Marriage Certificate - Dill, Jan E_10/16/1998v l�(-uu�5 y -c�U
�•' r�.�.oare� STATE OF INDIANA o,
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,_ � �°'~""°°°' ' APPLI�ION FOR MARRIAGE LICENSE, ��ie
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GIBSON
� � IC31-7-9-1. Fumlahlnpleltalnformetlonuponepplyinglorlicenie.
A Derson who knowingly furnis�es false inlormation to a clerk of the
.circuit court w�en t�e Derson aD0lies lOr a marriage license unCer IC
`__ .- ', � 31-7-3 commits a Class D telony.
.., �� ,�MALE
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COUNTY � —�— 9 �
Date ol AppliWtion
Female Applicant 50 > No ❑ Yes ❑
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ALKNOWLEDGMENT
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CONSENT OF p.�pENTS. P1flENT, OH GU.�RpMN
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COMGLETE IF YAqNIACE'IICENSE ISSUED BY ORDER OF COUXT. A marriage license having Oeen relusetl to Ne above nameE oanies. t�e
Counry Court, 6y wri�ten orEer issue0
ene fileE in autnori:es ana airects Ine issuance ol e marriage lirense to the above nametl Datlies.
RE1'UR\ OF MARRIAGE LICENSE AND MARRIAGE CERTIFICATE
I certity that tLere wae filed in my otiire a marriage licrose iesu�e—d-�/6fy eqhe� C�lerk of �the Cireuit Court of Gi6son County, lndiana,
dated S , euNonzing Ne marriage ot J��.s1i� and
n . .-,o • o . , ri
I fu�ther �fy that following mamage certificak was filed in �y o%ce: •
I,n,�+�-�� �-�% (name) ce'fy that an . y� 9 r' (date), et in
,ic�v�?N� County, Indisne, of County,
(atete), and of ,�µ� County,
(atste) w�ere mamed �6y" 'me" es� authorizcd under e merriege litmse Ihet wes issued 6y the Clerk of the
Circuit Caur f Gibsa County, diena. dated 1�f���L�.
Signed 6y:�AjQ�i.��� �L��^�=-�^-' , �� � (� �(�o�fficiel designation)
fSled snd recorded in accordence with the lews of the State of Indiana an ��;'�^ �� � 1%� (date).
.enrr. e.m i enn,.. Signed �� �/� Jr:�� :_n..:.��� Clerk