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Marriage Certificate - Urbanek, Jan_3/21/2015 • Form Prescribed by Indiana STATE OF INDIANA Number: 2010-0000065 State Department of Health Under Authority of Certified Marriage License IC 31-11-4 • Gibson County • • APPLICANT 1 APPLICANT 2 Name . ROBERT LYNN URBANEK Name JAN M WEISS Birth Date October 03, 1952 Sex Male Birth Date September 24, 1965 Sex Female Residence 327 E 795 S Residence 327 E 795 S FORT BRANCH, IN 47648 FORT BRANCH, IN 47648 County of Residence Gibson County of Residence Gibson Birth Place GERMANY Birth Place Indiana, USA Dependent Children Dependent Children None JADE WEISS Parent Vs Name JOSEPH W URBANEK Parent Vs Name RUSSELL K MADDEN Parent Vs Residence Florida, USA Parent Vs Residence Indiana, USA Birth Place of Parent 1 New Jersey, USA Birth Place of Parent 1 Indiana, USA Parent 2's Name BONNIE JEAN MARKS(RANKIN) Parent 2's Name WILMA JEAN MADDEN(REED) Parent 2's Residence Indiana, USA Parent 2's Residence Indiana, USA Birth Place of Parent 2 Arkansas, USA Birth Place of Parent 2 Indiana, USA MARRIAGE INFORMATION Marriage Date Saturday, May 15th,2010 Marriage City/Town EVANSVILLE Officiant Name MICHAEL DAVID MCCOOL Marriage County Vanderburgh Officiant Title MINISTER Marriage State Indiana License Issuing Clerk Becky Woodburn Marriage Country United States The information above is a hue and accurate copy of the information on file with the Clerk of the Circuit Court regarding the Application for Marriage and the Marriage License issued by this county on May 10, 2010. Clerk of the Gibson Circuit Court, Gibson County,Indiana,this 20th day of March,2015 &' • Clerk