Marriage Certificate - Wallace, Carol Ann_2/12/1998..- - - _
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STATE OF INDIANA
APPLICATION FOR MARRIAGE LICENSE
_ GIBSON couNTv
IC31-7-&1. Fuml�hlnqlelulnformetlonuponepplyinglorlleense.
A person wAO knowingly lurnishes lalse intormation to a clerk of the
circuit court when ihe person applies tor a marriage license under IC
3t-7-3 commits a Class D telony.
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MALE APCLICANT
Pe�rqu0 M�nYI Slatus: HIVM A4rrMO O OR No. o10.bi0us Marnaab �
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�CNNOWLEDGMENT
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No.
File
Date o—Xi opi�catlon
FemaleApplicant50>NO ❑ Yes�❑ �
If No, Medical Ex!aa-mination or Report DateO
Name of Physician' _���
FEMALE APPLICANT
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lastuarrupeEiweaBy: Denn O Oivwn � Annulmem p Date
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BinnObce ot mmner �SUie o� �omlgn comirv,� �
�CKNOYREDGMENT
1 a�no.leage �nn I nave eecervM mimmatron regarUmq aL+qerws cwnmuniuele Oipeafef
ma� aee ae.uany immmiuea. ana a iin oi me ini siim �or me virua mam�uso uD5 �acauiree
une ae�mleMy synomm /1 -�� ��
Spmmreot�oo���an%��n^�l���T/� pii�rQ-�P
ID� a�o.e �oWw�m nu oqecua m.enlying ey aam or amrnauon or sign�wm io me aeove I ine aoore appGCam nae o0jtt�ea m veniymg py oam or allienauon oe eiB^+mre �o me aeove
¢uw•iwBmant wrauee oi reipious oeeeb. anna.�eo9mem oecause a� re4grous xirtn.
G•rto�eoun one Ciano�GOUn oaie
SineollnEi�m 1 �s+earnnmmmumem�ornawn9nen
Counry ol GiMm ��'%�n1s aoo��� tme ��a corrxi.
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NOV ACCttif p
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o� tne GiWm Circ�it Coun
CONSENT OF GeRENTS. GAqENT. OR GUAqDIAN
W�, N� W�lnb OI NiHppIKlnl, hNlOy Qi�<CMSM� �w INS matnaqe.11 Mly me W�enl syn3.
t�tle bcb wlliCO mlke �M COnfGnl ol lne o�ner pd�enl unnpCGSyry
SLteollnaueu � �,
Counryo� �
F�mer �0 •
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SuUfCnppO �nC f�om Io Cllore me I�is _ a+y ol t9—
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StahollMizn� 1 U: Isw<V/alliemiNllneinlormation9��en
Counry of GiMm 1 / �m m� appu�ron n�me am mrrea.
Sgne�^� �1 wl � �( '�aJC'/C\'�,(ti.
Ntw AOOro55 �
Su45CnpM an0 f.om la Mlore me tnis __ Qay ol �_. 19��
Ckrt oi ine Gium Circui� Goun
CONSENi OF pnflENiS. PeRENT, OR GUARDIAN
We. me wrems onnie �DWK+�t �ertoy qlve consem tor mis marmqe. il onry one w�m� sqns.
sute bne .nicn ma�e me conxm ot me mner parem unnxessary
Sateonnaian� �
Cwnry oi � ss
Zt�e� ID �
Mpl�lt ID �
SuOxnDlO anE svom �o pllare me ��ia _ day of 19—
Ga�
COMPLETE IF MARPIAGE LICENSE ISSUED BY ONOER OF COURT. A marriage license �aving Geen retusetl to t�e above nametl parties. the
County Coutl, by written orUer issued
enC liled in authorizes anE Eirecn ��e issuance oi a marriage license to the above named Danies.
RETURN OF MARRIAGE LICENSE AND MARRIAGE CERTIFICATE
1 rertlfy Nat t6ere wae Sled in my otfire e merriage license is'sJu�ed 6y the Clerk of [he Circuit Court of Gibson County, Indiana,
dated �;���1� R�,�q n�� , authorizing the marriage ot �� R�- �1�) Ui�0.49JJ.R9- and
C,�.S1.6Q _ � l XAI.�-4fY.41.Ai�_ .
I fu�rthe�r c�ertify that the following merriage certificate was Sled in my office:
I. y¢���� �� namel. certify that on / 7i )q% (date), et n(17Q/11CV1`��� in
G���1� Caunty,[ndi a,� � ��� �1iQQ4Cf.fSl- of �51b�S"� County,
(atate), and � �oi�rnn�f� of �iu�(}h, County;
• (atate) were married 6y�,,m-e, �ars au[ho���dG nder a marriage license thet was issued 6y the Clerk of [he
GSrcuit Cou of Gi6son County, Indiana, dated` (��� �1 l
Signedby:����`�� , n ��Hn�AT9w.(officialdesignation)
Filed and reoorded in ettrordance with [he lewa of the State of Indiana on ��� ����n (datel.
Signtd � `'"�'A'a�'� 7V� �l/Y� Clerk
,��u.urn�w�m� - Gi6son Circuit Court