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2014NEW YORK STATE DEPARTMENT OF HEALTH Application to TownlCity Clerk for Copy of Marriage Record Yrta1 Records section TYPE OF'RECORD ~E~R1 Search and Fee $10.00 Certified Transcript per copy A Certified Transcript is an abstract iron the maniage record issued under the seal of the townlaty clerk. It includes the names of the contracting parties, their residence at the time the license was issued, date and place d manage as well as date and place of birth of the lxide aid Boom. A Certified Transcript may be used as proof that a manage ocal-ted. nt~r Number of 'C Search and ^ Fee $~ o.oo Certified Copy per copy A Certified Copy includes all of the items of infannation occuning an the original record of the marriage. A Certified Copy may be needed where proof of paentage aid certain other detailed information may be required such as: passports, veteran's benefds , court proceedings, err settlement of an estate. Brdel(3room/spouse rName (as recorded on marriage license): ~ -y 1~ ~. ~ - l,.r If Previously Marred, State Name Used at that Time: Date of Birth: fasy+attaMe/wtsrLy~ Residence (at time of marriage): Fist IBd4~ lot Goaily 861- '&idel4rcwrntS~ouse Name (as recorded on marriage license): Date of Birth: k-ayrat6e~Ner-iry'- ~~ r~ 'f ~ w ~ r ~; ~ S l,.l 7 tiv ~ kt ~ arrs-M.» 3 -- 17 - 7 s If Previously Monied, State Name Used at that Time: Residence (at time of marriage): _. _. _ ___ Marriage nforrti<atiott Place Where Marriage License Was Issued: Place Where Marriage Was Performed: Marriage Certificate No.: Local Registration No.: It-~l R~1 ro.nar G qo n s o w ~~7'w '° °. rows a C a r~vc i ~ v 1~u 7~ Purpose for which record is required: Date of Marriage or Period Covered by Search: ' ~ tIl~tNa on er ~ ~. ro ,: - ~ l= w a ~~ 1 c S..rolr teeer In what capacity are you acting?: What is your relationship to person whose record is requeed? ~~~~~ (If salt, state "SELF.) /~l/~- 1 ~ ~= / ~ o iv If attorney, give name and relationship of your client to person whose record is required: s..d-ta ~a..ah:ppwinaP Nw/dld/)J7Y) ~iynaima v~ nNrmwi n v.aav. r.pp..w... ~ .......` .........`.. Name of Applicant: Please print name and address where record is to be sent: r rC )~ 1 ~ F~~-~~ h f~ Address of Applicartt: cry start, ziP ~ coy sef. z-P ~ DOH~Ot (a/11) Pepe 1 of 2 s Application to Town/City Clerk NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Marriage Record Vital Records Section Search and Fee $10.00 I Searoh and Fee $10.00 Certfication ~ per, cepY Certified Copy P~ cePY A Certification, an abstract from the marriage recd issued under the seal of the Health Department. inC~des the names of the contracting parties, their residence at the lane the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. A Certfied Transcript includes all of the items of information ocxurring on the original n3cord of the marriage. A Certfied Transcript-may be needed where proof of parentage and certain other detailed information maybe required such as: passports, veteran's benefits, court proceed'a~gs. or settlement of an estate. ~~~: 'l PLEASE PRINT OR TYPE Name (Frsh (Middle) (Last} P~, ~ ~ G,~~ -~-~- ~ Name (First) (Middle) (Last} l~-~k~~~ s ~ ~- , B d , e Groom's Age or Date of ~~ , ~ 1 17 a Bride's Age or Oate of (~ \ ~ (~ ~ ~ Birth Birth Residence (County} (State} Residence (County) (Stace) Groom Q ~'i'~t1 ~+sS~ ~ ~ y Bride }~~'C C.'1~i5) ~ I Date of Marriage If Bride Previously or Period Covered //~~ ?~~.L ~1 6 0 ~ l OC ' Married, State Name t T e U d iTh 1 Search ~ im se a a For what purpose ~ information required? What is your relationship to person whose record is requested? ~Q(L eU~r ~o Cljc'~ ~~ (~ ff self. state "self.' S ~ (~, (' In what capacity are you acting? _ If attorney: Name and relationship of your client ro persons whose m~riage record is required. Signature of Appficant D~ ~ S Address of Applicant ~ ~~ ~~X a~~3 Please print narr~ and address where record is ro be sent. ~~TE ~ ~(~-~--~ ~' ~ ~~a~~~~~s~. Ny la~° ~ DOH-901 (~). (PLEASE SEE REVERSE SIDE) Where to Apply for Record of Marriage 1. License Issued in New York State (Outside of New York City) Year of Marriage * 1880 to present Apply to: Certification Unit Vitat Records Section P.O. Box 2602 Albany, NY 12220-2802. * 1880 - 1907 and license issued in the cities of Albany, Buffalo . or Yonkers 2. License Issued in New York City Albany: City Clerk, City Hall, Albany, NY 12207 Buffalo: City Clerk, City Hall, Buffalo, NY 14202. Yonkers: City Clerk City Halt Yonkers, NY 10701 Appty to the Borough affice of the New York City Clerk that issued the marriage license. The location of these ofFices follows: Manhattan - Municipal Building, New York, NY 10007 Brooklyn - Municipal Building, Brookyn, NY 11202 Bronx - (Records for 1908-i 913 are on file with the Manhattan office) 1780 Grand Concourse, New York, NY 10457 Dueens - (Records prior to 1898 are on fife with the New York State Department of Health) 120-55 Queens Boulevard, Kew Gardens, Jamaica, NY 11424 Richmond - (Records prior to 1898 are on file with the New York State Department of Health) Borough Hall, St. George, Staten Island, NY 10301. PLEASE NOTE: Records of marriages in areas of the present City of New York, which were not part of the city at the time of marriage, are on file with the State Department of Health. _. _ ~ c-~~,_.~ Ll 10 ~S3tfl~C3 E4=id-S0 -t1dR6'81 -~ ~~ ~ '~ ~ . „ ~. ~# ~ ~.. ;,~ ~~~- ~~~ j~ ~ ~r~r~~tl~~~. E ~;:~ ~ S , _ -_ NiS~SS~"1~~8L8S~ :~l `~-E3~CLS __ • ,1' r -iy' ~"~~... ~ ~~~ Application to Town/City Clerk NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Marriage Record Vital Records Section Search and Search and Certification a Fee $i 0.00 ~ ~ ^ Fee $10.00 Per coPY ~ Per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, ir~lttdes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and 9~m A Certification may be used as proof that a marriage occurred. A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings. or settlement of an estate. +'!:i PLEASE PRINT OR TYPE Name (Frst) (Middle) {t.ast) Name (First) (Middle) (Last) of of Groom Co,eENZC~ SNACU,c.; Crl/~D~CE.SS Bride EL~zf38E7N C,'N/~D.e..c55 Groom's Age Bride's Age or Date of Birth •5`~ or Date of Birth /n, a 5..5-~ Residence (County) (State) Residence (County) (State} of of Groom ~urcHESS N~ Bride DurGrf,FSS N. , Date of Marriage ff Bride Previously or Period Covered Married, State Name Search 3 . / ~ . Used ffi That Time E ~ ~ z ~ Ei STN L ~ e,v~ G Place Where Place Where Ucense Was Marriage Was Issued 7'c cs~,v ;-~ A/l luF? PPl ,u(7EC.S /U Performed Tocu,~J NH // APP/ /UFrERS N y For what purpose is information required? Whffi is your relationship to person whose re~rd is requested? If self, state'self.' NEt`b 1~ DuI~L/PATE [~,e16,/vAL ~USr SELF In what capacity are you acting? If attorney: Name and relationship of your client to persons /1/iFE wt>ose marriage record is required. d~ '-~ ,::.. S~nature of Applicant Date Ad rasa Applicant Please print name and address where record is to be sent. ,2f~ 3.3 ~~ `I~7, Uti1~T ~9 (,u~PP/,~~~,es ~g~ls, /vy /~ ~~a DOH-301 (3f93) (PLEASE SEE REVERSE SIDE) Where to Apply for Record of Marriage 1. License Issued in New York State (Outside of New York City Year of Marriage * 1880 to present Apply to: Certification Unit Vital Records Section P.O. Box 2fi02 Albany, NY 12220-2602 * 1880 - 1907 and license issued in the cities of Albany, Buffalo . or Yonkers 2. License Issued in New York City Albany: City Clerk, City Hall, Albany, NY 12207 Buffalo: City Clerk, City Hall, Buffalo, NY 14202 Yonkers: City Clerk City Halt Yonkers, NY 10701 Apply to the Borough office of the New York City Clerk that issued the marriage license. The location of these offices follows: Manhattan - Municipal Building, New York, NY 10007 Brooklyn - Municipal Building, Brooklyn, NY 11202 Bronx - (Records for 1908-1913 aze on file with the Manhattan office) 1780 Grand Concourse, New York, NY 10457 queens - (Records prior to 1898 are on file with the New York State Department of Health) 120-55 Queens Boulevard, Kew Gardens, Jamaica, NY 11424 Richmond - (Records prior to 1898 are on file with the New York State Department of Health) Borough Hall, St. George, Staten Island, NY 10301. PLEASE NOTE: Records of marriages in areas of the present City of New York, which were not part of the city at the time of marriage, are on file with the State Department of Health. ~N f _! flo I; w ~ ~ ~^ j +i/1 Q Y > z N 'W g U ~ N ~ h~ r o ~ (~ y ~ N co ~~m~7 a wWr~' N d a~~zd~ /~ h~l ~ Q W Gin¢ar z J~ ~ iLp D 2J ~ mm U.4+ ~ cn ~., 2'ra c 3 '- ~.tl?I~" 1 T f~ v ~ '~l i ~ ~ Application to Town/City Clerk NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Marriage Record Vital Records Section Search and ^ Fee $10.00 I Search and ^ Fee $10.00 Certfication per cepy Certified Copy P~ cePY A Certification, an abstract from the manage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the 6me the license was issued as well as date and place of birth of the bride and groom A Certification may be used as proof that a marriage occurred. A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed 'information may be required such as: passports, veteran's beneftts, court proceedings, or settlement of an estate. ,ry ~' ~. PLEASE PRINT OR TYPE Name (First) (Middle) (Last) Name (First) (Middle) (Last} Groom ~omas~ J Lam~~'r-~- B ae ~'c~-~-ici~ :~. l~r~~~ ~ou.~s k Groom's Age Bride's Age or Date of 17 Date of ~ p B O Birth oC ' (Sta t e) Residence (County) (Stat e) Residence ( County) ` ~ ' 1 /~ Groom ~~ch PSS (.. ~ I~"_T • ~ J / T I _ Bride I~~'z°R P ~ l~s , ~ , / . Date of Marriage If Bride Previously or Period Covered ~ ~ g s b Search Married, State Name I' Used at That Time ~k'- r ~ja ~O lx-'S K- Place Where Place Where • License Was Marriage Was Issued Performed For what purpose is information required? What is your relationship b person whose record is requested? ' ~' If self, stabe'self." ~,~ ~~ i SS (~ c7 Y In what capaciiy are you acting? If attorney: Name and relationship of your client b persons S~ f ~ whose marriage record is required. Sign, re ppUcant Date ~~J~ tf ~/ ~- ice/ ° A of Applicant ~ Please print name and address where record is b be sent. ~Q--+~Y iC~ 0.. ~-CCrnYJ~C~ DOH-901 (9/!~i) (PLEASE SEE REVERSE SIDE) Where to Apply for Record of Marriage 1. License Issued in New York State (Outside of New York City) Year of Marriage * 1880 to present * 1880 - 1907 and license issued in the cities of Albany, Buffalo . or Yonkers Apply to: Certification Unit Vital Records Section P.O. Box 2602 Albany, NY 12220-2602 Albany: City Clerk, City Hall, Albany, NY 12207 Buffalo: City Clerk, City Hall, Buffalo, NY 14202 Yonkers: City Clerk City Hall Yonkers, NY 10701 2. License Issued in New York City Apply to the Borough office of the New York City Clerk that issued the marriage license. The location of these offices foNows: Manhattan - Municipal Building, New York, NY 10007 Brooklyn - Municipal Building, Brooklyn, NY 11202 Bronx - (Records far 1908-i 913 are on file with the Manhattan office) 1780 Grand Concourse, New York, NY 10457 queens - (Records prior to 1898 are on fits with the New York State Department of Health) 120-55 Queens Boulevard, Kew Gardens, Jamaica, NY 11424 Richmond - (Records prior to 1898 are on file with the New York State Department of Health) Borough Hall, St. George, Staten Island, NY 10301. PLEASE NOTE: Records of marriages in areas of the present City of New York, which were not part of the city at the time of marriage, are on file with the State Department of Health. „-NEW ~ RI~~ STAT f_ E: -.NONE R. NONE ~ -~T. <a ISSUE{1: 08-24-10 Eai-in~.i. ~$-21-18 W~H9enFG h:: NEW YORK STATE DEPARTMENT OF HEALTH Ydal Records Section Application to Town/City Clerk for Copy of Marriage Record TYPE C1F RECORD C~E~fRE >~ (Enter ~lt<rmber of;Copies} Search and Fee $t 0.00 Certfied Transcript per copy Search and Fee $10.00 Certified Copy ^ per copy A Certified Transaipt is an absslract from the marriage record issued under the seat d the tamlaty clerk. It includes the names d the ooMracling parties, ffieir A Certified Copy includes all d the items d infartnatian occurring on the original record d the marriage. residence at the 6me the license was issued, date and place d marriage as well as date and place d birth d the bride and Boom. A Certified Capy may be needed where prod d parentage and certain other detailed infarmadian may be required such as: passports, veteran's benefits , A Certified Transaipt may be used as prod that a manage occurred court proceedings, or settlement d an estate. BridelGroaml5p~use ' Name (as recorded on marriage license): ~ ~~ Date of Birth: If Previously Marred, State Name Used at that Time: Residence (at time of marriage): Find ~ lsN f:aeafy SIeM Br'Id@~~7rO0r13~~uSB Name (as recorried on marriage license): Date of Birth: If Previously Married, State Name Used at that Time: Residence (at time of marriage): r~..d tsar, d~f Sldr Marriage>tnforrt~ation Place Where Marriage License Was Issued: Tern ar V ~~/r ~ PI Where Marriage Was Performed: i`owJ'a` ~ °~..V ~" Marriage Certificate No.: Local Registration No.: Purpose for which record is required: Date of Marriage or Period Covered by Search: wn:.sp,« s..ea ~ In what capacity are you acting?: lM~t ~ Y~ relationship ~ P~ whose record is requ~ed? (If self, state "SELF.) ~~~~~ 8reu lo: I~~P~+~ ~/dd/~ If attorney, give name and relationship of your client to person whose record is required: Sig atu Ap ~ nt Date: Applicant's Phone Number. e f A nt: ' )~ ~-o~ Please print name and address where record is to be sent: Address of Ap 'cartt City State ZIP City State ZIP uvnwi tatnl rape i or z NEW YORK STATE DEPARTMENT OF HEALTH Application to TownlCity Clerk for Copy of Marriage Record Yrtal Rewrds Section TYPE OF RECORD QEStRE © ~Ertter Number of Copies) Search and Fee $t o.00 Certified Transcri er co t Search and ^ Fee $i 0.00 C p p py ertfied Copy per co Py A Certified Transcript is an abstract fran the marriage record issued under the A Certified Copy indudes aU d the items d irdamation occumng on the original seal d the townlaty deck. It indudes the names d the oorrtracfing parties, their record d the marriage. residence at the time the license was issued, date and place d marriage as well as date and place d birth d the bride and groom. A Certified Copy may be needed where prod d parentage and certain other detailed irrfarmatian may be required such as: passports, ~teran's benefits , A Certified Transcript may be used as prod that a marriage ocaured. court proceerrings, or settlement d an estate. Bri delGroo-nlSpotise Name (as recorded on marriage license): Date of Birth: (or spa at r.. of ernig~J Gl~ rya. tar te-.erNa~. - If Previously Married, State Name Used at that Time: Residence (at time of marriage): r~.er rwdis. tr ssN. ` &IdefGreatt~tS*po~sa Name (as recorded on marriage license): Date of Birth: fa+D~dGeeofar-iy~l If Previously Mamed, State Name Used at that Time: Residence (at time of manage): r ~ r-.er ~ t~ ~(/ coerry / ~ sa. Mamie tr>forrnaton Place Where Marriage License Was Issued: Place Where Marriage Was Performed: Marriage Certificate No.: Local Registration No.: cc1 Fels l~u {~ / "~°' ~~" , i Teen a Toew a / Purpose for which rec is required: Date of Marriage or Period Covered by Searoh: rQ Yaniedona ` s~~ ~~ D In what ,city are you ling?: What is yow relationship to person whose record is requred? ~~~ (If self, stath'SELP. ' Serd- Ix ~0 ~~~ Glee/mr- If attorney, give name and relationship of your client to person whose record is required: Si d Applicant Date: Applirartt's Phone Number. ~ Nam f pplicant: Please print name and address where re rd is to be sent: Address of Applicant: ~' State ZIP City State ZIP DOH~301 (8/11) Pepe 1 of 2 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for Copy of Marriage Record Search and ~ Fee $10.00 Certification per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of girth of the bride and groom. A Certification may be used as proof that a marriage oxurred. Search and Certfied Copy Fee $10.00 per coPY A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. '~.'. •'{S•. ~ •h i. ~ ~'f' • ,'.1:. PLEASE PRINT OR TYPE Name (First) (Middle) (Last) Name (First) (Middle) (Last) of ~Ct~~S Jahn M~ // C ' ~helsec~ C ~~~ G~ Groom D /K ~( to rn n c f Bride - Groom's Age Bride's Age to of O '7 - 22 '" g 2 to of ~~ r z A ~ ~ 7~ ` ' Birth Birth t Residence ( Cou nty) (State) Residence (Coun ry ) (State) ~~ // ~(,CTTi~'leSS t~OCJYI ~1r ! Groom I rY y !'(~S S r~0 U~'1' Bride ~L( 1T , , ~ ~ , Date of Marriage or Period Covered ~ l~g~l~ / ~' If Bride Previously Married, State Name N~~ b Search Used at That Time Place Where _ License Was /,~/ 1~, / vv ~~ l~ /vwn T7GU Place Where /' // ,,,( Marriage Was ~~ / _ / _ ~ Gt/~// J G , Issued . (' ~~ Performed O ~! ~f ~~ .>. For what purpose is information requir ed? What is your relationship to p erson whose record is requested?,... f ~ /~I?~ e l' ~,~ I1Lr e ~ / ~ If self, state `self. ~fl T i , In what capacity are you acting? If attorney: Name and relationship of your client to persons whose marriage record is required. ... • .. .n.. .. .. Signature of Applicant ' Date 2 / 7 L~~=~lu.~'` i ~3 Address of Appli Please print name and address where record is to be sent. ~8 T r ~aC~ Chelsea lian~nt ic~e% " go ~u~a~rrac rs ~//s , r~Y/Zs DOH-301 (3/93) (PLEASE SEE REVERSE SIDE) ~----- TARYN FARRINGTON Notary Public, State of New York No. 01 FA6084049 Qualified in Dutchess County ~ ~M ~;ommission Expires December 2, 20 ~ y U Where to Apply for Record of Marriage 1. License Issued in New York State (Outside of New York City) Year of Marriage * 1880 to present * 1880 - 1907 and license issued in the cities of Albany, Buffalo . or Yonkers Apply to: Certification Unit Vital Records Section P.O. Box 2602 Albany, NY 12220-2602 Albany: City Clerk, City Hall, Albany, NY 12207 Buffalo: City Clerk, City Hall, Buffalo, NY 14202 Yonkers: City Clerk City Hall Yonkers, NY 10701 2. License Issued in New York City Apply to the Borough office of the New York City Clerk that issued the marriage license. The location of these offices follows: Manhattan - Municipal Building, New York, NY 10007 Brooklyn - Municipal Building, Brooklyn, NY 11202 Bronx - (Records for 1908-1913 are on file with the Manhattan office) 1780 Grand Concourse, New York, NY 10457 Queens - (Records prior to 1898 are on file with the New York State Department of Health) 120-55 Queens Boulevard, Kew Gardens, Jamaica, NY 11424 Richmond - (Records prior to 1898 are on file with the New York State Department of Health) Borough Hall, St. George, Staten Island, NY 10301. 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Piooai aBawew a41 wal i~agage ue'u~oila~ap y kba gad ~~~_~ p pao~ab a e!aaeW ~o o~ ao~ ~~^ Hl'1V3H d01N3W1liVd3a 31V1S ~aOJI IN3N ~laai~ ly,!~/wino10~ uo!~e~-!!dd~r '431e8H ~ wau4a?dea e~ a43 ~ ~ u0 em 'aBeumw yo awq ayl W ~ 84l l0 3~ed lou eJBM 4~!4M '~Jl MaN ~ ~cu~ tuesex! aye ~o seam ur w ~o spwaay :310N 3Sd3~td LOEO l JW 'Puels~ u81e~ `aB~oerJ 'iS 'IIeH u~m8 (U11~H X01 luau ~S ~Jl ~N ~ ~A!N- al8 ~ aye 8881 of Loud spwaad) - puowy~ty tizti t - JlN 'eaaawe~ `suaprta~ Mai 'p~enep~og sueanp 9S-OZ t l~A1eeH yo luaw~edeQ aPa3S ~~ ~N a4t ~RlM elf} uo am' 88g L w Loud sp~oaay) - suaenb LStiO t JlN '~o~ ManJ `ar,~no~twp PuexJ 08L L (e~tuo ueusyueW etp iAla- ~ uo era g t6 t'806 t ~ spied) • xuag Zoz t t ~w 'W4~a8 'Bu~Pi!~e I~~olunw - ~~+e 1000 t .tW '~Jl MeN 't3uip~~ pad~~unW - u~4ueW ~s"^0~°- ~~ asayt ~ u~i a41 •asua~~r aB~u~ew etP penes! letq ~eq k!~ ~IaoA MeN 8411+ ~ 4~m8 a4t of ~Iddd ~!~ ~~oA /KeN u! ps-nss~ `swa!'1 •Z tOLOL JW 'sae~uo~ IIeH ~BMJ ~1!~ .s-a~Jl ZOZbt JW ' 'IRH ~!'J '~81~ ~1lJ ~~IlnB ~OZZ t JlN '~Uegib~ Z08Z•OZZZt JW ' Z09Z ~9 'O'd ~~s sP~a gun uun u80 :01 Nddb sae~uo~ ~o We~9 '~tuegll~ ~ saq~o a43 ut Penes! esuaary P~ 108 t - 088 t ,~ luesead 01088 t . eBe!t~eW W mBJI (~!~ 1~oA MaN ~o ePl~O) e~elS ~oA INeN u! panss~ asuean • ~ aBeiaaew ~o p~o~aa ao~ ~I~dd~- o~ aaay/N 1 B0-^ 9!'~-S4 'S3HId~p Zl ;~3f19S1 ,~, 3NON 'ti .-s~Y~l6, 3Nf.fi tV '3 S3A3 9 lf~S ~~~"'SO-Ll ~' ~ "-"'` ~'1"l~d ~ ~~ S`1.'1'1~~51 4r ;, `k13~6i3e"` , ~ - ~4 S~Vi~ Z~Q'80~ Z ~dl ~.'~I~3I'2I~LAd~ •`~~. " Application to Town/City Clerk NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Marriage Record Vital Records Section Search and Search and Certfication Fee $10.00 Cerfified ~ Fee $10.00 Per coPY PY P~ SPY A Certification, an abstract from the marriage record issued under the seal of the Heap Department, includes fhe names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and 9~m• A Certification may be used as proof that a marri~e oxurred. A Certified Transcript includes aN of the items of information occurring on the ordinal record of the marriage. A Certfied Transcript may be needed where proof of parentage and certain other detailed infomnation may be required such as: Passports, veteran's benefits, court proceeding, or settlement of an estate. ~H-301 (3/93) (PLEASE SEE REVERSE SIDE] a ~T ':: k. ~~,~ i '~ DRTVER~,,~~ENSE F, '`~ :;, r 1D~ 99U ~4¢ BO1,: CLASS D ~b ~ BRARA °``~'~ ~ A1Vfp , `~ ,,..., ,~;~ ° _,4 - '. ~- ~~ ~: E; NONE ~ ~ ~~;,a 7. -1~ f~ P1i5NE U+[ !$SUED: 08.17-09 EXPIRES. 09-P3-17 ~w~ v'` N.. ~i'a: 7 ,, ~ Application to Town/City Clerk NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Marriage Record Vital Records Section Search and ~ Search and Certfication Fee $10.00 ~~~ spy Fee $10.00 par copy per coPY A Certification, an abstract irom the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as. proof that a marriage oxurred. A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certfied Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. DOH-301 (8/s3j (PLEASE SEE REVERSE SIDE) EW Y RK TAT ~ DR4IVE ~CENSE ~.,~ .. tQ; Sao ~~ a7g. c~a-ss t~ .a ~~_ ', ,,: ~i , .~ ~~ 4~_ ~ ~, .~ .' _ ,x~.„~„ t D2-2&11 F.XPIHES 05-0718 xuvforam Application to Town/City Clerk NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Marriage Record Vital Records Section Search and Certfication Fee $10.00 I Search and Certified Copy P~ cePY ^ Fee $10.00 Per cePY A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage oxurred. <:;: 4•n PLEASE PRINT OR TYPE Name (First) (Middle) (Last) Name (First) (Middle) (Last) of ,,•~' Groom J US h -^ ~ ` -LU -' ~ ~ of Bride Groom's Age Bride's Age Birth e ~ ~ l f °1 f l q ~ ~ / / Birth ~ r ~- I ~ 3 (G `T Residence (County) (State) Residence (County) (State) of Groom 1 c-•bL~.SS ~f ~ ~ Bride (.(.~""C-r//l_~S ~ ~ Date of Marriage _ or Period Covered 1 ~`~ ~ a J ~ l 3 If Bride Previously Married. State Name ~ \ / / ' r 1 b Search ~ ~ `~ Used at That T m~e y ,C Place Where License Was ~ ~~`~ 11~S l~, ~ ,~' S~/D ~ ~' L l1 ~ ~1t ~ Pl~e Where Marriage Was / ~ ~ c ~' d W i ~ ~ llX/Y-~ S~'Y~ ~' l ' ..~ P f . Issued i( er orme For what purpose is information required? What is your relationship to person whose record is requested? `-~-~lC-~ n ,' ~~~ G,}'l ~` ~, J~1~n ,~ If sells state 'self.' In what capacity are you acting? ff attorney: Name and relationship of your client to persons whose marriage record is required. Signature of Applicant .> Date ' dress of Applicant Please print name and address where record is to be sent. ~,j~~~,~ y~~ ~ ~~ ~ ~~ S~3v c7 ~ ~ ~ a e~ix-~-~ L~t~x--~- DOH-301 (8/93) (PLEASE SEE REVERSE SIDE) A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certfied Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings. or settlement of an estate. NEW Y RK STATEF DRIVER ~.ICENSE ID: 647 355 869 CLASS D DIORIO ` : ~- ,~ diAtaE~ C ~: o~iun ~~ R1 nnw~ ''..~p~~NG -~ 12590 SJ~(: F EYES. :. E. NONE ~ ;~` ISSUE0:07-01-13 EXNIRE5.12-23-19 ayowgw v'= Application to Town/City Clerk NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Marriage Record Vital Records Section Search and Certfication Fee $10.00 Per coPY Search and Certified ~Py ~ Fee $10.00 r SPY A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certification, an abstract from the marriage record issued under the seal of the Health Department. includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage occurred. A Certified Tratscrpt may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceed~gs. or settlement of an estate. ~~:;~: n~ . PLEASE PRINT OR TYPE e (Fret) (Middy) (Last) ~ (First) (Middle) (Lash ~G~ Groom LO J ~ ride t~ Groom's Age ride's Age or Date of fY y~' ~/ 2, J a to of 1 ~ ~ S l (~ Birth Residence (County) (State) Residence (County) (State) Groom ` '~"~ ~ Bride Date of Marriage ff Bride Previously or Period Covered r Z7 '~ Married, State Name /~' ~ ~ ~ (~ search used at That Time , Plxe Where Pace Where Was ~ ~~ d ~ 7 (-~~ P f ~ Issued er orme For what purpose is information required? What is your relationship to person whose retrrord is requested? If self, stabe'self.' In what capacity are you acting? ff attorney: Name and relationship of your cl~nt to persons whose marriage record is required. Signature of t Dabs Address of Applicant Please print name and address where record is to be sent. DOH~Ot (~). (PLEASE SEE REVERSE SIDE] Application to Town/City Clerk NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Marriage Record Vital Records Section Search and Certfication ^ Fee $10.00 Search and Certified Copy per copy Fee $10.00 P~ SPY A Certification, an abstract from the marriage recorc! issued under the seal of the Health Department, inchides the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the txide and 9~• A Certification may be used as proof that a marriage occurred. A Certified Transcript includes aU of the items of information oxurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceeding. or settlement of an estate. •<• ~• ~~. PLEASE PRINT OR TYPE Name (Frst (Middle) (Last) Name (Fast) (Middle) (Last) ~ ~ ~ ~ ti -I ~ ~ oom ~ - Bride ~ ~ ~ ~~ Groom's Age Bride's Age y or Date of ~ Z~ ~ to of r, ~ ~ ~~ (j Birth B~ Residence (Coun) ~ (State) Residence Couniy) (State) `~ /~ ~ Groom ~ ~ ~( ~ ~ Bride ~ ll ~ ~ 1 ~ ,e~.~ h Date of Marriage If Bride Previously or Period Covered ~ ~ ~v // ~ Married, State Name b Search to Used at That Time Place Where Pl~e Where d Was ~' • 1~ n ~~ ~'`t ~n Perforn~iedW~ UU ' k~~ ~St~ 4 1 For what purpose is i required? What is your relationship to person whose record is requested? ~~~~~ ~ ~ ~ ~~ ~ If self, state "self.' ~ r \ ~' ~ ~'~ In what capacity are you acting? If attorney: Name and relationship of your client to persons whose image record is required. Signature of App~t f Date ~~ ` Address of Applicant Please pnn nom d address where record is to be sent. S G.~-L'.. 1 ~ K~I~~t t~.rscai~ t G 1..1 erc-~M~c ~~ ,~oU~ ~1 ~f~~S~e . .~ ~ 1 Z E,(~? DOH-301 (3/93) ~~' (PLEASE SEE REVERSE SIDE) Where to Apply for Record of Marriage 1. License Issued in New York State (Outside of New York Cityj Year of Marriage * 1880 to present Apply to: Certification Unit Vital Records Section P.O. Box 2602 Albany, NY 12220-2602 * 1880 - 1907 and license issued in the cities of Albany, Buffalo , or Yonkers Albany: City Clerk, City Hall, Albany, NY 12207 Buffalo: City Clerk, City Hall, Buffalo, NY 14202 Yonkers: City Clerk City Hall Yonkers, NY 10701 2. License Issued in New York City Apply to the Borough office of the New York City Clerk that issued the marriage license. The location of these offices follows: Manhattan - Municipal Building, New York, NY 10007 &ooklyn - Municipal Building, Brooklyn, NY 11202 Bronx - {Records for 1908-1913 are on file with the Manhattan office) 1780 C~and Concourse, New York, NY 10457 Queens - (Records prior to 1898 are on fits with the New York State Department of Health) 120-55 Queens Boulevard, Kew Gardens, Jamaica, NY 11424 Richmond - (Records prior to 1898 are on file with the New York State Department of Health} Borough Hall, St. George, Staten Island, NY 10301. PLEASE NOTE: Records of marriages in areas of the present City of New York, which were not part of the city at the time of marriage, are on file with the State Department of Health. NEW :~~ Y~t3RK STATE. ._,~ DRI ~'F R LICENSE t ID: 863,656 439' CLASS D , t . PATERSON'°`' t u1hAX,E 5~. . o~„ " T oowmi ' 1a tUIERRIMgt±,{Rp ' _:7GHKEEP$~ lI~V' 12603 ? IB~h$:0403:B8;,; ~~~,~ '5 02 MT Sa( ` VE p - . F E S.. E I+~NE ~'' ' .~~ ~,'? a R NONE. `,lac x-' ISSUED: 12-31-12 EXPIRES O4-0320 ovsasres~ w' ,, ~1.?:. NEW YORK STATE DEPARTMENT OF HEALTH APp6C8fI0D t0 TOWtI/City Clerk f0~ COpy Of MBrrleg@ R@COrd vital Records section TYPE ~F'REGORD QES~FiED'(Enter'>~1~,r~,ha~ .,f rr,~,:n~~ Search and Fee $~ o.oo Certified Transcript ^ pef ~ PY Search and Fee $t o.00 Certified Copy ^ per copy A Certified Transaipt is an abstract from the manage record issued under the seal tithe town/dty deck. It indudes the names d the oartracting parties ffieir A Certified Copy indudes all d the items d information ooatmng on the original d d , residence ffi the time the license was issued, date and place d manage as well recor the marriage. as date and place d birth d the bride a-d groom. A Cafified Copy may be needed where od d pr parentage aid certain alher A Certified Transai m be used as Nn ay prod thffi a manage ooatrred. ~~ informffiian may be required such as: passports, veteran's benefits , court proceedings, or settlement d an estate. Bridett3raom15pouse N (as recorded on marriage license): Date of Birth: .~, r~ .~ ~ ~~ C r:~~ v t«~~~~~ If Previously Monied, State Name Used at that Time: ~ Residence (at time of mamage): r~ ----- BrtdtrlCr00mtSpouse "" SIrM Name (as recorded on marriage license): n ~ Date of Birth: ~ arenty.» l 2-~ ~~i~v~- If Previously Married, State Name Used at that Time: Residence (at time of marriage): r~ ~. t..r sew. Marriage tnforrtiation Place Where Marriage License Was Issued: Place Where Marriage Was Perfomted: Marriage Certificate No.: Local Registration No.: re.n r roaw a Purpose for which record is required: Date of Marriage or Period ,,~ Covered by Search: In what capacity are you ac ng?: What is your relationship to person whose record is required? s..aa ie.r ' ('~ (If self, state "SELF.) Q (~ f"'~dd~~ ~T N~DP~~ ~/dd/wry) If attorney, give name and relationship of your client to person whose record is required: Signs of Applicant Date: Applicant's Phone Number. ~ ~ al, ~S - ~.~ ~ i Name of Applicant: Ple print name and address where record is to be sent: ~0.~~~' ~ YI.Q ~ ov~-~c `C U Address of Applrcant: ~~ ~~~.~~s ~ ~~ . ~ 2 ~ ~~ ~~ State ZIP City Stet. ZIP DOH~301 18/11) Pepe 1 012 ~ ~ NEW YORK STATE DEPARTMENT OF HEALTH vaat Records Section Application to Town/City Clerk for Copy of Marriage Record .TYPE OF'RECORD ~FiED (Enter dumber of Cc~:piss) Search and Fee ~t o.0o Search and Certrfied Transcript pet ~ ^ Fee $T 0.00 PY Certified Copy per copy A Certified Transcript is an ahstrad Tram iFre marriage record issued under the A Certified Copy indudes all d the items d information ooanrin on the seat d the townIdly deck. It indudes the names d the oorrtrading parties, their record d the marriage. 9 original residence at the time the license was issued, date and place d marriage as well as date and place d firth d the bride and groan. A ~~ Copy may be needed where prod d parentage and certain other A Certified Transai m be used as detailed irrfamation may be requaed such as: passports, veteran's benefits , Pt aY Proof that a marriage occurred cant proceedings, or settlement d an estate. Bride!(3r•oomlSpouse Name (as recorded on marriage license): ~ Date of Birth: , If Previously Married, State Name Used at that &ide/6roortrl~ourse Name (as recorded on marriage license); If Name Used at ~' (at time of O~ ~ ~-rc.r-c cy s ~ 1 ~~ ~ ~r sM. Date of Birth: ~~.~ [,~ ' /~ ~ f t Residence (at time of marriage): ~+ ~" `" ~ ( tom. ~+ l~~L a- T"TO ~ G~~ ~ ~ ~~ N Fh~ ~ N t*. iiAarriage tn# ant. .. Place Where Marriage Licen`se~Was Issued: Plat-ce1 Where Marriage Wa/s Performed: Marriage Certificate No.: Local Registration No.: ~lRPtasNGr7es ~L~S --'""`~Ff'tSS W6~PPywGcci'~-~IS ~~..~c.c-fe;s ~~ ~~l Tew~ ar 1 Tees a Purpose for which record is required: ~ Date of Marriage or Period 2 Covered by Search: SOruc1,' ~~CDar'-G~ Ibri~d an or In what S"ia11ri1°"r capacity are you acting?: What is your relationship to person whose record is requved? ~~db~l~ (If self, state "SEEP.) 2©p wt s..d-r~ tom-- ~ ~~a~ tiidei~ If attorney, give name and relationship of your client to person whose record is required; Signature of ice Date: Applicant's Phone Number. d Zvt-t~Q-Y/ ~/ ~~~- ~35~2y 2-5. Name o Applican : Please print name and address where record is to be sent: Address d Applicarttt ~_~ C~~r ~-~~ ~~ P~s~Gc,c s ~C ~s y o clry sere ZIP ary S~ ZIP DOH301 (8111) Pepe 1 of 2 Application to Town/City Clerk NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section for Copy of Marriage Record Search and ❑ Fee$10.00 Search and ❑ Fee$10.00 Certification Par COPY Certified Copy per copy A Certification,an abstract from the marriage record hashed A Certified Transcript includes all of the items of information under the seat of the Haab Department inctdes the names of axuriN on the original record of the marriage. the contracting parties,their residence at the lime the license was issued as well as dare and place of birth of the bride and A Certified Transcript may be needed where proof of groom parentage and certain other detailed information may be required such es: passports,veteran's benefits.cart A Certification may be used as proof that a marriage occurred. proceedings,a settlement of an estate. PLEASE PRINT OR TYPE Name (First) (Middle) (Last) Name (Fast (Middle) (Lest) m m Groom h^' 1J Zr,. Bride Groom's Age Bride's Age or Date oforDate of oar / lel (jl Birth o b o6/ Z Birth Residence (County) (state) Residence (County) (state) of °} Groom — Ll�<s5 Bride 1>'�c h is A^ Data of Marriage t Bride PrevfourJy or Period Covered Marded,State Name by Search 09 13 It 3 Used at That Time Place Where Place Where . License Was Marriage Was Issued 7o ou r o� w - Performed l \o For what purpose's information reuprired? What is your relationship to person whose record is regUaMad? If set,state%elf.' Ste\& In what capacity are you acting? If attorney: Name and relationship of your client to persons whose marriage record is required. Si :d 1 n / Date ress of Applicant war F (� Please print name and address where record is to be sent PlY:VA ,e o DOH-301 (3/93). (PLEASE SEE REVERSE SIDE) NEW YORK STATE DEPARTMENT OF HEALTH Application to Town/City Clerk Vkal Records Section for Copy of Marriage Record Search and Search and Certification ❑ Fee$10.00 Certified Copy 191PFaror o Per�' y oPY A Certification,an abstract from the marriage record issued A Cerfified Transcript includes all of To items of information under the seal of the Health Department,inckWes Me names of occurring on the original record of the marriage. is contacting parfies,their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groomparentage and certain other detailed infermabon may be required such as: passports,veteranb benefits,court A Certlfication may be used as proof that a marriage occurred. proceedings,or sealen rent of an estate. mmommmummum PLEASE PRINT OR TYPE Name (ensu) (Middle) (Last) Nemo (Faen ( si (Lffiq Groom STT sw/v l �iE EAV&f B de F IQRr%mv r( Groom's Age Bride's Age oillhta°' /0 -©6- so �°f 3 23-52 Residence (County) (State) ReSidenca (County) (state) Of Ov 1 A/`i 9 be r-c-kegs N Date Perioof d Card lo -- 1d- -7S ' /by Search Married.R Bride hat N /VG Place Where vt u lf- e o P T-o uj l/ Piece Where /.� Livens Was O(F WRAP/ry S F M��� {�UNTI44 rc� �� US Iisued !�S N Pertomsd CA/rI17-141e Toil1-04/6 For what purpose is informafion required? What a your relationship to person whose record is requested? C L CU ST gseg,atata'sell.' �L� In what capacity are you acting? If allMW. Name and relationship of your client to persons P c sef., /u YSP� wfta®e marriage record is required. S nt Das Address of Applicant Please prim name and address where record m to be sent cr ttA-w?e 0444 Srew0(kT 9We1v41P,p o0�6HlCeP�S(�i Ni 126x3-S6?9 Y H�duTGraenip �,q-.ve Oo()6'hKeedslE t/Y 12 3--5-697 DOH-301 (3/93) (PLEASE SEE REVERSE SIDE) i Application to Town/City Clerk V�RO��STSeT EPARTMENT OF HEALTH tion for Copy of Marriage Record Search and per copypy Search anti rf1--� Certification ❑ per copy Fee E10.00 Certified Cay, ISI i I Fee Li�l A Certification,an abstract from the memage record issued A Certified Transcript includes all of the items of inlornhation under the seal of the Health Department,includes bte names of occuninp on the original record of the marriage. the contracting partes,their residence at the time the license was issued as wel as dab and piece of birth of the bride ant A Certified Trarscnipl may be needed where proof of groom. parentage and certain other detailed inlormetion may be regtiad such as: passports.veteran's benefits.court A Certification may be used as proof than a marriage occurred. proceedings,or sef tenant of an eaters. PLEASE PRINT OR TYPE Neme (First) (Middle) (Last) Neme (Fiat) (Middle) (Lasa Of of GroomBride Groom'a a Bride§Age Bi Date of Bi Date of Birth Z Birth ZOq Residence (County) (Stab) Racitlence (CcunM (State) Of Of Groom Bride S Data of Marriage t Bride Previously or Period Covered Manied.Stats Name seeroh Used at That rune Place Where Place Where License Was Marriage Was Issued Penrenned Y For what purpose is information rewired? What m your relationship b person wi ose record m requested? rcoet,stabs%0.' In what capacity are you acting? rcatbrrsy: Name end rebtonship of your clientb panms whose menage record is required. Sior eofApp" Dab r of Applicant Ptsaee 'nt erM address where record is b be sent iO� H0n24w0\0()e motion PcL�ms�t Hyde, pox,N 1vv b loG to-eVwei Lone, DOH-301 (9/98) (PLEASE SEE REVERSE SIDS NEW YORK STATE DEPARTMENT OF HEALTH Application to Town/City Clerk fCopy Recorder Secfion of Marriage Record Search Certification ❑ Fee$10.copy Certified Copy ❑and Fe coyly 0 Per copy Pc+coPY A Certification,an abstract from the marriage record issued A Certified Transcript includes at of the items of information under the seal of the Hearth Department,includes the names of occurring on the original record of the marriage. the contraling pasties,their residence at the fime the license was issued as well as date and piece of birth of the bride and A Certified Transcript may,be needed where proof of poen. parentage and certain other detailed Wormebon may be required such as: passports,veteran§benefits,court A Certification may be used as proof that a manage occurred. proceedings,or settlement of an estate. PLEASE PRINT OR TYPE Name (First) (Middle) (Leap Name (Fast) (Middle) (Last) Of rr Qobc + O(Qh Bride uc j<,, cl. Groom's Age Bride's Age B�of gz � � gg B�of Residence (County) (State) Residence (County) (State) of Of Groom Bride Date of Marnage If Bride Previously or Period Covered 5 I s O I I q Married.State Name by Search Used at That Time Place Where PI8oeVfh0`0�Jth'l�' �r5 T ''� ' .�� Marriage was Cden is\a✓,d f Clk Ucensewas u3cL Issued Performed NC w R o cj--"�c For what purpose is information required? what a your relationship to person whose record is requested? if! t�l khV%elf.' � In what capacity are you acting? If attorney: Name and relationship of your client to persons whose marriage record is required. Signelum of Apptcanf Date Address of Applicant Please print name and address where record is to be SenL Uq (2-ed 4e- 1-1o\iow P-0c'd Waphtnc�ers Falls, M� IaSq � DoH-301 (SM) (PLEASE SEE REVERSE SIDE) NEW VORKS7ATE DEPARTMENT OF HEALTH Application to Town/City Clerk Vital Records Section for Copy of Marriage Record Search and Per cCOPWY copy 00 Certification ❑ copy �, Pah' Certified ❑Search and Pae A Certification,an abstract from the marriage record issued A Certified Transcript includes all of the item of information under the seal of the Hearth Department.includes the names of occurring on the original record of the marriage. the contracting Partes,their residence at the time the license was issued as well as date and place of birth of 0h bride and A Certified Transcript may be needed where proof of groomparentage and certain other detailed information may be required such as: passports,veteran's benefits,court A Certfication may be used as proof that a marriage occurred. proceedings,or sePoemmnt of an estate. PLEASE PRINT OR TYPE Name (First) (Middle) (last) Name (Fang (Middle) (Last) of nn of Groom k" J"- ` t' Bride 1''r-.•,c.,\(q Ufc.\ Groom's Age Bride's Age or or Date of Bnlhre� ob /O9/8Z Birth Residence (County) (Stet) Residence (County) (State) Of of Groom D r_y.«s All Bride Date of Marriage If Bride Previously or Period Covered Married,State Name by Search 09 � 13 113 Used at That Time Place Where Place Where License Was Marriage Was Issued Tow, of w Perfortred \ \o — be For what purpose is information required? What is your relationship to person whose record is requested? itself,state Ws ' Cnn., n( h^^9 ter, >c �Wi Z SQ-\ � In what capacity are you acting? If attorney: Name and relationship of your client to persons whose marriage record is required. Sig re oficaht � Date J (/{ Dir 130 I/ Address of Applicant Please print name and address where record is ro be sent `wood Crco! C,� l -v O? P ,x.VA h DOH-Wl (3/93) (PLEASE SEE REVERSE SIDE) Application to Town/City Clerk NEW YORK STATE DEPARTMENT OFHEALhI Veal Rewrtls Sedan for Copy of Marriage Record Search and Ce��atroon ❑ Fee copy Certifsd Copy 19 Fee 0PY Per copy Per coPY A Certification,an abstract from the meniage record issued A Certified Transcript includes at of the items of information under the seal of the Heath Department.instates the manes of occurring on the original rttord of the marriage. the contracting Partea,Net residence at the time the license was issued as wsil as date and Place of birth of the bride and A Contact Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: Pats, rts,vetermh's benefits,court A Certification may be used as proof that a marriage occurred. Proceedings,or settlement of an estate. PLEASE PRINT OR TYPE Ro Se�U Fe L,a Name (FW (Middle) (Lead) Name (FMQ ( e) (Lasd) Groom OCT-tw/vr McE.WN29P 10 . at t-Qkrimv Groom's Age //`` Bride's Age BiM�m /0 -06— SO &Date of 3 23-SZ rth Residence (County) (State) Residence (County) (State) Greem Dv N}' e de &rC,lrPss N Data of Marriage if arida Previously or Period Covered to — `! —7S— Married,Stele Name y by Search Used at That T" Piece,Where ucesewas V<cL/F6e BP Totd/j/ Marriage WasuvT�f/6Fv� �wNfEOUS Issued 06P W/f14to / S ala,N Performed 1t7/.t/T/.1/6TO L0416 :r�CUWd For what purpose's information rmation required? What a your relationship to person whose record is requested? !Qpultc CPCL)0P11-Y-/fdR/U19W0AZ taet,$tateW.• -�eLF In what capacty are you acing? If atortny: Neste and relationship of your client to persons 4P(?QGse/VTA/�' /t'�YSP-L� whose metdege reooM is required. S nt Data 7 — Address of Applicant I Please print name and address where record is to be senL cr tt&"0x4e SreW,,fKT 996--V4FY keep'sl Ni 1260 R H jWTLOA VP Gs{ Ale Gov6��eeds/E ,Uy lzGa3-5677 DOH-W1 (3193) (PLEASE SEE REVERSE SIDE) NEW YORK STATE DEPARTMENT OF HEALTH Application to Town/City Clerk Vital Records Sectiofl for Copy of Marriage Record rf�--� Search and ❑ Fee$10.00 Boesch and I� Fee$10.00 Certification per copy Certified Copy L.61 Per copy A Certification.an abstract from the marriage record issued A Certified Transcript includes all of the itsns of information under the 3"of the Health DepeMrent,includes the names of occurring m Cie original record of the marriage. the contacting parties,their residence at The time the license was issued es well as data and pace of birth of the bride and A Certified Transcript may be needed where Proof of gam. parentage and certain other detailed infIX bon may be required such es: passports,veteranb benefits,court A Certificaton may be used as proof that a nsmiage occurred. Proceedlrge,or eetnemaM of an asbb. PLEASE PRINT OR Name Name (Frac (Middle) (I.mry Name (Frei) (Middle) (two ofof Groom BrideUUMBILL I Groom's ge Bride's Age p� or Dab of or Date of ZZ�1 CJ`"1 Bits Birth Reeidenoe (County) (sate) Reeidxhce (Counts (stab) of of Groan c Bride S Date of Marriage It Bride PremusV or Period Covered Married,Sate Name by search Used at That Tbhe Place Where Place vvnene License was Mamege Wee Issued Performed / For what purpose is intonation required? What is your relationship to person,Whose record is requested? tact,abb'est.' CPIF In what capacigr are you acting? t atWW. None and relationship of your client b persons whose marriage record is required. S' reofAppicent Deb A dr of Applicant Please Orint and address where record is to be sent. wA Iton Iy poi U06 'Y mpmt' vl�oq, (()qit yweli Lof)e DOH4101 (9/93) (PLEASE SEE REVERSE SIDE) NEVJYORK SApplication to Town/City Clerk Vital Records Sectioecton DEPARTMENTOFHEALTH for Copy of Marriage Record Search and ❑ Fee Search u ❑ Fee AdCertification Per COPY CartifiadC � PWCOPY A Certification,an abstract from the marriage record issued A Certified Transcript includes a1 of Ne items of inrormation under the seal of the Health Depertrnent,includes the namea of occurring on the original record of the marriage. the contracting partes,their residence at the time the license was issued as well as data and place of birth of dhe bride and A Certified Transcnpt may be needed where proof of groom, parentage and certain other detailed information may be required such as: passports,veteran's benefits,court A Certficabon may be used as proof that a marriage occurred. proceedings,a seNemam W an estate. PLEASE PRINT OR TYPE Name (First) (Middle) (Lasa Name (Final (Middle) (Last) Of Groom '�Jnfr Robe} O(Q�, - ends �r n Suc �Ce ed Groom's Age Bride's Age or Birth gl2o gg ei�� Iy gI �6 Residence (County) (Stare) Residence (County) (state) °Groom 'Bride Date of Marriage If Bride Previously or Period Coveredrj I30/ 14 Married,Stare Name by Search Used at That Time Piece Where777,-77;7 fC Ucesewes � �p1ne� ecs M as Issued Performed New R o cl-r J e MI For what purpose is information required? WTat a your relationship to person wncee record a requested? tact.s�be,,•self.• —tt� CC.L�v-hAwrC' Se_ 1 k In what capacity ars you acting? If atarney: Name and relatorahy of your client to persons whose marriage record is required. Signature of Applicant Dare Address of Applicant Please print name and address where record IS b be sent 6,4 (2-2d Waplptnc)1 �s I s, N'� IaScj� DOH-sot (3193) (PLEASE SEE REVERSE SIDE) ANEW YORK STATE DRIVER,:LICF.NSE ID: 127222 482 CLASS D �MNNEDY - �' -� 9RITfANY SUE . HA 0 OB 14p! E W ETES EI,`NY 6OB E NDNE a u. '`Y ✓d^ IQUW.W 1-12 EV:RE O&10.17 pryp {yl 4: X, NEW YORK STATE DEPARTMENT OF HEALTH 1- 5-96 / o G L/ Vital Rema seam Appkcation to Town/City Clerk for Copy of Marriage Record 7TWmaTYPE OF itECORD DESIRED(Ental'Number of Copies) o and ❑ Fee$do.00 Search and d Transcript Per COPY ❑ Fce$io.00 Certified Copy Per COPY raseipl is a dW 1r,m the aariage rand idred under the p ydty deck tt indudes the n,,,,d Me cm"*g Parties,Char remN j*m Copy uaMcsal d tlx•deme of adarmal,on rcmmmg m the m" tla timematimneM Swed,dale arid*mofmaria mwd lata d hunt adze britlA CoMW COPYmay be needed where proof of paemage e d Carton awr aleapl may be USM rpraof theamanye orasred. etre aeBda%P�ea. 'veterans bmft, n raOMMPMN Narne(as recorded on rrentage license): _ Data of Birds: If Pra W$fy Married, Sfate Nemo Resitlence(at fine of manage): wr Name as on manage license); ' Date of Birth: hMarrMaw,.s,r Z�V W O Reviousty Married,State Name Used at that Time: ��' ReaitlerKe(al time a manage): Martiagwinfarmetloa � er Place Where Mamage License Was Issued Place Where Manage Was Ptalamed: Marriage Certificate N RW ,.: LocalRegistrationNo.. T. Teww Purpose fa which lemrd is regWred: Date of Marriage a Period Covered by search: In wtert phare you acting?: Wtrt is Ysarelaemmip to Par,,W,,,Mcord 6 mWwW9 swr+s.s ti\ �� C�C( Need.ste►'SEU'J 10ir.waet If attorney,give name and relabaahtp or your diem to para,,wtpse reoad is re($lired: B mAPPacow ate: Appticam's he Number. Name of Applicant Uy� jam— �J 1 O ). Please prim name and addrera where temm is re be sem; 7a Ga -zoo2rerem Wr�Applim. , s �\ C C E D,F{em lwnl Ppa 10 2 &ea ap NEW YORK STATE DEPARTMENT OF HEALTH Application to Town/City Clerk Vital Records Section for Copy of Marriage Record Search and Search and Certification Fee$10.opy Certified Copy Fee$10.00 ❑ Par copy Per copy A Certification,an abstract from the martiage record issued A Certified Tranvcript includes at of me items of information under me seal of the Heath Department,mcWdes me names of occurting on the original record of the marriage. me contraCting Parties,tie's residence at me time the license was issued as Well W date and Place of birth of the bride and A Certified Transcript may be needed where proof of groom' Parentage and certain otter detailed infarmetion may be required such es: Pemports.veteran%benefits.court A Certification may be used as proof that a marriage occurred. proeeedngs,or settlement of an estate. PLEASE PRINT OR TYPE Name (First) (Middle) (Lasq Name (Fn 11 (M1: a) (Loan of Groom Bride Of LaRI 1> C06 P• "Detect ge Bride§Age 1 z Lt CA or Date of 10/05 Birth Birth Residence (County) (Stare) Readence (County) (State) Of of Groom DJ TCK%55 IVy Bride OJTCirt,SS (U Date of Marriage or Period h Covered Married,Stale Name L'A -1 N k SearcUsed at That Time Q Place Where Prete Where License was WRPPlN GC2 Marriage Was Issued Performed WPC PPI N�,2 For what Purpose's information regrdrsV 1Nhat o Your refetiorrehip to person whose record's v requested. I ✓lM h ti 2 ATL O r� teat,soMe•self.• LIF In vest capacity are you acting? t allonney: Nerve and relafiorehip cf your client to persons whose marriage record it;required. SigmtumafAppkwt Daae _ Address of Applicant - Pl�se print name and address where record M to be sent, 6 Py�� ti WpPPIn � FA is Ny 12Sti6 DoH-sot (am) (PLEASE SEE REVERSE SIDE) h - ID:109 070 617 D013:1244-62 COSTAANDRE,M 145 VALENTDIE LANE YONKERS'4�._}�Y 10705 5EX M EVE6 BIP HT: S10 CLASS D ISSUED 11�1O0.t E IAES'.1T1b11 624b3; y A 4''i NEWYORK STATE DEPARTMENT OF HEALTH Application to TowniCdy Clerk for Copy of Marriage Record Yawl Reines Section TYPE OF RECORD DESIRED(Enter Number of Copies) Search and ❑. Pae$f Y Search and � Fee$to.00 Candied Transcript per COPY Certified Copy per COPY A Goblet Transcript is an Antract fan are manage remd MEW water the A Gabled Copyindudes all of the Aare A infameDm oaamng m the myna seal of th madaty dark it includes the nacres dare cantreclag parties,Ica record dee manage. merdenm at the ure ate know was meq date and play of manage wd as date and place of birth dee Mile and gmn. A CwNed Copy may be needed where prod of parsonage and aawin other darted edcrrnman may be required axh as pewpoa, sehean's bemNa, A Candied!Transcript may be used as Pod that a manage occurred. Out pmmedngs,a~aa of an estate. Bridel6raoml5pousa Name(as recorded on maniage license): Date of Birth Rr A/lI / MwerrGrarrOrpaa<y 4r Ops 'acre O4»i< 1 W n,A-0m 21,16ar040inall If Previously Manior,State Name Used at that Time: Residence(at time of mamaga rt �. l.. w /2S2 Qf<Ress &a NY &idelGroomiSpourm Name(as recorded on m mage license): Date of Birth: awe a w a54 CE_ ratan eSS 4EA liver f f scat If Prevtousy arcme ed,State NaUsed me: Rppdeoce$aiAl r�oi,cram . AP{C tzsG y' n 8- Rr MEAN, Nr I.0 ALSf ar. Msrriaga monnation Place Where Maniage License Was Issued: %ace Where Manage Was Performed Marriage Gerd is No.: Local Registragon No.: Px.rrl /Ma.al ur_ ;, afkea T..._ , .A Propose for whit record is mWired: Data of Marriage or Period H Covered by Search:rl�lQ f1LM G C C wilA costal AV In what capacity ere you acting?: WhatarYour'SEeorehpwPerson,waroea recall rsrerpred7 1.aieaimw (If self.sfab'SEIF.) arae s S er1G.� SG If F•_.:,..:, hr.lxx/mw If attonrey,give name and relationship of your client to person whose record is required: Signature of Applicant Date: 5Y(4Y;ay A card's Phone Number. _ ,- 895- 905-2797 Name of Applicant Please print name and address wham record is to be sent A ress of AQpppppplllicant / �II` tsO1i if 4 G+}.r./G /#Oar'F�'*ert h.5 01 oar sure ZIP err sin nP Dokadl tan)P.A.10 2 Application to Town/City Clerk VIS RecorrddS action EPARTMENT OF HEALTH for Copy of Marriage Record Search and G ❑ Fee$10.00 Search and copy ® Fee$10.00 Certification per copy Per copy A Censfica mn,an abstract from the manage record issued A Certified Transcript includes as of the Herne of information under the seal of the Heallh Department,inchdes th narnes of occuneg on the original record of the unamage. Me contracting parties.Meir residence at the time Me license was meed as well as date and place of birth of the bride and A Certified Transcript may be needed where proof W groom. parentage and certain other detailed mfammaon may be requwad such es: passports,veteran's benafib,court A Certification may be Lad se proof that a marriage occurred. proceedings.or settlement of an estate. PLEASE PRINT OR TYPE Name (First (Middle) (Last) Name (First) (Middle) (Last) Groom T k) ec1 Of afire Whee �� Groom's Age f��J Br�b Age oor irDDate of q - 9 — a -( BSMG d 2 Residence (County) (Sorrel Residence (County) (Sulu) Of of nI� Groom S-S NY Bride rJllG�2Tr A) Date of Marrege If Bride Prumusly or Period Covered _ , / Z me Married.Stale Na bv$�, Used et That rune Pima Where G Placa Where IssuedWas lt/ /h gds Fal(s N aemmpa' For what purpose is intomu6on required? Whar a your relationship to person whose record 6 requested? sulks aa� mlu'self.• X1571 ,, rye m �Rrr�a�f Ifaeh.a " In what capacity ere you acting? If atlo nay: Name and relationship of your client to persons w hose manage record is required. SofA scare Data /4/&4Q A cess of Applicant Pleesa print name end address where record is to be sent. (R / zq d'ow /a. I�GAGa,j tiY /L 548 DoH-sol (s/an) (PLEASE SEE REVERSE SIDE) Y10RK STATE DRIVER LICENSE ID: 594,865 687 CLASS D WHEELEN _ STEPHANIE,(HH 1.APPLE9AUN"E WAPPING Eq$F 12590 DOE: 02-2686 -' SIX F EVES Xq W 5p1 E'. NONE 9 NONE a ¢�"-•.•. I$$pEO fi4}12 SJIaES 02.3415 nsmvwe S Application to Town/City Clerk NEW VOW STATE DEPARTMENTOFHEALW for Copy of Marriage Record vW Rama Sacbn Sercb end ❑ Fr S10A0 fC"bWewch co CnEF� CwlTied Capy Pff Pa oapl' A Cseficawl,en abetrea trapMmertspe r xd leerd ACmffed T.wrldpt WWkA"rofwitrwufifam+fon WdWOn"M of the HWlb Deprwwnl mkida fwd as '"O alfw al'Di faded offamrmge. tliacafweofry Padiee.fni red0elce o fw fms M fowee wriruadrwefrdoe,Wpk otblffriaffobddeend PEN mW=No alm doweled WOMMOM my 6e 9O - feq.W ouchm prepofw.vowel's OenefY.coot ACwffcefonnmNbeu"dspmoframwrieB•socarred. p�eceedllOe.a'e'lanem 01mestm. f+LEASE PRINT OR TYPE N� (Fj� (Mjdy) 1�) Name (Fisq (/MIiddle) /SAe9 I� of // 1/ V (jfaan C�Gr ( T�' oO-� 4K�Owsl'� B,;da L0.MWWSN Ofoom'sAaa WDeeede 7 'f(61 a Doeor R/� /c;3 am Bkh Residwlce (Cary) Rddwm (Cain) (Sme) T 18MtH cdYaam Nom'{-c�n eSS N � Beide d2C��aJz o� vem gla(�14Y8 MarocLOMONWO n/�A germ Wed ftTlwtTM r I PYrYVhwe twill S "' T Pmfunned t eyvr tJcapp n315 l(S NY WaaWae Wcpp ;,y< < s i rw ea Fawhw papoee w inknrfal fequind7 1Mw1'syaa nfffafdtV b PweO^"'fes mcaN ie faqurbdf fast.Mele'eeL' InwlvfrprdYerycu~ fagafwY• NemeafelfMolaaHp ofyw cfempPMeau wlnr mwdepa naald'srequ:ed. h DaW FL--.)ft 'l 1'7 Zo(4 Pdld flenwee .We=efwfemmfd w b m ewf.�K"�"+r� O wGpp 5 1_ 5 s ilei DOH-9071S/O8) (PLF SEE PEVOWE SDE) NEW YOPK STATE DEPARTMENT OF HEALTH —1 Vaal Reowd:Semon Application to Town/City Clerk for Copy of Marriage Record TYPE OF RECORD DESIRED(Enter Number of Copies) Search and ❑. Fee $10.00h and Fee$10.00 Certified Transcript per cfied Copy percopy A CaGfied Transwipt is at absaad from the mar aps m owd issuedbe0 Cnpy irWltlrx dl d ere items d imemabw ooumft on theseal dewawNary clerk It timdWes me narm.dmecmtracpa9 Pdtlre mesiege. 9 ogndre9derlce at th time ere hOsMis Was mu ed.date and dare d marrias date and place d birth out bride amd goon. red Copy may be needad where prod d paeaapeand teem other A Certified Traaripl may be and as prod maga d YdormeXon may be required sut,as: =via berefils, manage ocmred. ow"prereOCIMP,Or marmot of an estate. Snde/Groom/Spouse Name(as recorded on maniage license): Data of Birth: C5 p rwy.ww..N�r�y a.r If Previously Maimed,Stare Name Used at that Time: Residence(at bme of ma age): E(asmrr eam. yN i " corded a o^al Dw�e rCSS sew �/>' marriage license): Data of Birthwss. ..N.. /d pBsis Name Used at that Time: Residence(at tlme of ma a11ge):ear.. CYP�� W r7c�7We5S ..w Y rad Marriage warnation Plats Where Manage License Was Issued: Place Where Madage Was Performed: Manlage Certificate No LocalRegistrationNo.: P,- 4 T... ) Pumpose for which record is required:: Dam of Marriage or Period Jc90 U" a �I 2 �O LVlS4 f� fly CCi=M;Search: In what capadty ata you acting?: Wht w yew resaonatmp b pemsan vRmose recetl a required) Assisi,11� (7 S 03 (Itself,ssb'SELT-.) !• rt G7U $(x�Cl or m r��10� Htut» If attorney,give name and relationship d your client to person whose raced is required: Sign97MPApplicald Date: Appbcarl's Phone Number. 32Wh& N e � �.+- Please pri�m name and address where record is to he sem: r is r ry Fir �abi�1 � n / r 'k/ d Address dA 5` % rR'blVt LcznP t0 Shb aP UY yyy ZIP Rise t o@ NEW YORK STATE DEPARTMENT OF HEALTH —1 V"Ramrds seam Applkation to Town/City Clerk for Copy of Marriage Record TYPE OF RECORD DESIRED{Enter Number 7Copies)Search and ❑ Fee Et O.00 Search andCertRed Transcript per , Certttied Copy ❑ Fee Sto.00A Ceatied Tra ism Par COPYseal d are W ahueq frau the manage remrtl sued rnrder the A Carded Capyndrdes atmaom oarmnng m me moriamWWIdY dark itmtludes Ne names dam offlar gPadea dxa readddxmanags,reedma a de dine the eoensewa iaaned.date ay pax d Miep asWNas date and plate of birth of dx aide and gman. deliCOPY m 6e ned paredage antl mnein dherA Cerddetl Transcript may are usedasprodMatamanegeaoorretl. maY :plass_ vdaran's bersatcourt Proms,a sedan Bride/Groom/Spowee Name(as recorded on manage license): Date of Birth rata hreprrrreenyy C� lar. /�aH�SI If Previously Marred, State Name Used at that Time: Residence(at time d manage): iti syr � Bride/GroomiSpouae a.r Name(as recorded on manage license): Date of Birth: Meprr..r�nry rr syr, W If Previously Marred, State Na rre Used at that Time: aio� Residence jai time of manage): _ IW gyre yy Marriage Information Race Where Manage License Was Issued: Piece Where Marriage Was Peifomyd: Marriage Certificate No.. Local Regrseeson No.: /d..at Pra..w Lfiver Purpose. Whl IS retpllfBd: Date of Mardage a Period Covered by Search Ird.Imr In what capacity am you ecdngl: What IS YormWotiahq to Pasco Whose record is mWweo (d and.state'SELF-) s--]T hrWredymq If attorney,give name and relationship of your client to parson Whose record is gad F�r+s�y9 ~r1°rte rera Signature of Appicant Data: Appdmnrs tone Num r. ► --, Name o1 Applicant — ;� Besse Print nems and address where record is to be sent: fJr CaviP M —) � _ .. 0 Address dApplrcarm Si- °qj ave aP DoltmlrOf1)Pee.hof 2 � 6W ZIP NEW YORK STATE DEPARTMENT OF HEALTH Application to Town/City Clerk Vital Records Section for Copy of Marriage Record ININNEW Search and Search and Certificetion ❑ Fee$10.00 Certified Copy '� Fee$10.00 Per copy Icy copy A Certification,an abstract from the manage record Issued A Certified Transcript includes all W the items of information under the seal of the Health Department,includes the names of occurring on the original record of the marnage. the contracting parties,their residence at the arm the license was issued as well as data and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed'nfonnabon may be required such as: Paeeports,veterans benefits,court A Cerfiicaton may be used as proof that a marriage occurred. proceedings,or setlanrent of an estate. PLEASE PRINT OR TYPE Name First) (Middle) (Last Name (Feat) (Middle) (Last) dof Groom �t'Ll(1 Bride Q Groom's Age (� Bnde'a Age Birth or to of WCyl / p l� O or Date of A �� Birth J Residence (County) (Stere) Residence (County) (State) of - W �xr r e Groom 1 Bade Date of Marriage If Bride Previously or Seriodars Covered 1„ m\ Y rao` u� t ry�e b Search !C '=C. Place Where Place Where, License Was Marriage Was Issued ll Performed For what purpose Is informaton required? What's your reletlonshgh to Parson whose record is requested? faef,statew.• 5�1� In what capacity are you acting? If afomey: Name and relationship of your client to persons whose manfage record is required. Sign=,,,, Z Data Address of Applicant Please print name and address where record Is to be sent 3)- Nh ilcresf Cu" - 3a " co� `uVCCW1 J&-� W� , I�� Fps lasso DOH-301 (31W) (PLEASE SEE REVERSE SIDE) • NEW STATE rows srDEPARTMENT OF HEALTH Meal Records TATESection Application to Town/Cdy Clerk for Copy of Marriage Record TYPE OF RECORD DESIRED icnVer Number of Copies) Search and �. Fee ato.00 Search and Certified Transcript per copy Certified Copy ❑ Fee$ta.00 A Ceahm Trac per�y sea of me town/ary dak It�aesOes note names"mono rage redid iswee antler me A Caddied Copy includes ad d the cans o(irifam�m acummg an the aegnd resderm a the cone me fcaee wes 0°o,d me Dallas.Ihar reMdama menage. as date and pare d birth odea bride and groan. � oma top as weer A Cerehe1 Copy may aY needed where proal d Parentage and conn aper A Canned Trarrsoipt maybe used es prod mmemadegeamxred, �mr'rrn maleentafan set,as:paspots, waear's bmefia, praomdrtgs,a selaemmt dm estate. &Id Spouse Name(as on marriage liconse): Date of Birth: NvC�pAU\ �C � >YYI��NMYW Mae, If Previously Marred,Stale Name Used at that Time: Residence(at time of damage): r..r Mae, Name(as recorded o mage license): Data Bi a a raw If Previously Marred,State Name Residence(at time of marriage): manmp ktfom"w +w Place Where Manage License Was Issued: Place Where Maniaga Waa Performed: Manage Certificate No Local Registration No wawa Purpose for which record is required: Date of Marriage or Period Covered by Search: vs . alwi,aw,w In what C3p8Clty,am you acting?: What is your Iolabi person wllabe remm is required? sed iew C \� (IfseH,slate'SELF.) C� If attorney,gmname and relationship of your client to person whose record isP—O~e0"p repo ed: gnsWre of A t Date: � Applicant's Phone Number. ` t\ Naaame�of Applicant _ Please prim a and address where record is to be sent: _Awc��e�_ �Cdvcy \C��vvcv �Cbvew Address m Applicant son DPI h17,01011)Pea.l of 2 Sbl. PP 1 1 Hl rJ, DRWER 1 ICL+ NSE s ID: 854 871 583 CLASS DM THOSETN �L NICHOLAS W BMNOV LANE WAFFINGEBS FLS W/3SS0 008: 07-1338 .L Sp Y EVES.IN NL 60.1 E: NONE P.. NONE ��/� ISSOE60C#W EYPIflES,O]-tAIE RmxnWS 3+ °.•. ` 1 P L ' 3 tb.x �