Marriage Certificate - Whitehead, Angela L_9/11/2008• THIS IS NOT AN ORDER BLANK �
-�� ADDITIONAL CERTIFICATION COPY OF YOUR LtARRIAGE CERTIFICATE MAY BE O iA�NED FOR 510.00 FROM THE OFFICE OF
HEP.LTH STATUS �dONIiORiNG, STi�TE DEPARTMcNT OF Hc.1LTH. P_O. 80X 337d, HONOLULU. HAWAII 96807. �Vrite fu�l name ef
�� groom, fvll name of bride, belore marriage. date of marriage. place of marriage, antl reason for ordering a copy.
_- �. Your reques( lorm must Ge signzd. _ As reGui:eC by law, enclesed is a t:ue
� ROGER WHITEHEAD
ANGELA WHITEHE,4D
- 131 W. OAK ST.
� OAiCt:AND CITY, INDIANA 47660
STATE OF HA�NAII
tiONOLULU
��AME OF GRCx�r.�
.ROGER LE=_ WHITEHEAD
DATE OF BLRTH
Ocrobz: 27, 7559
USUALRESIDc�Cc
� -131 �`/ OAK ST.
FATHE3'S V4+.1E
!AP.4Y LEE :'JuIT�HcAD
btOTHER'$ ..L11�JE V ;1 �h.tE
JERRI LYV;: HARD�V
NAA'E OF BRiDE
ANGEL4 LYVN LOYD
DA?E OF 91ftTY.
July t. '� 3'C
USUAI RESID&VCE
731 W. OAK 5?.
FATHER'S N?.7•7E
COY VJAYVE GREEN
FIGTHE�'S hV+lucN Ni�Pd'c
JOYCE ELAINE BOLDRcY
GROO�t'S DECWRED P.iIDDI'c �F:.ic(S)
LEE
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VINCENNES.INDI.4NP.
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o� q�c p: a,RiM
0���:EY.ILLI�:OIS
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copy of faas recorded on lhe certificate
of CAarriage on file in the O�ce et
Healtn Status Monitoring, Hawaii State
D?panm?nt of Health.
Please note ;he respective surnames
antl miCdle nar�es whic� you ztected to
use legalry a.°,er your marriage.
OEPARTMENT OF HEALTH
HAWAI! U.S.A.
C=RTI�ICATE N0151 2005 - 017950
SiAicG?.CG:.wi2.i
INDIANF,
S7�T'c On COU\ i nY OF d1ic7H
14DtANA
S�rTE OR COUY � RY OF BIRTH
INDIAVA
s�a�e oa cou�rav
INDt?_"'v.
BRIDE'S DcCWRED NIDDI`t N.V•�c(5)
LYNN
5�ATE OR COUNTRY OF BIRTM
ILLINOIS
5 iA7E OR COUNTRi OF BIR7n
ILLINOIS
GROOhiS DECtr.RcD SURNPAtE BRIDE'S DECLARED SURNAht?
WHITcHEiat7 NJHITEH[AD
DA1E OF h1:RRL:Gc PL1C'e OF C'eRcMON'f COUNTY ISWND
July 19, 2005 TIKI BEACH, KIHEI MAUI ' h1AUl
DATE ACCEPTED BY S7ATE REGISTFLIR
Augusi 4,2W5 �
OHSed 5:(Rac.t tAt tA5'cR� This copy serves as prima latie evitlente of Ne /act ot maniage in any court proceetlin9_ [NRS 5724](q, 779-13(b)]