Marriage Certificate - Scott, Brenda Sue_4/25/1991r..e r...�nw e�
�.ai.e. s�� aew m SI'A7E OF 1\DIANA
����m������ tli_ .ICATION FOR MARRIAGE LICENSE
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Date N APVlicutio
11ALE FE.NALE
Atedicel Examination eport Dated �-�� �3 Atedical Euamina[ion Req:rt Dated O 6 �
i -, n
Neme of Physician �� � Kame of Physician ^�'� � �
ALL CVESTIONS 11UST BE ANSN"ERCD. IC J619A prneriEM'F�IV �u4msn�-Kpoever p�ocun� tLe I��umo uf � Ilttvu b m�rty Oy �ny I�lu �t�temevt pn�enution er
proten« �eql Oe (leetl In wY .�m :ceeAloe Iive GunarW aollo� (��)'. .
MALE APPLICANT � FE.MAI.E APPLICA,YI'
Pnv�ou�?iviulSiatm: NeverM�meE�- OR
Ly�MVn�geEnEeEBy: M�tpO DfvOme❑ Avnulmevt0
��b OI MrtE vlrJleE EY ]?BIrtO Cart ❑ IuGICI�� Decree
❑ ome.ISVK��yI _.
1. Anyauno�o�Oweyoueverlttv
�GuEgeE m Le ef uv�ounE mlv<? N� Yv� O
1f �ovo b yv� . Eu tps �UIuCYntlon Eeev rtmoveE4 No ❑ Yn 0
2. An 4ou �llllcbE �itE � tr�p�mlaville El�e�m? N�YV�p
J. Are you rtived b tpe lam�lv �ppllcm�
cluv� tC�n �emnE wu�in? �lp�-yN ❑
�. Are you ue� uvOSr Ne leflvence et Inma�c�ting IlquorR N� Ym 0
S. An You ea� unGer tEe loflv�ea el � o�r[otic Grvg9 No�Ve� ❑
E. Li�t tEe fu0 n�mn ol �nY tleptnAent cLilErtv.
v. nn yau momma ay.oy �e�n em.. e. a.e.n
m.uvwn �• .��• eeaoeem ce�u.en! wo ❑ ve. o
�r.o.... �. "rn•. u i. reauiree wu wi. nvv�iu�ion ee..eomo.niee er
�W�I�[bry p(oo( Wu y0u �r! �n coOPlunm �ItE �vY �rt ONer Or arlere
urveG Im tEelr rvpport.
9. Pull n�me o( fuper �"!�L+'�Q--� 7/
Pes�aevee o( f.wer 1�f exe�ua eo s�.�e17 h
BiMpl�ce ot lLLEm ISt��e ar ImeiBO �untry)
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4. Ful� mulen v�me al motpe� K—'Y_
O
Rnbentt af moW er (il EenueE w qa�e)
e�nepi�ce ot moa�r ts�.� or mr.�go mu
SutedloEl�vJi . � . In N� yp6a��tbe b trve �M m�ra�l
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sm.��m.a.�e..e.pmem..m. .. .w � r s 3
Ckrt a! We Ctbov Clfalt fmn
CA�SE`.T OF PARCM9. PAXGYf OR GUARDIAN
M� tLe pu�uY: dNb yq1oN Gvmy {Hrmmem br Wb mu�L�a �f aNy ane D�re2
�yu. �YU I�eb .LW rmGn N� m�em d We a6rr p�rm vmisury
9uual ldl�u
$�KtILd �vE ��em b Edp�e m�
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_ llerY
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Previou� MviW St�wc Naver M�rnwp-- OR r �
Lul M�M�ge EuEVJ BT ��� ❑ Dlvmc� � Aonulment❑
Oue oI EIrW verlfied Ey: �BeM Cert ❑ JvEidJ Deem
❑ ome. �so.e�mi ____..______..______— — __— _.
i. wm rau no. o. e... rou ..m even
WjuEQeJ b Ce of uvwupd minET No� Vea ❑
1I �n��er i�'yea : Gu N� WjuG�utiou Eeen mmoveE? Ao O Yn �
2. Aro You �flllebd �itp � tr�naml�tlEb ElwueT Y�p Ym p
1 An yeu rt1�W b t4v mJe �ppllc�n� /\
[lour N�n �emnE cou�int No�.C1 Yes O
�. An you now mem We iullumw o( Ivbxic�tivg Ilpvor! N Yes O
5. Art you no� under tpe ip(IUence ol � p�rcotl[ tlrugT No ee ❑
6. Wn We lull e�mn o1 �ny pepsvEent c�11Emv.
v. e.e yo� rtauvea ey .vy m�n oms. o. e.e�.,
u.�vwnm..m..aeuoeemmim.en2 Wo❑ x��❑
ir.nv.. �. •r�. : u�. rw�uaa wn m�. nna�mmm w.ccamwo�•e ey
u4at�swry p`ml lpn You m In eempli�oce �itp �oY eeurl oNer or aMers
I��ueE f0� tCel( �Upport.
8. Pull n�me of htEer _ i�
neaie.oa or �.we. (u exe .o suC��//__ __- � _ _ �' �- �
BirWpl�ceal6tlerlStateo�lorei6vwwtrylV.� �•��.
9. Fu�l m�iEen o�me o! moWer �Q�,.wp^-/-��((-�%/� �-1 =. __ /^�,�L' .t
� RealEentt ol motEer (il Eece��e! w eta¢) `�K�[� � �/ __Y"� ,� ,1
Bln�pl�ce al motler �SUte ar forelRn mmtry)�161-�O-2r^-�(S�Ci!±��r�
Suted�bV� ' Ideeeppppppe�edeut�NelNmm�tbnPVm /
��Y Slspad ����i/. 1� b ypl1p n Ie�vlFn al
n �L �/��
u� nae�ee
s�e.«mea.�a. .�mn . . i. a.>� is
Qert af tb Gibee C4mit Ceart
CO]SEp'1' UF PAREA'I5. PAPE\T OR GUAPDIAS
R'a tbe D�rz�ss�. d Nb �pdk+m �erWY tl.e mmem br thb m�rtlqe If aNy en< Ortmt
�Ipu. �Yte 1¢4 �l4A �evdtt 0<mm<Mel We eWer puent uM¢nury
s�.�.m,�,.� }...
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SuO�cMed �M �.am
Fa1Aer
19_
_ CIerY
COMPLETE IF MARRIAGE LICENSE ISSUED BY ORDER OFCOURT.AmarriagellceneeharingbeenrefueedtotheabovenemedperHeathe
���Y Court by .�Atten oNer issued eM f�ed
1n euNOrizu md dtrecte Ihe bausoce d a marriage Ikeme W 1he abwe nvned partia.
RETURN OF MARRIAGE LICENSE AND MARRIACE CERTIFICATE
BE IT REAIEFIBEREO. ehere wu (ifed in my o/Tce a marrwge Iicrnu iaued 6y lhe Cferk o/ lhe Gi6ion C'veuit Cowt o/ Gi6son County, /ndiana,
aa�.e ����'� D�ray o/ e��C��9� thorizi theJav�p fogn m hrubaM aM mile
— _ _ w i li�i ��. ��
/
Br d 1 o ronon� N/o(� /ulolqp murnage ceni/flcte ua� /llei in my ol/<e lo�mlt:
� �Y`l i rsiw_ti AeebY cenQY tAa� on th aYW
webwaM�huNreia t ��yy o�
Smte o/ f�dia� ioon / Coun1Y. Swte o/
an4 a,�� . ' co.�,�r. s�a:e y
mere 6y me united in maniuge m uuthorized by a mamvye liceme iuued /or thal purpou by the Clrrk o/ 1he Gibion C"vcuit Court o/ GiGOn Counry.
mr�, w;. �q � Y o, ��� ,9� s�� �-t a° ,�.�,•-��
rnr�m�na�e�o�,� adtc�
r,r�a a,�e ..x,.a�, �� �,aaK� man �n<<a.�. a w� s�< a r�eero �n;, m, w-� , s_��
i� ed � 1—� T--C([rk
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