This document contains statements from a physician and laboratory to the Clerk of Orphans' Court regarding an application for a marriage license in Pennsylvania. The physician examines two applicants, Elizabeth Thompson and Teola Patillo, and certifies that based on medical examinations and syphilis tests, neither applicant has syphilis or is in a communicable stage of infection. The laboratory also provides results of syphilis tests for both applicants done on specific dates.

1. TO:
MARRIAGE
THE CLERK OF TIIE COUNTY COURT OF
WEST VIRGINIA:
The undersigned parents (parent or guardian
/.^Z r€*,2,/*
COUNTY,
having sole custody) of
, a minor born on the---/Q--day of.
D 1q , do hereby consent to h l-.s marriage to
Witness the following signature(s) tnis '{Y A uy ot 1dl-q-, ' , D Qg
WITNESS TO SIGNATURE:
I
2
Sworn to before me this-day of- , 19,
(Signature of Person Authorized to Take Acknowledgemeni)
(Tiile)
(County and State)
CONSENT
SIGNATURE OF PARENT(S) OR GU
vs-008A (r-l-64)

2. MARRIAGE CONSENT
To: rHE cLERK oF rHE couNry couRr o, &Li couNry,
WEST VIRGINIA:
undersigned
4
ts (parpnt or guardian hav sole custody) of
a minor born on tt"--9Laay ot
do hereby consent to h t(--- marriage to
witness the fouowinr r,r:;",r1*-'""1 ' o * ,, W , ts A/
WITNESS TO SIGNATURE:
Sworn to before me this-day of- , 19
(Signaiure of Person Authorized io Take Acknowledgement)
(Name of Applicant)
(
OF PARENT(S) OR GUARDIAN(S):
(County and State)
vs.oo8A (l-l-64)

3. r0/tqE0r0
lffalEcfi
I KhU6 3:Sl3 ftHs$e Lmkup - I'Iau,..
m,ffieGotsnruy.com
Purege rcsuttsr
1 l$ngr 3:$tB {l{ew Internatlonal Vension}
ArJdh durEe*
s So glve your SOtl a disemlng heart to govem your people and to
dlstlngulsh between right and vunrrig. For who is able to govem this
grcat peopte of lmuts?"
kf*e )
10 The log was pleased $ratl,fanel[ hio asked forthis. tr so God
said to flf€, "Sine you have asked for this and not for long life or
weaith for younsclf, nor harre asked for the death of your enernies but
for disemrnent in admtnlsteililg iustice,
12 t wtll do what you have
asked. I witrl give you a wise and discerning heart, so that therc will
never have been anyon€ llke you, nor wi*i there ever be. 13 lrloreoveq
I utrlll give yuu what you have not asked for-hth rlches and honor*
so that in your litetime you wttl have no equal armong Kitr.
t*.cm*IrErnaf*tml ve tden ( ?{fl ,
t lr*Er X*"tt Fs€aSE Lo6t{l$ - Her.".
mBiblesntffinffiy"c*m
Parsrfie rcaultsl
I Kinga S:9-I3 {llew Internatlonal Verclon}
&rdio +aft+ct
e59 tee and to
to goveih this
Heu rnternafonal-lf*rs,hn { Hil}

4. (l) To:
HCO 1424 REV. t/64
Commonweolth of Pennsylvonio - Deportment of Heolth
STATEMENTS TO CLERK OF ORPHANS' COURT FOR APPLICANT FOR
MARR!AGE LICENSE IN PENNSYLVANIA
s,- I{ Ma'l 1Irocett M- D.
(Physici on)
s'l F tr'nnmk1ln Ave Alloulppa. Pa.
(Addres s)
(2) This loborotory completed on Odrcber 2l , B& , o DRL
of Heolth on specimen of blood
E I izabeth Thomoson
test, oiproved by the Pennsylvonio Deportmeni
of
(fulI nome of opplicont)
AtiOuinOA. Ira-Bv@- (Lddress) (Authori zed Representoti ve)
PHYSICIAN'S STATEMENT.
I om o physicion registered or licensed to prociice in the Srote of Pg.
or o commissioned Medicol Officer of the U. S. Armed
Forces or the U, S. Public Heolth Service ]
HCO 1424 REV. 1/64
Commonweolth of Pennsylvonlo - Deportment of Heolth
STATEMENTS TO CLERK OF ORPHANS' COURT FOR APPLICANT FOR
MARRIAGE LICENSE IN PENNSYLVANIA
(l)To: S. H. l[alllnger, M. D.
(Physici on)
5r 5 tr'rarrklln Avenue Allqulpnar Pa.
(Address)
Ocfober 2l rs&,o
lest, opproved by the
of
Pennsy lvonio Deportmenl
of Heolth on specimen of blood
Teola Patillo
2O9 - lth Ave. (full nome of opplicont)
VDRL(2) This loborotory completed on
A t iquiopa, Pa. R., Pafholooist
(Authori zed Represen toti ve)
ond certify ,ho, * o.,^t . Lg--- ----
('onk'
""tuicne'
s*iol No')r
exomined
ElLzabeth Thonpson or Allqulpne, Pa.
PHYSICIAN'S STATEMENT.
lom o physicion registered or licensed to proctice in the Stote of Pennt.
or o commissibned Medicol Officer of the U. S. Armed
Forces or the U. S. Public Heolrh Service
'Ferr'| . Prt{ 11o
(n om e)
on opplicont foro morrioge license, On rhe bosis ofmy exominotion, medicol history
(ronk, service, seriol No.)
ond certify thot on OCt. 19r 19 68 I exomined
(month, doy)
.r AlrqurelH:r.,Pa -
(n om e)
Signed in presence of physicion
e11$.,1FFn ,,:E!!:1r
re 681n'-, 9 -
(oddress)
M.D.
,es.
of the opplicont ond the result of the siondord, serologic tesl for sy.philis, it is my
opinion thot the opplicontwhose signoture oppegPs below is not infecied with syphilis,
or if infected, is noi in o sloge which is cgmqfnigq{le.
l
Oot. I 1O-22- 19 68Dote
STATE BOARD
I
I
200 Oak St.
M.D.
Dqe.
(qddress)
(oppli cont)
LICENSE NO. 1642 ARD LICENSE NO. 1I}48