Indiana Code Title 31. Family Law and Juvenile Law § 31-11-4-15

Sec. 15. Each marriage license must have two (2) certificates attached to the license.  The Indiana department of health shall prescribe a uniform form for these certificates.  One (1) certificate must be marked “Original” and one (1) certificate must be marked “Duplicate”.  Each certificate must contain the following:

MARRIAGE CERTIFICATE

I __________ (name) certify that on __________ (date) at __________ in __________ County, Indiana, __________ of __________ County, __________ (state) and __________ of __________ County, __________ (state) were married by me as authorized under a marriage license that was issued by the Clerk of the Circuit Court of __________ County, Indiana, dated __________.

Signed

(OFFICIAL DESIGNATION)