Marriage Certificate - DeLong, Shanon Lichelle_2/6/1998re,,,n.am,eer � STATE OF INOIANA �o. �
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�°'�"�"°°m APPLICATION FOR MARRIAGE LICENSE File
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' GIBSON COUNTY -aq �
Date ol AD iication
IC31•T•9-i. Fuml�hlnplel�elnlormellonuponepplyinglorllcenee. FemaleApplicani50>No O Yes ❑
Apersonwhoknowinglylurnishestelseinlormationtoaclerkofthe IfNo.MedicalExamina1ionorRepor IeA �
circuit court when Ihe person applies for e ma�riage ticense under IC ,,`-\0��� e�
31-7-3 commils e Class D telony. Name oi Physician �LV
MALE AiPLICANT � FEMALE A7PLICANT
PIrvUU� M�n1�15YM: N�rN A4rt40 p� Ofl NO.
Lul MurI�O�EMW BY: a�ID ❑ Di�mce ❑ Annulment O Oab
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•LKNOWLEDGMENT
I�CYIIO�I[EO! 1�11 I Mv! fK[ivlE inlOrmilip� �lQlrOi�p ElnylrOYf [OmmYnKdGt C�S!d5l3
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unTVne O�Iicie�cY fY���I.
sipn.Wre ot �ooucmt ie }� ��'g �
iM �pon �oo�icmt nn oqecleE �o renlv�ny pY oUn oi �ILrmnion or fignaWre lo Ine apo.e
61nOrlqpmenl pK�uN ol rrlqqVa Celielf.
Giat ol Gwn Daie
Sltleo11tN1�M 1 IfwNrqllirmlM�l�e�nla�mAron9nen
. Coun7 0l GIOam °' �� �oo�K��wn h i��e �na co��mi
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. GONSENT Of C�pENTS. P�RENi, OH GU�RDUN
We, �M W�Mb OI INf �CCNUn4 �UOOy O��e CMltnl 10/ IMf mmiaQt I� M1Y �� W�MI S�ynL
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SupurlbE �M �worn lo GNas m� Ini� _ UaY oi i9—
Qen
N�me
O�ie o� Binn
CrpviW)Mari1tl51�Wf'. Nere�MarripEy OB NO.aI
Year
lutuarriageEMeaBy: DeemO Uvorro❑ �nnulmm�❑ One
Date d dnn m�nee er: �nn ceni�bte O Otne� ISOedhl
i., blyW�ro+�orMrlYOUnmGMn�EjWOlE�OElolunfouMmiM� NO Yn❑
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t. �re Ya �ebletl ta 1�e melv �p0lk�ni cbser �Mn fecatl cwfin? No-Q / Tp ❑
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l �n you row en0er ine inllueece al � nucolk Urv9? No � Yn ❑
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I�CRNOWLEDGA1ENi
I acYnowleEqe INI I �are rlCeirtC mlamation �eqarEin9 Ea�pe�ovf cOmmVniCeDle OiSttltf
INIarHUWIIYtr�nfmi�hE.arM�listalinettlttite Iwl ri�u Nalc�ufefND5lacGUirtE
iTTVn101IKRK�SynO� I ,,���/�
Sgmmre oi a�ant �[Q((AM � _ _ Oaro � �
i�e �OOre aODliunl �af oEl=<teE �o mnlyinq pY wl� or �Ilirmalion w fg�uWre to ��e �DOre
¢tnowleEqmmt ptt�me ol rr4giwe Dtlieb.
C4�� o� Caan Dale
SlalaollMian� 1 f�. Isw<arhllirmin�tlneinlormation9i.en
Cwnh ol Gipwn �/ 1 ///�n}}}i JJJ(((oo�knlm ie ime �M corrM.
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I�SI,��i+�—` �m Lkr1 Ne GiOSOn CircWl ('qurl
CONSENi 0� �OqEMS. �qqENi, OP GUAADIPN
We.IXe PLenb ol �nis aoolkanl, nveCY 9ire cwunl lor Inif marnpeJl pn7 one Onent sqnf.
iblt b[b «nKn ma4lne conunl ol lne ol�er W�enl u�nttm�ry _
Smeoltrqiam 1
counry a � aa.
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SueeviMC �M t.orn �o hion me inn _ eay ol __
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Crer�
COMPLETE IF MAPRIAGE LICENSE ISSUEU BY ORDEN OF COURT. A marriege license having 6een relusetl lo the above name0 parties, the
County Coutl, by writlen order issued
end IileE in euthorizee an0 tlirects Ihe issuance ol a marriage license lo the above nametl parties.
RETURN OF MARRIACE LICENSE AND MARRIAGE CERTIfICATE
! certiJy thet there wae filed in my oTce a marriege licenae issu 6y the Clerk of the/7Circuit Court af Gibson County, Indixna,
dated �'�-5- `l �// , authorizine the marriage of �� �•� ✓���-4- and
,9� a.�-w�. ��,Ssa�
f furth �r 'fy that the fa %wing marriege certificate was filed in my a�re/}: .� /, ,
1, nxme), cer it)' at 7'�7 9� (dete). n. �Gi�AL�!/C�-C.J in
County, Indian Q of County,
(atete). and la.di.eTri�°_ 6�1�� of County,
(atate) wem mamed 6y pme na authorized under a mamege license that wes issued 6y the Clerk of Ihe
Cimuit Court of C,(�,/'66s-/pn `Caun 1 diana, dated 0 �� 9 -�/�-�� �
Signed by: ��T � � w� i.�„ lAt�at.K' (officiel deLsignation)
Filed and rerorded in accordance with the law•a af the Slate of Indiane on 9-d 4�/,� (datel.
Signed �'(Dw�� Clerk
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