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Marriage Certificate - Reid, Sandra K_12/3/19991'� 6 rs.� n.�,m.a sr saw s.0 esa r �ra �..a. ws+sr a �,,.>., � 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. L'�..'1 MALE M�tlb15Ypn: NM/ Mu�NU O OH NO.OI PnriWf Mv�i�i Or�wb O bu�uMml I � NO. 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 N�m� fi! MbCN � Y�u OabolOiM NMN �p • D�y � �'t� 1 G��cr Bi n •orla�ipncwnvy� ��� � Re e Cre r R.R �p� _� PtbiOUf M�tl��l5l�lm: NM� WMlE ❑ OR NO O a .I�J11YL LutMmiaa�EnEeEBr: O��NO Di.ac� �ruw 0�401dMwtlfNGpy: O Bir1�CMiliul� �ON�rISMC�iIyp� • �111QM d\�C 1. M yw ron a 1uw you �ni ew� �aWaob �o w o1 unwune m�ne+ No O v�� O Il�nt�wM}�L'MfIMbI�w���nnmprWi No0 /Yaf O / t. M yW ��4iW to tlw I�m�l� �DDUt�n� Wf�� 1��n wcon0 cw�inl No O/ v�� ❑ ]. �V ��w no� �n0w tM MIIwM� ol �n �koM�1c Dn�e�pai No P�� /yi � O �. M� you no� unOw �M Nll��nc� ol � n�rtOLC 0rvp� No 4/ Taa O S. Lii11M�n�� �nY M�r YOr;n. U�._1 _r�� �L n I e. pl Fwmm�a�pofum'.i,urr 111 �OOpM. qtl boptiq P�nnU ONyI RniE�rc�W1��Mr1i�Ott��fM.+o�l��r� y BiM0�k�0���1M�I51tl�IX�onyncOWlry� . (D� iuC m�iGn nun� ol �pplic�nl'f mo1Mr QI MopIM. Yal /NOpim P�nnl� ONyI R��bm�� ol mot�n III QK�nM. f0 tl�l�� _ Binn W c� ol mom�r ISbb w lae�pn cwmryl �CKHOM'LEOGUENT I�Cktp�MEp� Uyl I MH fK�iHO inlMmalVn Ip�rOUq C�nplrWf (ammWK�01� C�S��flf �NI�qwY�Oyk�nurvtlWd �Ii�lO1NUM�ib�Ipl��aNaXal4uLfAD$I�COmnE 1TTNM 41(1CMMY �V�IOrtM� I � � sroM��,.aeoo�c.�� �J o. G-S'-`% I TM \OT� /pp4LM1 t��� OO�KIM b tinlyYly DY O��t� OI �Ilnm�lqn O� fpn�Nry 10 �1�� �00�! Nt�q�Ippm�nl Dc�yu o� n�piouf bHb. crn a can aie St.bollMi.v 1 �.+'u,Hnnmm.iP.�niormU�onpn�n fuvnb d Olewi /` 1°' �° m�� �w� nro� u vu� u+a con�ct. 5h�b� ��e.z�?, ��'. .�r� Nv AEEreff (\ (� � ol N� Glpfon Grcull Cavl fANSENT OF VMENTS. VARENI, OH GU�HDIiS1 WL �M prmb o� Vw �pqiunt. MnOy 9M cm�m� iw Ini> m�ni�p�. n onh onr oum� vpm. �I�I� INU �iCt� T��� IM CMMnI OI ��� OI��I p�r�nl YnnKOfYry sm. a uw�.�, � ... Cwn�y d 1 f LLMr ID • uow.. io. S+pKnpb �nE �.pn lo bla� m� Nit _ OaY ol 19— GoY 0lle OI Mtl� �ViIiM Uy: ❑ BiM GHi1K�l� Q ]. �. 5. �$DK��Y� N� you rqr or n�.� Yw �.�r pwn �aWE9b b a ol unwuM miM) No � Yn O II �nfO� if "ylf: Mf NO �EjvEKllbn EMO reTOMI HO O Y�f O 4�yWtsllllElON�m�I��DO�C�nICIGMtllf�n�lCOMCW�InT No�_/Tef❑ be you no. umv m� in(luanc� ol m�konoYC Mr�npd No }y/ Yu O Ar� you rw� uMar N� intNtnc� ol � n�rcal�c Crvpi NeT Yn O Lnlln In m�Ol�n a MenlcnilEnn. I � �q iuq nama ol �Od��� � ��N�r pi �aoo�b. u�� �aoo�.e amnu onry) ReYae�K� 01 I�Inp f� oec�uM. fo fltle) Bmno��ce oi �un�r ISUn o� loreipn cwntryl le) Fvl� m�iEm n�m� ol �p>f[aNl mo1Mr 01 �OOO�W. u�t �EOV�i.� Vuenl� Onlv) RnqeMe ol moNa lil Ce[�uW. �o �1�1�1 B�rinpl�ce ol mplMr ISlate o� IoreiQn cWniryl ACKNOWLEDGMENT i�c�no.�ea9e inn i n�.a wcevaE :n�wm�uon np�mvq a�Merw� commenk�d� E�w�ve In�I L� t�. W 11y V�nfm111 W. �M � Ib� ot IM IN1 �ill� Iw IM riNt N�l uu� a AIDS (�cpvi/W iTmV��ECIiC�N�CYfY 10 � % � 11�1 � S�QMIYI�OI�OOIKInI 'J _�_�_. /v/V�i O!• r. T�t �OOV� �DGf �nt �p OO�KIM b�anlym0 �1 dt� o� �Ilirm�lion Or fpmWH 10Ip� �OOV� �C�n0�1lESminl EIGIU)e d Itb�qYf D04t1�. �I�IY OI �W�1 ��1� St�UO1IMiuu 1 ��+��J�IInmtMlu�inlormtlwnairen WunryolGlEaon � 1 u' �^�n�+�oo�iutbn+avw�MCanct. Sqnea��!"11..�A�� /i'VN Ne+/.UOrof /1 �� ol �ne GiD>m C'ucvit Wvn 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), um (�cu.nicn m�b in� consem o� m� omn D�rmi ennecesvry s�.i. ai inann, 1 Cwmvoi � aa. �.mo io. MoNer 10 � SuOUnpeE �M f.o�� lo Ot�we me Nn _ pry o� 19_ Ga�� 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. � 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). ' �0�1,�o�l�til�T� ' Signcd Clerk •m.•.vn�..rn... ' ' -- (]jhann Cirruif urf