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COUNTY Dutchess
CITY/TOWN Wappinger
DISTRICT 1368
NUMBER
REGISTER 71
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Robert F Stockwell, JR.
MIDDLE CURRENT SURNAME
CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Jessica Ann Ferris
-.J
1 . A FULL NAME
11. A. FULL NAME
FIRST
FIRST
MIDDLE
0-
N
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Stockwell
(OPTIONAL. SEE REVERSED74-70-3027
D. SOCIAL S;viB" NUMBER
12. RESIDENCE A. B. F redenck
(STATE) "'- (COUNTY)
C. CHECK Ol\lf d 0 piTY 0 TOWN 0 VILLAGE
AND t-re enCK
SPECIFY
90 VVaverley Dr.
D. STREET ADDRESS
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSEJ099_72_2537
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A MD B. Frederick
(STATE) J... (COUNTY)
C. CHECK ONE 0 CITY U TOWN 0 VILLAGE
AND Fd'k
SPECIFY re enc
D STREET ADDRESS 90 Waverley [Jr.
~1(u2
ZIP
>l
YES CJ NO
/1980
YEAR
21702
ZIP
~
E. IS RESIDENCE WITHIN LIMITS OF CITY ORINCORPORA(jD VILLAGE)- 0 Yj984'O
13. A. AGE25 3B. DATE OF BIRTH 6 4
MONTH DAY YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
3. A. AGE 28 38. DATE OF BIRTH 09 /27
MONTH OA Y
4. EMPLOYMENT
A. USUAL OCCUPATION Administrator
5. :~::~;:I~~:URrdh~B3~dSS Taconic
(CITY. STATE / COUNTRY IF NOT USA)
14. EMPLOYMENT .
A. USUAL OCCUPATION Lab Assistant
- . .. . . laconic
B. TYPE OF IND4S.TAY OF.lhIilUSINESS.' ",
15. PLACE OF BIRTH t"oug KeepSle, ,...y
. (CITY, STATE / COUNTRY IF NOT USA)
16. FATHER .
A. NAME Howard Edward Ferns
U,SA"
B. COUNTRY OF BIRTH
17. MOTHER
6. FATHER
A. NAME Robert F. Stockwell Sr.
B. COUNTRY OF BIRTH USA
7. MOTHER
. A. MAIDEN NAME Maria Palmieri
8. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL AN~ULMENT
Louise Ann Ehrets
A. MAIDEN NAME S
U A
B. COUNTRY OF BIRTH I
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES .'
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D~ORCE CIVIL A~ULMENT
DE6TH
DI{j-TH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
(3) 0 DIVORCE
(3) 0 ANNULMENT (2) 0 DEATH
/ /
- YEAR
B. HOW DID LAST MARRIAGE END?
C. DATE LAST MARRIAGE ENDED?
MONTH OA Y
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
1ST 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
4TH 0 0 4TH
I duly swear/affirm, depose and say, that to the best of my knowledge and belief tha1 the information
as to my right to enter into the marrrage state.
21. SIGNATURE OF GROOM~ V a
SE
23. SUBSCRIBEO AND SWORN TO/AFFIRMED BEFORE ME
SI,GNATURE 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 perlorm 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 OF.! CI C E~K 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT) .
o 0
o 0
o 0
o 0
edimentexists
by New York Domestic
,-A-..
{ SEAL }
"-v-'
07/13/2009
DATE
Is, NY 12590
YEAR
09
11 2009
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INOICATED.
STATE
27. TYPE OF CEREMONY
o 'fii RELIGIOUS
9 0 OTHER. SPECIFY
ZIP
10 CIVIL
28. PLACE WHERE MARR1AGE OCCURRED
A. STATE NEW YORK B. COUNTY Ou..-td1ess
TITLE
M In i;5+ ('I'
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF JiQ TOWN OF 0 VILLAGE OF
SPECIFY vJ C. R"i '(3.Q. r
(1 h .0 -' Ou.~
ZIP
NAME (PRINT)
SIGNATURE.
DOH-98 (03/2006)
\in
31. WITNESS TO CEREMONY
Cr~'~ Uw...,e.~:/:"
SIGNATURE. ~
NAME (PRINT)