Marriage Certificate - Roos, Amy_4/1/1998r>mv,.kne.ee� • STATEOFINDIANA �
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""""""°""""'""' ryryyy{{JJ LICATION FOR MARRIAGE LICENSE
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GIBSON C
IC314•9-1. Furnl�hinglMs�inl�QimalionuponapPlyinglorlicense.
Apersonw knowinglylurnis�esfalseinformationtoaclerkollhe
circuit co�when the peraon y�plies for d marqage license under I C
31-7-3 canmilaa CFa»b lelorry. // //
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CONSENi O� PI RENiS. P�RENI, OR GU/•RD����
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Civ�
No.
File
OUNTY �"� 3� yy
Date ol ApDlication
Female Applicant 50> No O Yes O
II No, Medical Examinai' n or Report D ted Z"�
Name ol PhySician ��•
APPLICANT
r+ame [nst
Grtriwf Maeiul Sbluf- Neree ManieO Q OR No. ol Gmriwf
LaeunarriageEnCeEBy: Wam O Oirorce ❑ �nnoimm� O Oaie
Dab ol Oitl� v¢rilieE pY: Bitl� Cerliliule Ol�er �Spe[ily�
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5 Lis� Ine lull namef ol any CepGnEenl cnil�ren
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9�rmo�ace o� �a�Mr �SU�e or breign coumryl .if`�
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S�gna�u,eolApo�¢anl� — _ Date�—����/
ine aDOVe app4cam nas oejec�M �o renlying py oatn ar allrtma�io� o� sign+lwe lo Ine aEO.e
aOm»IeQgmenl �SCaux o� �el�grous Celiels
C4e� o�Cwn Daie
S�atea��Miana � �sxearia��irmma��ne�nlo�mnrongl.en
Counry ol Gleaon /� 1 63' �� ���s aoo���a6on �s ime ar�a conea
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CONSENi OF oeqENTS. P�AENi, OR GUnPOUN
wn me oarems o� inis aodkani, nereey give consmi io� inis marruge. u oniy one w�mi sryne.
vaie bns.nkn ma�<me cmemi o� me omm oa�e�� o��ecesv�y _
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CM�Y
COMPLETE IF MARRIAGE LICENSE ISSUEO BY OHDER OF COURT. A marriage license �aving been relused to Ihe above name0 Oarties. the
County Coun, by written ortler issuetl
and IileE in authorizes and Oirecis Ihe issuance ol a marriage license �o ihe above named panies.
RF.TURN OF MARRIAGF, I,ICE\SF. ANU 61ARRIAGF. CERTIFICATE
! cerlify [hat (here wns �led in my office n mamage license issued 6y !he Clerlk. �oJf �th�e �Ci�rcuif Court of Gi6son Caunf}t Indiunn,
dated � _ 9 5�, nuthorizinR tbe marriape ot n aAh-!/J a• � W7NJ/ nr�d
c. ���
! furth�er er`tit � thnt e e(ol u�inQ m rriage certificate was (led in my offic 99 yl y�
I, �1.�. � . (namel. t rf'(c t t on /(date)Q2W1'R��L��'!� in
��� Counfy, Indinnn, �' ofj�J(��� g, ,� Count��.
J�S,di_dL,�, (sL�fc). nnd — � o!�/iR�� Cnun(y:
��-�*-� (stafe) w�ere mnrried �� me xs authorized under m m�rriuge license that u�ns issued 6y fhe Clerk oI fhc
Circuit Cour� f C7-ifbs�oyn� unh; Ind�'nn/�/ dn �
SiKned by: �r_EN"`�"�F7"X�.f `� �. r�Lln� „rorr�rfli d�srR��n��o„� ,
Filed xnd recorded in nccordnnce with the law�s o( the S[Me ot Indinnu an
Signed ��`^°'+�YU [[�e.�r� Clerk