100
+
!z
w
en
w
III
o
-'
~
o
:z:
en
z.
o
~
~
a
w
a:
w
(!l
0(
if
a:
0(
::!
u.
o
W
f-
0(
C,,)
IT:
~
w
C,,)
w
a:
w
~
en
en
w
a:
o
o
0(
Ci:
13
w
0..
en
t-
:>
<C
c
wi!
ClI.L
-c(
~
()
w
en
z
w
0
:i
+
ii~~ W
~3:~ ....
a:~_ <C
~~~ (,)
~C,,)w
::!(!l5 u:
!z3!:en j:
~~~ a:
tEO(/) w
Of-> 0
w~C3
1-05'4')
~~3!:
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Kenneth C Trainor
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYfTOWN Wappinger
~~~~~c: 1368 '
~5~I:J~R 100
1. A, FULL NAME
FIRST
0-
N
B, BIRTH NAME, IF DIFFERENT
C, SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 11 0 62 7612
0, SOCIAL SECURITY NUMBER --
2, RESIDENCE A NY R Dutchess
(STATE) (COUNTY)
C, CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Fishkill
0, STREET ADDRESS 5808 Boulder Way ZIP 12590
E, IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES '6 NO
09 / 27 / 1963
MONTH DAY YEAR
3, A AGE 45
3B, DATE OF BIRTH
4, EMPLOYMENT
A, USUAL OCCUPATION Outside Field Tech.
B. TYPE OF INDUSTRY OR BUSINESS Verizon
5, PLACE OF BIRTH Poughkeepsie. New York
(CITY, STATE / COUNTRY IF NOT USA)
6, FATHER
A. NAME Kenneth G Trainor
B, COUNTRY OF BIRTH USA
7, MOTHER
A, MAIDEN NAME Vera McClarion
R COUNTRY OF BIRTH USA
8, NUMBER OF THIS MARRIAGE 3
9, PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
2 0
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C, DATE LAST MARRIAGE ENDED? 06/ 15 / 2007
MONTH DAY YEAR
D, ARE ANY FORMER SPOUSE(S) ALIVE? [YYES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
07/21/1995 Goshen. NY L'1
06/15/2007 Poughkeepsie, NY cf
DEATH
o
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL YI
I
L 0 SUPPLEMENTAL FILE
-.J
FROM THE BRIDE
11- A, FULLNAME FIRST KeUI~~tnn Chidi~U~RENTSURNAME
B, BIRTH NAME (MAIDEN NAME), IF DIFFERENT Leeman
c, SURNAME AFTER MARRIAGE Trainor
(OPTIONAL - SEE REVERSE)173 58 2357
0, SOCIAL SECURITY NUMBER --
12, RESIDENCE A NY B, Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY!"i TOWN 0 VILLAGE
~~~CIFY Fishkill
0, STREET ADDREss5808 Boulder Way
ZIP 12590
DYES tJ NO
A964
YEAR
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13, A AGE 45 3B, DATE OF BIRTH 07 AJ7
MONTH DAY
14, EMPLOYMENT
A, USUAL OCCUPATION Dental Tech.
B, TYPE OF INDUSTRY OR BUSINESS Dental Lab
15. PLACE OF BIRTH New KensinQton, Pa
(CITY, STATE / COUNTRY IF NOT USA)
16, FATHER
A, NAME Ronald Leeman
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A, MAIDEN NAME Sandra Lee Artman
B, COUNTRY OF BIRTHU S A
18, NUMBER OF THIS MARRIAGE 2
19, PREVIOUS MARRIAGES
A, NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
DEATH
o
B, HOW DID LAST MARRIAGE END? (3) 6 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C, DATE LAST MARRIAGE ENDED? 12 / 24 / 2008
MONT~ DAY,' ~ YEAR
D, ARE ANY FORMER SPOUSE(S) ALIVE? LJ 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
12/24/2008 Poughkeepsie, NY 0 r:1
o 0
o 0
o 0
I impediment exists
o 1ST
o 2ND
o 0 3RD
o 0 4TH
wledge and belief that the information I provided is true and that I
,
NAME (PRINT)
SIGNATURE~
DATE 09/02/2009
by New York Domestic
U
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
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) John C. Masterson
TIME MONTH YEAR
SEAL SIGNATURE ~. DATE
'-v-I MAI~~ ~~WaaiS
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND '
PLACE INDICATED,
MONTH
YEAR
12:51;~ 09
2009
',11
01 2009
03
28. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTY P tt-f-t.A~.:;
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF IZJA'OWN OF 0 VILLAGE OF
SPECIFY e u s.,.. F: f; I, k{ ( (
NAME (PRINT)
SIGNATURE"