Marriage Certificate - Lamey, Andrea_8/16/2000=,0�3 �Q�.3.3�
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STATE OF INDIANA
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APPLICATION FOR MARRIAGE LICENSE
COUNTY �—� 9 �
Dele of Applicalion
Female Appliwnt 50> No O Yes ❑
�I No, Metlical Ezamination or Re ort DataE
Name of P�ysician
GIBSON
IC31-7-8-1. Fum1�Alnqtalselnlormellonuponepplyinglorlicerue.
A person who knowingly lurnis�es false inlormation to a clerk ol the
circuit coun when Ihe person applies lor a marriage license unEer IC
31-7-3 commits a Class D lelony.
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BY ONDEN OF COURT. A marriege license �aving Oean relused to Ue eDOVe name0 parties. t�e
Court. by written orCer iSSUeE
auNOrizes ana Eirects t�e issuance ol a marriage license lo lne aGOVe name0 parties.
RETURV OF JiARRIAGE LICE\SE AND MARR[AGE CERTIFICATE
I ttrtify that there was filed in my offitt a mamage litenae iasu 6y the Clerk of [he Ci✓rc/u+{'� Caurt of Gi6son Caunty, Indiana,
daled , euth izing the merriege of �� � � •�-a-- •— � end
�� t A��Q o.� ,
f furt✓ Se{tif� t Ne �ilipfving m� fitete wss tiled in my o �ce: y
j l ��� /A (na ial c ti� that on� (date), at in
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County, fn ana, of [, � County,
(sta[eJ, and ' of 6h�a^+ County,
�� (stete) were married me es euthonzed under e mernege license Lhat wes issued 6y the Clerk of Ihe
Circuia Co tC� son County, ( di a, de[ed �/� 9 .
Signed 6y���4'�'K'/-a' a9�y?+����� '�l.G/�.t�+� (ofhciel esignn[ion) �
h77ed end recorded in attrordance with the Iaws f the Sted [e of fndiene an 5f (date).
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