Marriage Certificate - Reid, Sandra K_12/3/19991'� 6
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STATE OF INDIANA
APPLICATION FOR M
GIBSON C
IC�1-7-9-1. Fuml�hlnqlal�alnlormellanuponapplYln9lorllcen�e.
A person who knowingly lurnishes lalse iniormalion lo a clerk ol the
circuit court w�en the person applies lor a marriage license under IC
�1-7-3 commits a Class D Ieiony.
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MALE
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ARRIAGE LICENSE F��a
OUNTY I�'R"
oate ol AoP�ication
Female Applicant 50> No ❑ Yes ❑ /_�(7(}
II No, Medical Exami {�on or R�Q D d YJ I�
NameolPhysician �/Arn�ry���
FEYALE APPIICANT
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ACKNOWLEDGMENT
i�c�no.�ea9e inn i n�.a wcevaE :n�wm�uon np�mvq a�Merw� commenk�d� E�w�ve
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CONSENi OF P�HENiS. GwRENi.OR GU�HDTI�N
WI, Ilfe 0���^�� ol ltus �oO�KM�, bete0y qr.e confenl lo/ InR marn»e. II Wy pne pLenl eryn),
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COMFLE7E IF�MARRIAGE LICENSE ISSUEU BY OROER OF COURT. A marriage license �avinq been relusea to Ihe above named Darties, Ine
County Courl, by wrilien or0er i5sue0
and IileC in aulhorizes anA Eirects lhe issuance ol a marriage license to Ihe aCOVe nametl parties.
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f RETURN OF MARRIAGE LICENSE AND MARRIAGE CERTIFICATE
I certiry that Ihere was filed i� my affice a merriege licenee isaued by the Clerk o! fhe Cirtuit CQ�rt of Gi6son Countg fndiana,
deted 4 , autharizing the marriage of ��• /�° and
I fu er certifynthet e following erriege certitcate was filed in my office� ��L
1, ��.a+_"• ���� (name), ccrtify Lha,tL on 3 � i 5 5 5�dak�, ea w" in
County,Indiana, �/� /T� —i� of �� CountY.
n (atak), end � � — � � � o! County,
bw (efate) were merried 6• me ns uuthorized under a mernuge licensc fhet wes issucd by Ihe Clerk of thc
Circuit Court CibSm�r nf�y,Indinne, �da � y ��� %
Signed 6y: (,� t/• �, ���•- - fo(ficinl designafianl
FSled end recorded in atcordance with the lewe of Ihe Stnte af Indinne on �- � j ��jj�dnfe).
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' Signcd Clerk
•m.•.vn�..rn... ' ' -- (]jhann Cirruif urf