Marriage Certificate - Newton, Pamela J_3/10/2003re„�,n.uewe� \ STATE OF INDIANA No.
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��'�°"�'°°"" •APPLICATION FOR MARRIAGE NSE File
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GIBSON COUNTY �teolA plication
IC 31-7-9-1. Fuml�hing lelsa Inlormallon upon applYing lor Iicenie: Female ADPlicant 50 > No ❑ Yes ❑
A person who knowingly lurnishes false inlormation to a clerk ol the
circui�couhwhenNepersoneppliesloramarriagelicenseunderlC ItNO,MedicalExamina or p Da tl
31-7-3 commits a Class D telony. Name ol Physician
MALE APPLICRNT
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A�KNOWLEDGMENT .�(�KNOWLEDGMENi
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COMGLETE IF MAqR1AGE LICENSE ISSUED BY OHDEfl OF COURT. A marriage license �aving Oeen reWSeC to tne aEOVe nameG panies. t�e
Counry Court, Cy wrillen orCer issueC
end fileE in authorizes anE Eirecte t�e issuance ol a marriage license to t�e a0ove nameG parties.
RETURN OF 11ARRIAGE LICENSE AND r1ARRIAGE CERTIFICATE
I certify that [here was filed in my affice a memage license issued by the C(er4 of the Circuit Court of Gi6son CountY, lndiana.
dated � � �.��, authoriting [he marriage of �.// � pC�d(��� md
�� Q,. %�
I fur er cer ify Lhe e follawing emege cerdficate wes filed in my o ce: .�y/ .
I, ,f�D'++''�� (na e), certify [h t o r � (date), at /'�'�-�+i1-�� in
[� Countg Indiana, of _,�� County,
o (state), and ot�t+�� County,
� (afate) were married 6y me e eu orized under e mamege license [hal was issued 6y the Clerk of [he
Circuit Court o Cibson Co/y/pty, diana, dated �� � S f.% , -
Signed 6y: � �s_!-�'/L.�, (officiel designe[ion)
Filcd and rtrorded in attrordante wi[h the lau's of the Sta[e ot Indiane on (da[e).
� Signed ��4-P-A G�«/�� Clerk
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