Marriage Certificate - Helsley, Huisun Judy_7/5/1985'J 8
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Iorm M�ce1MJ B�
�mi.v.euueewoi 3[ATEOFINDIANA • No.
x•�""'��"`"`�O APpLICATION FOR MARRIAGE LICENSE �,
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.a«u..i.ia�.im � � -�g-rQJ
�� Gibson County Dete af Applkatbn
MpLE FEASALE 8
Medical Examinetlon RepoR Dated �-� 7� �`-S Medicd Examination Report Da[ed �-°2�- S
Name of Physlcian Name of Physician ��
ALL QUEBTIONS MUST 0E ANBWERE . C 01-1�]-E pro<rIEeE "P�lu �ubmev�-W�wvr prmum ��r luu�nw of � Ilt�nq b m ry!y �ey tdu rt�temen4 nprount�tlon or
pnt�vw �E�11 M(tveE m�vy rvm no� eac«Etvg fro� EuvdrW Eollm �fsm.0U1'. _
MALE APPLICANT
Pnvlou� M�tlul Butur. N�vr MmIM O OR �
Wt M�nf�p EeEed BT w.�e ❑ D1vort� Anvulment ❑
D�4 of OIM verlLeE EP. O 91rtE Cart. ❑ JvEtcl� Decree
,/� - � •
o�+.. fev�ur� _N.!�.l..tl.�.�_. _(ic�l!-a9
1. wro you oow or h.ve you .v.r neee
WjudpeE b b oI uv�ouvtl m1uE4 . No Yv� O
u m.�.. t• -yer. e.. w..a��a��.�oe e«e ..mo.sas No o jr� ❑
x. w.. you .tm�ee ��w. �nv.m�..m�. ei.....+ ko[�� r•.o
]. An Y0Y nl�bd b tE� (e0�b �pplloet
tlour t�m wwvtl cou�lnR No lfa! ❑
l Aro you oow mEVe 0e lefluence of Intozlc�ling Ilquor9 NoO� JYe ❑
s. w�. yo� so. �oe.. wa mn�ee�. o�. o..ce��� ane* No� Ye. ❑
e. �i.� m. mu o.m�. o� .oy e.ce-�.jaem omie..e.
��� Q� ��/;}�- ...�C.➢..L-_..../. _ _ ___.._.._.___.....
__..." V V V . . . . _.
f. Aro you roQUI'ed Ey �ny court aNer or arGen po O Yv� B�
lo rvpport t�e �Cave EepenEmt c�ildrenl
If �mw�r b'Yei .It la ra9ulnd th�l tEb Appllotlon Ev �ttampwlvC Ey
Wl�l�cwry proo( �E�t yw �ra In mmpllww �ItE �ny coun arGer ar orEen
InasE (m lpelt rvppOrt.
!. Pull n�me oI (n�er __'�y`^.`�'-- �--�-- I- -_. ..-.
0 O Re�ldence al (�tAer 11t Ee<e�eeC so et�te7 _ _ /��
Bin�D�Ke o( I�tOm �9t�te or rorolgn <euntry� O -
o. r�n m.ie.e �.m� e� mom..
Ra�ldenro a( matnm (II de<eueE ao rt�b) _L
01rt�pl�ce a( mot�ee (6ub or torelgn Comtry)
9u�.d�buy �aR� ..m.�.�.�L.�dvm.Je�N.
y./� In Nb �pp6cLLbe b tme �ed cortaL
CmmY 01 hJ�?'�'-� � ��:
S�ivae
Fw AEErs� �
Su�rte��dud�.embDS(enmebhl dry [ �O 19 �
Qerk e( t!e GIMn C4mlt Cevrt
CO`3CNf OF PARLNfS, PARLM' OR CIIARDIAN
Wq Ne v���+. d �Ab appllunt GereEy pr� miuem br iAb m.rm�a II aNy ene p�rem
�Ipv. rt�d 4C4 �h1� n+de+0� m�+eet d tAe OILe� p�rmt unnmm�q
9�.�.a,�,.�.
B�ErMd �vd �.em b EQor�
4 ••
FEMALE APPLICANT
Pnvlom M�tlt�l S�wc Never M�rtled ❑ OR �
LutMVrl��EveWOy: W�tEO Ulvom�oulmeel0
D�te o! EIR! verlfleE Ey. O Blrt� CeM1. O JuElcl�l Oecm�
�. �6���,� ....b.u.�.e�-,S_...o�_ �tn.w.a11._...---
�. n.. yo� �o. o. n..e yo� .... e..n
w��a¢.a w w o� �n.o�oe m�na? No va. o
u.e.�.. �. �ye: . e., �e..a��m�.uoo e�e nmo.wt No ❑ Y�e� O
Y. wre rou .uuc�ea �im . v.e.mium�e ai.au.t No o�re. a
J. An you n1�bE b tha m.le �vD����e� �
clo�er N.n �emoE cou�lnT NoB'''� YJJJ�� 0
l Am you now mCer Na Ivlluenea o( Inmzic�ling Ilquor9 No� � O
s. Art you oo� ueaer tEe Intlueo<� o(. n�rcotic arve't No Yu ❑
E. Lu t 1 1 n�mo t my EepenEmt c IIEron.
I�.�,,. r��_ _ ��..�—
b. wre yeu requiree ey .ey mun omer or oreer.
to auppon Na .00.e e�o.oa<m �mia.��? No Ya� ❑
If m��er If "Yee'. it i� nQUired tA�l thl� ApPllc�tlav Ee �ecomp�nleE Ey
��tl�l�ctory Praof tL�t you v� le compll.nee �ItE wY roun arE�r or oreen
IuueE fo� tl�[b rvpport.
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B. Fulln�meall�t�ar...._ � ..__._....___.._.__..
ae.m.ncea�t.�n�.iueece...eeosWel.__...�K,�.^-e-�.... __— _'_...
Bln�pl�ce of f�t�er ISI�b or IoretHn ceunlry) "-_/_�!.��+M.._ ___" .-__.._
a. e�u m.m.� �.m� oi mom.. _—._____.�.___--/___C3�-___'
anmenc� ar mam.r p1 avc<..ed .o .�.tel .. _.__ .._. _ .. -.
91rt�pl�ce ol mol�m ($t�M o� fO�elgv comlry� . . ._. .. _-__-._.._
St�ledl�dy�y Idapuerov �t�t.�M1�lvlvm�tlee �m
r1t.oM A.�� E _� �� � uu�on ,. ,�e .m m �
Ceuety ' ,,( ��,,�p,.
s�m.a p j��i.t�w. 7/i/iri`�.1-
v� nm.e. 7
Sus.c ea.m..amm wu w a.ro� /o . �s J
Cleet of �b GIl�en Cl1mlt Uart
CO\5E.Y1' OP P�RE�TS. PAREhT OR GOAPOIAN
N'a Ne pueN�. d N4 �OD�IC�nt AereDY 61ve mmen lor tLb mvrl�6e. II aNY ene pve�u
�kN. �t�U f¢u rhld �.odee Ne mmmt ol tAe eNa v��ent unnecm�ry
St�[e W IMl�n1 t
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i'�Nm SItnN
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19_ II SW�aMdud�vornbEe/eumeiA- dry 19�
_ CIeA CIeM1
COMPLETE IF MARRIACE LICENSE ISSUED BY ORDER OF COURT. A merrlege Ilcenee hevingbeen refueed W[he nbove named pertle0. �he
Caunry Court by vritten oeder IeeuM e`d Ned
�„ aut6odxa evd dlrecle the lesuaae d e marringe Ikeme m the above nnmed par4�.
REI'URN OF MARRIAGE LICENSE AND MARRIAGE CERTIFICATE
8E !T REh/EAIBERED, fhoe wm (Ied in my o/�ce a ma�rriage- li�cm.•x iuued by fhe Cle@rh�-o/ (he Gibeon Circuif Cnurf o/ Cibaon Counfy, Indiana,
doted,t(�e . .T � �°Y°%�"'r—�-'/9�oufhorixingl�%oiningtoBefhermAue6andaMmi/e
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Bs tl /urthn remanboei, tAe/olfomirtg mamagecertiJicutemae (i(ei in my o//rt ldmir. ("� � \
f. pQ.�'�O. � � lM hrrebY c$Lt//Y IhQ( on tA (/]-' ^ AaYW
-- �g a( V-T� �� 1� _ County o/
ont thowa� nine huMred a�
Q��_ �- v� �/ o�) Comty. Stats oJ
Smte o17Mla� c y '
a� B� �� Coutiy. Slate o/
mer< by me unifed in mamage m auf o�ized by a martiage Gctme istued /or fhot purpou by the C�erk o/ the Cibron Circuit Cowf'/CiWon CounfY.
1Mted Ni� � �y oJ l9� Signd �'� K]
p/ficial Dmisnatim 0
�1(d wd reoorded in oeeo�arce miN the Inms o/ Ne State o/ f�ia�u thi� Aay�o/ 19
„ . n� . . �� _ .—_ ..,_y
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