EE MARRIAGE LICENSE APPLICATION
DIRECTOR (YOU MUST PRINT IN BLACK INK)
OF LICENSING
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alan Se lw coisas apa soa ery aber must fe sll on is Mariage oeise AMPUGTON THe 7e, US One Ses 00 GRITTY TN
‘Statues, Secon 146223, and MIN Stes, Section 517 8, Sod 10)
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‘Does oot bt oF ears ve a felony concn Tor eine comsaited ba Oar Anu 1, 2000 ude MiGaea law ote ln of anne
incision? Bide YES GENO yes, diction. ‘Groom YES QDNO yes, ution
{1 Bide oc Groom bas commited felony rime unde any aw, enor fer August I, 2000, andi asouminga fret sarmame afer maioge, document served on be
rosecsing atorey ad prof of service a requzed by Minesoa Sates 23313, be atachad
Asac copy oa documents seve cng Moat of Service Dates of Serie _ Depuy Regina:
‘Cherchy solemnly swear that Thave read and understood the statutes writen above, and swear that | eller bave committed no felony cimer ander
any law, on ot after August 1, 2000, or if have committed a felony erie, that Ihave faly complied withthe notice of name change as tequited by
Minnesota statutes,
AND
1 heteby solemnly swear, under penalty of perjury, that the all ofthe above statements of fact are true in every respect; that we ate no neater of
‘sin than the first cousins once removed; that nelther is committed to the guardianship ot conservatorship of the Commissioner of Publie welfare
‘without written consent of the Commissioner of Public Welfare; that there is no legal impegiéat to this marriage; that neither of us has 2 spouse
living and oye Gf the applicants is a mang the other isa woman,
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Groin Wdnatre naib ine prnenceofe Nery Degas) ‘Bride Snr ont Be ened rence ofa Napa)
soma ones Sunscnmen AND swopst0 mevoRE ME Tis
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Sorakb ‘NOTARYDA
DATE OF APPLICATION 2} J2-[O7) DATE LICENSE ISSUED
Ho 2910 (00Levy mye era SLnen ary
LCENBE VaLIO FOR 80x MONTHS FROM OATE OF S8UE-NO REFUNDS
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cavae once raouga, hater i carota the guaranty ot consaatrp ote coment f Buran sera or renon of devlopmentl
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SUBSgRIBED AND SWORN TO BEFORE ME THIS suse AND SWORNTO BEFORE ME TH
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