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STATE OF SOUTH CAROUNA <br /> LICENSE AND CERTIFICATE OF MARRIAGE <br /> 2013M L0700472 BEAU FORT <br /> LICENSE NUMBER COUNTY <br /> GROOM-NAME (First) (Middle) (Last) (Suffix) BIRTHDATE(Month,Day,Year) AGE <br /> (1) MELVIN SHAWN NICHOLS (2a) 09/11/1967 (2b)45 <br /> BIRTHPLACE(State or foreign country) RACE No.OF THIS MARRIAGE <br /> (1st,2nd,etc.) <br /> (3)FLORIDA (4) WHITE (5) 2ND — <br /> RESIDENCE(Street and Number) <br /> (Be) 38051 CHURCH AVE. _ <br /> CITY,TOWN OR LOCATION COUNTY' STATE <br /> (6b) DADE CITY 1(6c) PASCO (6d.� FLORIDA <br /> BRIDE-NAME (First) (Middle) (Last) (Suffix) — BIRTHDATE(Month,Day,Year) AGE <br /> (7) FRANCES ANN BENNETf (aa) 03/29/1963 1,81))50 — <br /> BIRTHPLACE(State or foreign country) I RACE (NO.OF THIS MARRIAGE <br /> ('lei,2nd,etc.) <br /> (9)PENNSYLVANiA l oo) WHITE j(11) 4 T H <br /> ---------._-..--- _— -- ----- --- _ --__ — _ -- ---- - <br /> RESIOENC@(S+roe!and IvuniL•erj <br /> (12a) 5824 16TH ST. <br /> CITY',TOWIJ OR LOCATION COUNTY STATE <br /> (12b) ZEPHYRHILIS (12c) PASCO — (1zd)FLORIDA - <br /> MAIDEN NAME OF BRIDE(If Different From Above) ;I CERTIFY THE BRIDE/GROOM HAVE MET THE STATUTORY REQUIREMENTS TO QUALIFY FOR THE STATE INCOME TAX CREDIT <br /> AS PROVIDED BY SECTION 20-1-230 OF THE SC CODE OF LAWS. L I YES ❑X NO <br /> (13)GELORMO — j(14) <br /> Application for a license was filed with this court at 01:30PM (time), on the 18tn day of April 2013 <br /> These are,therefore, o av,thorize any person qualified to perform marriage ceremonies to perform the marriage ceremony for <br /> the persons above named and for the so doing this shall be sufficient warrant. Given under my hand and seal <br /> at 01:30PM (time),thi5'th _ 19th day of April 2013 <br /> Kenneth E. Fulp,Jr., Probate Judge <br /> SIGNATURE OF ISSUING OFFICER TITLE OF ISSUING OFFICER <br /> GROOM <br /> -SIGNATURE( 1(x�J -- BRIDE-SIGNAT/U'R-E' �q ,, ,. f� <br /> (15) • �-�^ `eet7.'�r�. (16) �(uo WW'►1� <br /> I CERTIFY THAT THE ABOVE NAMED PERSONS WERE MARRIED 0 PLACE OF MARRIAGE <br /> J U N �0 f/� _ _ QQ� ��$ <br /> uW <br /> (17) (Monti) r ( Y, 20 hear) - i t161 �i�"Y; iCuurny) SOUTH CA`�OLIN <br /> OFFICIANT-3f NATURE ( I OFFICIANT-PRINT NAME <br /> (19a I(19b) nle;a Ann _ — <br /> OFFICIAN,I- ITLE <br /> 'kdowy, ,ate,Qarolina, to At Large <br /> �m Feb 19,2018 <br /> (19c) ---- <br /> OFFICIANT-"AI�INGADGRESS — <br /> A sox,1 171 <br /> (19d) "Beaufort, 2990E ---- -- --- <br /> DHEC-0681(07/2.00) BRIDE/GROOM COPY <br />