Marriage Certificate - Scott, Diana K_10/30/2002�.
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� STATE OF INDIANA •
APPLICATION FOR MARRIAGE LICENSE
GIBSON COUNTY
IC31-7-9•1. Fuml�hlnplelsalnlormationuponepplyingforlicente.
A peBOn who knowingly fumisnes talse information to a clerk of ihe
circuit court when the person applies tor e marriage license under IC
31-7-3 commits a Class D telony. �
MALE AViLICANT
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Fat�er ID •
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Su_xn'xE �nC fwom to Celore ne L`+f — Cay ol :3—
Cien
COMGLETE IF MAqNIAGE LICENSE ISSUED BY ORDER OF COURT. A marriaqe license �aving Oeen refused to ihe aCOVe namea parties, Ihe
Counry Court, by written oraer issue0
enE /ileG in aut�orixes ana Cirecb the issuance of a marriage license to t�e aDOVe nameC perties.
I reri
dated
RETURV OF MARRIAGE LICENSE ASD MARRIAGE CERTIF[CkTE
[het [here was filed in my o%ce a merriage lirense issued byq the Clert of the Cixuit Cou:
euthonzing the marriage of
Gi6son County, Indiene,
� end
I tnr i r re 'fy ha[ e t llowing merriage certiScate wes filed in my o
I. (n , mrtify that n SY% (date). e[ in
Caunty, Indiane, of County,
(atete), and af Coun[y,
� (state) u�ere mam 6y me as authorized under a mamage license thet was issued 6y the Clerk of [he
Glmuif Court of 6son County, In�di°� , de[ed 6 7
Signed 6y: �� � - JS��I,I�, _� �_(of�ficie�l �Jdesig�nqetiqa-n�)
FSled and recrorded in accordance with the laws of the State of Indiana on —,�v �_/__/;�� (date).
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