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COUNTY Dutchess
CITYrrOWN Wappinger
DISTRICT1368 '
NUMBER
REGISTER 1
NUMBER
:s I A I t: Ut"' Nt: VV T UM'"
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
William Gregory Abraham
MIDDLE CURRENT SURNAME
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Cathleen Margaret Darby
.J
1. A. FUll. NAME
11. A. FUll NAME
FIRST
MIDDLE
CURRENT SURNAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE>118_66_4870
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. NY B. Dutchess
(STATE).L (COUNTY)
C. CHECK ONE 0 CITY'U TOWN 0 VILLAGE
AND W .
SPECIFY appJnger
D. STREET ADDRESS 6 Pnmrose l;ourt ZIP 12090
ol
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES f9~O
3. A. AGE42 3B. DATE OF BiRTH 01 /08 / 8
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Manufacturina Management
B. TYPE OF INDUSTRY OR BUSINESS Foun ry
5. PLACE OF BIRTH Port Chester, Ny
(CITY, STATE / COUNTRY IF NOT USA)
B. BIRTH NAME (MAIDEN NAME), J.F plFFEllENT
Aoranam
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE" ~\:l-oo-ll/::>
D. SOCIAL SIiiCJJ.fVrv NUMBER D t h
NY U cess
12. RESIDENCE A. B.
(STATE) ol (COUNTY)
C. CHECK QI'jj:, 0 CITY 0 TOWN 0 VILLAGE
AND vvappJnger
SPECIFY e; PrirnJo~~ Cuull 12590
D. STREET ADDRESS ZIP
or
E. IS RE~~NCE WITHIN LIMITS OF CITY OR INCORPORATf~VILLAGE?').9 0 YIil'~~O
13. A. AGE 3B. DATE OF BIRTH L... ~
MONTH DAY YEAR
14. EMPLOYMENT
6. FATHER
Administrative
A. USUAL OCCUPATION Mid Hud~ull Flour & 'v\!C:l1I
B. TYPE OF INDl,IEgRY QR IiUSINESN
IVlannauan Y
15. PLACE OF BIRTH '
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER M rt' J h D b
A NAME a In osep ar Y
, USA
B. COUNTRY OF BIRTH
A. NAME Leslie Roy Abraham
B. COUNTRY OF BIRTH England
7. MOTHER
17. MOTHER C th' M t f'tz Id
a enne argare I gera
A. MAIDEN NAME USA
B. COUNTRY OF BIRTH 1
18. NUMBER OF THIS MARRIAGE
A. MAIDEN NAME Judith Ann Hubner
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
DE6TH
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D~ORCE CIVIL A~ULMENT
D11TH
9. ~~~~~~~R~'f~~AE~8us MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT 2BOSOEATH
C. DATE LAST MARRIAGE ENDED? 09 / 19 /
MONT~ DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? [J YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY. STATEICOUNTRY, IF NOT USA) SELF SPOUSE
1ST 09/19/2008 Poughkeepsie, Ny ~ 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
4TH 0 0 4TH
I duly swear/affirm. aep'ose and say, that to the best of my knowled e and belief that the information I provided Is t
as to my right to enter Into the marriage state. h
21. SIGNATURE OF GROOM~ 22. SIGNATURE OF BRIDE~
USEC
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage In New York State of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license Is to be used only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) Jo C, Masterson
{ SEAL SIGNATURE~ DATE 01/11/201 TIME MONTH YEAR MONTH
L- -J MAI~~~r~aiS ush Rd, Wappingers Falls, NY 12590 AM 01 12 \2010 03 12 2010
-v- 12:23pM
STREET CITYITOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 28. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY ~
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE TIME DAY YEAR 0 0 RELIGIOUS 1 IVIL
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
YEAR
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. -.~ YEAR
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
..
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o
o
o
YEAR
28'. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUN.;:d)\l.Tttfctr
C, LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /
o CITY OF 0 TOWN OF t!!l'vILLA~~ 6.
SPECIFY IAJNJP.~ \~ ~
NAME (PRINT)
SIGNATURE~
'o~'v\0J\