Marriage Certificate - Hyde, Neva L_9/17/2014 85
roan Prw.em Sr STATE OF INDIANA
Vans Stare board or
1aO3toner 3 APPLICATION FOR MARRIAGE LICENSE File _
drat
GIBSON COUNTY — - ca5"cat�'(-
Oate of Application
IC 31 -7-9-1-Furnishing false information upon applying for license.
A person who knowingly furnishes false information to a clerk of the Female Applicant 50> Not Yes ID ! '7Y^f
circuit court when the person applies for a marriage license under IC If No, Medical Examination o Report Dated -__ _ _ ly
31 - 7- 3 commits a Class 0 felony- Name of Physician /i._ 'r I% 7 016,i.
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MALE APPLICANT FEMALE APPLICANT
Name / no )ye; Sr, A dN I Name !I/f F.u lr Middle Na0
Dale of Birth MmeJ^ b 15r� Dale of Bath f n by
jr6SA
Race of Bath(State or taegn country) o eisha4kti Pace 01 Bard(State or toregn counlyl&
Re5bence AWr Sleet BP C t _pats/_;_ n [[__ nesa'lence qa'p l3r Ipr /'na y �Iaa
�U�j �(!C y rrt,:t'� C(L{- _t�iCf?J7' �Ii / 1_L) /lL 1 YI1:/?�,/rd C'r. X11 n-Ant)_
Aevbms Marital Status: Never Marred D OP No.of Previous Marriages 3 Previous Marital Status: Never named Li OR No.ol Previous Marriages_ i
Last Manage Ended By: beam 0 Divorce A� Annulment❑ Date lax).terra Endeo B Cream❑ Drrorce� Annulment n Date_
Date d Donn versed by. ❑Reran Cenaate pOOtne`t ISpeCWI [Ale or oath centred by LI Brvr Cermrcate A Other(Spearyl
,i.V
� L atil Cil C(J•V22. phUVc°rz 0 Jai LL'L'Q:Cl'
;. Are you nor or have you ever been aOAbged to be OI unsound nand? 4 le s n I Are you now or ham you ever been area/900 to On d data-it'd mod? hIVS7 Yes 0
II answer is}es:has Dore aoluaca1M been removed?- NO 0 Yes C ',answer es-yes:has the and r iCltmn been;ennead" NO O Yes D
2. Are you reared b me lemaie applicant Case than second canon" N(/ yes 0 2 Are you related 10 the mile apol caul deser lion second cousuc• NV./Yes n
3 Are you now Yodel Me Influence of an atala4 beverage? NO✓v(es C 3. Are you row under Be rime OI an alcoholic beverage' No V Yes Cl
er
4. Are you re.under me meuence of a narcotic drug'' NI' Yes 0 4. Are you now urd^r Inc mice or a narcabc drugs ll� Yes n
En'c'•'.1- 5. List the 4A names of any dependent cnadren. _— 5. Let are full names of airy aermender cnaren),
wJ• A224-77'),2 / 04 Y o(J•_/AAL.Dtr?.• - l71 Q�1%!_I11i!---
Z
¢ 6. dal Fob name or applcros lather ' ') E. dal Fun name of oopin:mis laver - ---/n --- /.� •�a
a- lit adopred.list AdOpWe Parents Qtly) Id a Willed.451 AOppbve Pomena OrR/!
< Residence of lather 111 deceased,so state) �1 /) %h��`^'�'�1 Rewerre of acne In deceased.so slate) r•--,�ry '�/�� —
Berelace of lather(Sate or foreign country) `Ac- u-- Birthplace at lather(Slate or la worn country) &4zt/c2R
IOIFUo maaen tame of applicants mother 1v VOL lt.� 1 1 IMF u4 maiden name ol appKanls mother rl to L I
(it adopted.lel Adoptive Parents Only) �t:;-'f-.('j{!y�' 1'!�'/��Kl VfsjI�IL'�F P' of adopted,list AL/Opine Patents Orvy) / �(v/�7 1r v�
/ has I`W Resonance of notner of Deceased.so sale) L ^" 'L"4EL �' -=
Residence 01 ndmer Id Deceased.so sale) .,/1
Budpt.ce ol mother(Sate or toregn country/ r1 1(Cv/ti4--- ambiance Cl moter(Sate or bregn country) ∎-220-titre✓ ---
ACKNOWLEDGMENT ` ACKNOWLEDGMENT
I acknowledge that I rave rece 'ed information regardeg dangerous canmunrnde baeases I acknowledge Mat I nave received udamatM regart/mg dangerous commuter-able diseases
that are se wally tramemm'•.y•a list OI the test?es}�r e w -r 1 causes AIDS(acamled that are sexually transmitted,and a list of theeesl s/tes Icr Ne virus than causes AIDS acquired
lnuelune deficiency syndrome. ( ' immune deficiercY Sy'raione . / / J/' �_��
Signature of Apd . 7�% Date �'�jZl Sgnature d Applicant) .LLtit)X&L'/l.CN Dale
The above applicant has objected to verifying by oath Of affirmation or signature to the above The above applicant has ogdcted to vent YIN by oath or aflurnation or signature to the above
acknowledgment because of religious beliefs. acknowledgment because or religious beliefs.
Cone of Court Date Caere of Court _ Date
ji I swear/at/um Val t e mfamamn iven Sate of Indiana v' I swear/a/tum Mal Pe nlarretion given
Sale oI Indlare 9 Coof ss VYS apptrpmn¢hue and=rect. County 01_____ _— ss m Mrs application e true and correct.
.l' V 1
l ( '�
Sgnmed• vrL<' 12t iIc`� Sgrrerfj�- /".;vV- ,/ Q f L(l�
New Address _ �/yy��yy/�I� //���� ,`New Address -y1� _flat y�
• Subscribed and sworn to Oelore lime t a'O-3..•day ol_01.0.-td_. OCV/ sIt,Cribed orb swan to below me Muss%-/=1day of_f l/.S. 7(L'�
l)�i}J • L�'' h.
1.,•;41 t k1l)\ Clerk of the Glbe�n crime adorn;
Lit'Nil• C. 1142-1{l n 1n14�7r7t J "Clerk al Mee GCIson Carol Court
CONSENT OF PARENTS.PARENT,OR GUARDIAN CONSENT OF PARENTS.PARENT.OR GUARDIAN
we,the parents or the applicant.hereby give consent or me marriage.II only one parent sgns. We.ten parents of this appliant.hereby give mnsent to,MI¢marriage.II only one oaten signs.
state/acts which make the consent al the Other parent unnecessary sale lads wh¢n mare the consent ol me odes parent unnecessary
Slate of band 1 Sate at Indiana I
County of I ss Coin,or _ 1 SS
Father__ _— —_ ID. _—--_—_ Fattier _ Inn
M1bVEr ID. _ A101rrer_ ________________ _ _ ID• ________
Suoscrreo and sworn 10 bemre me the day 01 Su0%noco and sworn to berore me this —day OI ,
Ceti, ______________ Cler'r
COMPLETE IF MARRIAGE LICENSE ISSUED BY ORDER OF COURT.A marriage license having been refused to the above named parties,the
County Court, by written order issued
and filed in ,authorizes and directs the issuance of a marriage license to the above named parties.
RETURN OF MARRIAGE LICENSE ANI) MARRIAGE CERTIFICATE
I certify thin there was filed in my office a marriage license issued b the Clerk y j the Circuit Chun r f Gibson County. Indiana.
dated_tY4 f�t,_ I I autao,-cal the ntfa rein,f;erJ- --�t��(Q'LIY- `C'�si_<..—g-_lb.-[?l-C- _and
I further 'ern F that t`he,loll' •in marriage certificate Ices flied in m y q/JIC
!. t� lam- -ltiy.e.- ' (no, e), certify that on _.?_ , CU) (date). nn_ = +a in .
_County. Indiana. J/ �' 'c" ('1--- _County.
�_e (state).and )G _— ._-o/_—. --County.
.12).."--' (state) were married by one as ruahori:eel under a marriage license that wets issued by the Clerk Of the
Circuit 0girtt/of Gibs();Count It lia)a,dated (i-� (9711)'/... —.
Signed by:_IN Ili� C!«ec_.ervi (ollici(t designation)
Filed and recorded in accordance with the laws of the Slate of Indiana on _(_Y�. P- �- 3_L _r U L__ (date).
.Sign`•(/ ° ____J.(,.(/ _-Clerk
r;ihtt'n(-irrnit Cr min .