Marriage Certificate - Murphy, Jennifer_5/21/2004i:0
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STATE OF INDIANA
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No.
APPLICATION FOR MARRIAGE LICENSE F�ie
GIBSON C
IC71-7-9-1. Fuml�hlnplslulnlormatlonuponepplyingforlieenee.
A person who knowingly furnishes felse intormetion to e clerk of the
circuit court when the person applies tor e marriage license under IC
31-7-3 �ommita e Clesa D lelony.
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6—�— � 9
OUNTY oate ot npo�ication
Female Applicant 50> No ❑ Yes ❑
If No, Medicel Examinat'on o� Report Dat d
Name of Physician
YALE AVPUCANT � __ _ FEYALE APPUCANT
. AUlIYI BYN�: NM� M���IW I
Lu� Wn1�W Er�MOBY: DuN O Drvorc� � MnWm�nl ❑ O�l�
D�d M ew+ muwje� ey: ❑ Bircn Gni�sa,te,, p❑ Oma.13o«iNl
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1. At�'/W IW � M MM y0Y MI OMf1 �E�YEqlE �O D! G� uf1fOY1W mYIU? NO � Yp ❑
II �nfwr ia'yn' M� IM bryGUtiOn Cwn iwna�e0'! No � Yp O
t. �n YW n41sO b tM l�male �pyi[�nt cbaar l��n fscpq cwiinl No �/ re� ❑
0. A�1 YW M� uMV �M in11W�K� 01 �n �kOMIK ElvMw? NO '✓� /YJ�� ❑
�. M� yty 1q� UIWaI �1N in11YO1K� 01 � Mrt04t CNy� NO Cf �n ❑
5. LH��M�VIIntmMO��nY4sW�MIC11iN1ln.
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�CNNON'LEDGMENT
1 K4no�Wp� �MI I ��ve ra[eirM imwm+tion rpvCm9 O�nperou� wmmenicaEla Eise�sea
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G�rt ol Caet Dne
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Counry d GIEam 1 °' Im m� �od�+u �� nua ua mnxt
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GONSENT OF GMENTS. P�RENT.OR GU�RDIAN
WI.IM D�f�f1�3011111i �ppl�fAfl�. MIlGY YIM CMM111 IOf IM1If 1�4flNQ0.1� MI�' M! p010l1� )rollf.
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SuOKeibO �M f�orn to EMOn m� In�a - Oav ol 19_
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Da�eo�Gnn.anfeeer OeirtnGni�iu�a�ourorl�+N1
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1. Me yW ra� a Me you mar Own M�WqW lo G ol unfOUM mIM1 No d Ya ❑
u�m+m u'yu,- w ua �a�uakatio- ::"sn �nnoveat NO C� Yw ❑
x. Me you rebtw �o u+e mala �oDlium Nmw mu� rcoiM eaWn1 Mo O Yp O
J. Me yw now v�Wm Na inllusMa al m�kWalk EMr�p�) No Q� Ya ❑
�. Ar! YOU �q� NqM N0 infIVMCO 01 � N�COUC Crtpi NO � Yp ❑
5. Li�t I�a Iu0 n�rtNf ol ��ry MpenEent NIIEtM.
6. (�1 FWI name o� wd�nh i�Nar
III �EOpUE.lif� �EOptir� Peranb Onhl
Rnbenc� ol laVror (il Wca�f W. u�ut�)
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(C� Full mab�n name ol �pplit�n�'f motMt
(II �OOp1s0.4st �EODIM P�mnb OnNI �
HesiOmt! OI mONa� (il EKUfeO. M�111e)
BinnWn o� momm �Siete or mroqn munvy� ��•
ACKNOWLEDGMENT
I xknoxlapqe tMl I If�ve �ecsire0 iniorm��qn rparEi�q Ua�per0uf WmmuniUpM Eia�uat
Ru1�Ox5WIhV�nfmi eE.�M�lif�ollMbttsileflor�Mdm�l�tluuf�fAlD$(�MVIrW
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T�e �Ean �pdk��� Na opjs[UO to renfyvp Dy dM w tllirm�(bn or �ip�uWn b IM �OOn
�c�rowllC9mmt Gctufa ol �alqqua Eelith.
GOk OI GWrt Dtte
9ateollnOk�u 1 Ifwu./�Ilirm�lulVieintorm�tionpnw�
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o: in mi� �Ddiu�ian u m» uia carr�cf.
fd�n ol GIWm
s�v�w�1'l' A�1i�IJ, �"��1t�DI%�IAdt�n
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M 1 rII/4�c� �,I/Ol�/a� _ CMry p� �M G� u�l Coun
CONSENT OF PARENTS. P�PENT, OR GlIMD14N
We. t�e Mrtnb ol l�u �Od�nl. ��mDY 9�ti �o^unl lor I�U marti�q�.11 onN � W�^t fym.
fN�e lecb w�icn m�ke Ilw confent al t�e otMr paront unnec�svry
Smeonnauru 1
GaumYOi 1 u.
ramer �D �
Motnar �D •
$upacriMO �M swom b Celon m� tnia — Eay ol 19_
�W
COMVLETE IF YARRIAGE LICENSE ISSUED BY ORDER OF COURT. A marriege license �aving been relusaE to I�e abova name0 parties, I�e
Counry CouM1, by written orEer issued
an0 filetl in authorizes and tlirects tne iuuance ol a marriage Iicense to tne aDOVe nameA patlies.
RETURN OF MARRIAGE LICENSE AND MARRIAGE CERTIFICATE
I certlfy that there was filed in my office e mamage licenae iasued b.{ the Clerk of the Circuit Court of Gibson County, lndiane,
dated� �� � y y y , euthonzing the mamage of ,���^a.,-�'��(" ,R�� and
�i. __ .l. � i n_�s/J Z.e �QoO/. . i�
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1 further rtify that, e following marrisge certlficate was filed in my ce: + �
(, %��� (nam , rertifY tha on tYi � 3 t 5 5 9 (datel, et ��i�ift�'/"' in
� Countg Indiana, � • ot �`�` -, County,
•e� (atete). and ' ° of—,�°'�'� County,
�(atate) were m 'ed v me as authonzed under a marriag lirense Nat was iasued by the Clerk of the
Cirruit Court Qf Gi6son Count , Indiana, deted 7 y �
Signed 6y. L� , � (official designationl
FSled end recarded in accordence with the lewa of Lhe Stete of [ndiane on _ � g (date).
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