
n n G. i
(date).