Marriage Certificate - Sims, Twila_5/24/2000� �
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� STATE Oi INDIANA • �
APPLICATION FOR MARRIAGE LICENS�
GIBSON
IC�1-7•9-1. FumlaNngfalsalnlormetlonuponepplyinglorllcen�e.
A person who knowingly lurnishes false intormetion lo a clerk ol Ihe
circui� coun when the Oerson applies lor a merriege license un0er IC
31-7-3 commits e Class D lelony.
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No. I
File j
COUNTY y����
ate al Applicelion
Female Applicant 50> No ❑ Yes ❑ ,/
It No, MeCical Examina � n or Re ort Dated T—��- Q�
Name ol Physician �
MALE APPLICANT I FEMALE RGPLICANt
Pn�qm ManpISY�W'. N�rtr ManleC O Ofl N0.01 Pnrquf Maniapn �
L�f�M�Ili�i�EMOEBY. 0����❑ OivOrtl� M�nulmen�❑ O�le /�
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♦CI(NOWLEDGMENi
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ei.n oi ewn one
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CONSENT Of P/�qENiS. PARENi, OR GU�ADI.�N
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•CKNOWLED6MENi
I ac�no�IMqe Wt 1 n�ve rtcervM N!wrtulion nL��tlMO dM��Wa cCmmun1u01a OWtuf
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�ctnw4C�nent peuuu ol eNigieua W4elf.
CkK ol Coun a�e
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LONSENi OF f�FENTS, F/�HENi, Ofl GU�FOI/�N
wn �ne oermis ortnn aoo�iant noeEy 9�•e wmem b.lnia m�rtl.pe.11 onyone w�enl �Nm.
mbbeu.eJr.nm.bmecon..mo�meomvwnmu�muaury _
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Gwnry ol 1
Ft�Mt ID �
MotM� ID •
SuOfcriCp �M a�orn ta Celore me tNf _ Ury ol 19_
CNn
COMFLETE IF MARPIACE LICENSE ISSUED BY OPDER OF COUNT. A marriage license having Eeen remsea m ma aoove namea varuea, �ne
County Coun, by wrilten order issued
end IileE in authorizea enE directa I�e issuanca ol e merriage license to the a�ova nameG partles.
RETURN OF MARRIAGE LICENSE AND bfARRIAGE CERTIFICATE
I cerGfy that thue was filed in my omce a memage lirense issued 6y the Clerk of the Cixuit Court of Ci6son Caunty, (ndiana,
defed �; / 94S , e�utnharizing the marriage of ��� �-�""""� end
�ZL"t� .7 .ClA� ,! r--' ,
( furt':lce 'r�fy thal � e f 11� owing�ne �'ege certificate w�es filed in my o ce: 9` /��
f .l1niLLH X1n.f�Ct�LI (n �e rer ifY that on (datel, et�, L .I in
�,�.in-„n County, lndiana, " � of�^'�'� - Count�;
y��i =�-� (stste), end of ,i9 ��'� County;
.� i�-�+ (atetel e'ere married 6y me as�7 authorized under a merriage license Ihet was issued 6}• the C1erk of the
Circuit Co rt of Ci6 on Cou/q/ ty, yfn�d�in�n-�a�, d�at.Jed �^'�y-?�� � 4� �� �
Signed by��-.^ �+'u"'�a�, p�- °—=a=� �a��a� designe/tion)
h57ed and recorded in ecrordance with the laws of the State ot fndlena m �� � 9 %? (date).
. 5��� /`-"e'4-� G=� Clerk
�b�A.pp�n,��� . Ci6san Circuit Caurt
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