State of Indiana,          )
                                        ) SS:
Jackson County            )
To All Who Shall See These Presents, Greetings:
                       KNOW YE, That any person legally authorized to solemnize matrimony is hereby licensed to join marriage as

Husband

DOB (mm-dd-yyyy)

and Wife

DOB (mm-dd-yyyy)

and for so doing this shall be your sufficient authority.
                                    IN TESTIMONY WHEREOF, I,

                                    Clerk of the JACKSON Circuit and Superior Court, hereunto subscribe my name and affix The Seal of said Court this

Date (mm-dd-yyyy)

Clerk

State of Indiana,          )
                                        ) SS:

Jackson County            )
                                   THIS CERTIFIES THAT I joined in marriage as

Husband

and Wife

on the (mm-dd-yyyy)

Officiant

State of Indiana,          )
                                        ) SS:

Jackson County            )
                                    I, AMANDA L. LOWERY, Clerk of the JACKSON County Circuit Court of the State of Indiana, do hereby certify the forgoing to be a full, true and correct copy of the license issued for the

marriage of

and

                                    and of the certificate of said parties as returned and

filed by

                                    Clerk of the JACKSON County Circuit and Superior Court, JACKSON County, Indiana as the same appears of record in my office.

IN ATTESTATION WHEREOF, I have hereunto subscribed my name and affixed the Seal of said Court, in the City of BROWNSTOWN, Indiana this day of

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