Marriage Certificate - Garrett, Autum Lynn_4/8/1999432
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STATE OF INDIANA
APPLICATION FOR MARRIAGE LICENSE
GIBSON C
IC31•7-8-1. Fuml�hinqlel�ainlormatlonuponapplyinqlorlicen�e.
A penon who knowingty lurnishes falsa inlormalion to e clerk of ihe
circuil court when the person appties lor a marriage license under IC
37-7-3 commits e Class D telony.
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No.
File
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OUNTY oete ot pov�iwtion
Female ADDlicant 50> No ❑ Yes ❑
If No. MeCical Esamination or Report Dated
Name ol PhySiCian
MALE AVVLICANT I FEMALE AVPIICANT
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�LKNOWLEDGMENT
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♦CKNOWLEDGMENT
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fANSENT OF PMENTS. VMENT, OH GUM�I�N
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CONSEM Of PMENiS. P�REHT.OR GUMOI�N
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MaNer ID •
SuOKnME �M awwn lo Oe10/s m� w� _ ary ol 19_
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CONVLETE IF MARRIAGE LICENSE ISSUEO B1' ORDER OF COURT. A merriage licenae �aving been relmea to tne above name0 oaniee. tne
County Loun, by written arEer iuued
enE IiISC i aut�orizea ena airecb tne I�auanca ot a marria0e licensa to me aEOVe name0 panip.
RETURN OF MARRIAGE L[CENSE AND MARRIAGE CERT[FICATE
I certify that there wae filed in my otSce e mamege licenae iss/ueJd 6�j' fhe Clerk of the C'vc t Caurt of Gi6sm County, Indiana,
dated q . authorizinB memege of _(i,���"`"�-� �^�"""�' end
� �i��
1 fur er`fj ti�f t�6et�he fol7ow� �°� arriag�e cer ' cate wes led in my offire: '
I,�' (-J"H`4"'� �. C�-�^+-� (n �m . mrtifY �et o � y 7(datel, at in
h+.�-••^' Caunty, md;ena o� or Cannty,
. fln� (atete), and of County,
�--�-� (atate) nzre merricd me es aulhanzed nder e mamage licenae fhet was issued 6y a6e Clerk of the
Cimuit Court o Gi6.+ n co� ,� a;� � y
$�qn� yy; � �.� � (officiel deaignetion)
FSled end mrorded in attrordenre with the laws ot the Stete of Indiane on �a � 7! 7 (date).
_. . �i�%iw�._.00 �/ii... ...._,.
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