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Marriage Certificate - Keehn, Sarah M_4/12/2000iM1n Pa4W�] B� e�wm wn row a w�m man+wvnr a,�,,,., � • • SiATE OF INUTANA No. APPLICATION FOR MARRIAGE LICENSE F+�a GIBSON COUNTY '�^q �4 . - te o Av7li tion IC31-7-9-1. FurnitAinylalselnlormetionu0onapplyingtorlicense. FemaleApplican150>NO ❑ Yes ❑ AOersonw�oknowinglyturnisheslalseinlormationtoaclerkolthe ItNO.Metlical�aminationorFieportDateE �circui�couriwhent�epersonaDP��esforemarriagelicenseunGerlC - � 37-7-3 commics a Class D�telony. . Name of Physician ; N�r�x Iw�.aevm Viei+�uf M�ntt15Ulua: NM� M. Lu1M�rtupEnONBy: M��� � O�b OI dM vHNlO Dy: O MALE APPUCANT � iaa Ynr q.prce ❑ �nnvlmmi p Dne L �n�ouM.aMnyounve�tn�ajwp�abCao�umouMmma+ No� vn❑ '11�m�vif�Y�L�u1�e�CryE¢tlqnONnnmOrM'! NOC�/ YpC ]. YIYWftI�IK101��I�TII�lpplKll�1<b�H1�inNCp�ECOUfN) NOC Yy❑ ]. AreYWnO�unO�llt��MIhNIK�01�n�ICO�a4CE�r���C�� Na��/Yn❑ �- N� Yw no� un0v Na inlN�e[� a1 � n�rc0t6 Crvp� NO C Vq ❑ 5. 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WfMb OI INf �pplKJ�l �!�lCy OrA [Onft�l �d INf m�rtyp�.11 ONy M< W IN.�lit�>, W�� IM� �1v[t� m�Y� IM cM3Mt d N� ON�� plIMI unnec�avry $la�1011MilN � 1f: �vo1 � hitrr i0 • 4>NIe 10 � SupfCnpN an0 t�wn lo MIM mt Nu _ OaY ol 19— CbrY FEMALE AGCLICANT wm. �('� O�baIBIM MMN Prtvqm Min1a15�iluT N�rtr MirtieC O OR N0.01 RNIN� MIIryqM � LniMaem9eFn0e0BY: ��O _Diwm�` MnNm�n�O D�bL 4 Oale ol dM rttILM py: C BiM GN4'q b R 011w �Sq[Ity) ('�� ``�1{I �V VnfJ���j{�- � / I. lreywno+o�n�nYPMrpNn�OjWObloCrolunwuMmiMl Noa Yrp If �nsw�r ia'Yn: Ma Ne �CI�'�a4on pNn rlmprNl No,❑J /Y!a O 1. �rlywnllllV101MRUI��pqK�n�CIpYfWn��CpqmufN� NO�J[ Ttl❑ J. �re You m. unOw 1�� mllveKl ol �n �KO�04C ONtny'�t No JY Ye ❑ l �ttywro�uMar��einllum40��nVtatsONpl HOY Ya❑ 5. Y ne iW rum �y Oepena�nt c�ib�m. n���1 fi. Ia1 Po11n�msol�ppKln(�I�Na f� � U lY` ' Otaeooiea.W�nCOpOnGUenu0nhl t1Yii�ti�cu. � Rnb.rc� 6Wmer f� c«rwa. w ata �' �" Bitl�p4U ol bNV Iwl� d lonlpn munVy� lelF�unu�amram.ai�»�c+r.nmau., �n� (I��OOpI(C.4f�AE0WMVUMbONYI �••� • Fefqence OI mpNp (J E�cM�eO, t0 sYl�� BlMObc� ol moNn �SUb> Im�iqn munlry� . 1LKNOW�EDGMENT I�cinarieE9e N�11 ��r� �ttmM inlO�milqn �K�bHi btptrouf CdnmurvC�Wt OifWOJ �tfal an fu WIIY V�mmXM. �n0 � lit� OI IM �nl �i�p IOr N� drvf W I uum AIDS (KOUi�M iM �OOre �o0�wnt na eel<iM �a .ailY�np eY d�n w�IGmulion or siqru�w� b N� �Cav� �c�no.�Mgmmt oecau» ol n4qw� Erix��. Gbi ol Cqun O�le S�tleo�InC'a�v ) IvuUtlL�mIMIN�inlOrtnlliOnOiqn COUnry o1 GIC�an \, (�1 �' In w� �OVIraUOn b Irv� �M cwnct SiqnN YT�"_"'�_rtyl. I _ _ NeM �OOr�p SuCUn �eb��a.mn(�lo�Mt�.e ^eW,�— U�YaI fl �J��L21X� L4r'. ol tM GlOfon CJran Cav� CONSENT Oi GAqENTS. PMENi, OR GU�fl01�N We. llte Oarenls al �N� ap0lKiµ ��r�py O�rt COnMn� Ipf Nia m�rtlai�.11 OM/ ON p�R111 f7ni. f�l1� 4c�i v11�[II ma4e Ne [Wm� o11M ot�e! pi/el'1 vMK�iLry $Ialt011i�un� � ». �+�.�Y ol 1 Fsmrr Mo��e� Su�fC�iE[C ��0 Sw0I1110 ClIOA n.111Yf � pty OI 10• 10� _ 19_ Uat COMPIETE IF MAPNIAGE LICENSE ISSUED BY ORDER OF COURT. A marriage license �aving Geen refused to tne aDOVe named parties, Ilie Counry Court, by written orEer issueE anG tileC in aut�orizes anG Giretts Ne issuance ot a marriage license (o Ine aEOVe nemea parties. RETURN OF MARRIAGE LICENSE AA'D MARRIAGE CERT[FICATE 1 rertify that there wes fi(ed in my affice a marriage license issued 6y the Clerk' nof the Cinuit Cour[ of Gi6son County, (ndiana, Idated �iy�•�..*; C{ q9� , authonzing the memage of ��N'� \ 1 �$�]LL\ and �� '94.�L� �.) I further rertify that lh tollowing marriage certibra[e was filed in my office: 'I �-(- !, �1��lo�1� ���l W� neme), certify thet _���,�L (dete), et t-Tf • R�� in -�Y�-%�n � Counly, fndi�an+a,,� ���� � - �vAm of�� County, �}�IA,Mn (state).mdS�1�v.�..� `(� cldM� of .�k�fi\�»._. Caunty, -�"f1i0AAMfi (ste[e) were mamed 6y me es authorized under a merriage license Ihet wes iuued 6y Ihe Clerk of Ihe Circuit Caur�t/ �of Gi6son Counfy, yln�diana, dated _ ,,, ����� Signed 6y. �1�LL4/h K �A�i�U.4 •' _ , (o u'f�, elNdes,gnetion) ����7�� �' Filed and recnrded in accordence with the lews of the Stete of Indiana on ,(��1l1.��,� �_(date). - -�C-�!/. �n L . �