069
USE CURRE
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFE ME
SIGNATURE ,?F TOWN OR CITY CLERK ~
This' license 'authOrizes the marriage in New York State of the bride and . groom named above' by any person
Relations Law ~11 to pertorm 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 (PRINn John C, Masterson
TIME MONTH YEAR
SEAL SIGNATURE~' DATE 07/10/2009
'-v-I MAI~oGMida~S ush Rd, Wappingers Falls, NY 12590
STREET CITYrrOWN STATE ZIP
~~~R~~RT~~J 'o~O~:N~Z:~ 26. SOLEMNIZATION OCCURRED 27, TYPE OF CEREMONY . /
SONS NAMED ABOVE ON THE TIME MO, DAY YEAR 18""CIVIL
DATE AND AT THE TIME AND
PLACE INDICATED,
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:SlATE UF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Pp.tp.r Mi!~P"'p.s SnY~~~RENlfsuRNAME
COUNTY Dutchess
CITYrrOWN Wappinger
~~~:~c: 1368 .
~~~~~~R 69
1. A. FUUL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SE E REVERSE)
D. SOCIAL SECURITY NUMBER 124-72-0766
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND W .
SPECIFY appmger
D. STREET ADDRESS 8 E Chelsea Ridae Dr. ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES"lJ NO
10 /02 /1981
MONTH DAY YEAR
3. A. AGE ?7
3B, DATE OF BIRTH
....
s:
<(
4. EMPLOYMENT
A. USUAL OCCUPATION Computer Programmer
B. TYPE OF INDUSTRY OR BUSINESS Mines Press Inc.
5 PLACE OF BIRTH White Plains. Ny
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Peter James Snyder Sr
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Marilyn Edythe Anderson
B. COUNTRY OF BIRTH U S A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
YEAR
MONTH OA Y
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. 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
., I '" I C r"'U..C NUMDII:I1
(TH/S SPACE FOR STA TE USE ONL V)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Ch~!~t~ Lynn Ne!!RRENT SURNAME
~
11. A. FUUL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Snyder
(OPTIONAL - SEE REVERSEI-44 27 1 341
D. SOCIAL SECURITY NUMBER 0 - -
12. RESIDENCE ANY B.Dutchess
(STATE) (COUNTY)
C, CHECK ONE 0 CITY..a TOWN 0 VILLAGE
~~~CIFYWappinaer
D STREET ADDRES~ E Chelsea Ridge Dr.
ZIP 12590
o YES"D NO
;1'983
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE26 3B. DATE OF BIRTH 02 ,23
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Student
B. TYPE OF INDUSTRY OR BUSINESS Dutchess Community
15. PLACE OF BIRTHDeschutes County, Oregon
(CITY, STATE / COUNTRY IF NOT USA)
18. FATHER
A. NAME Tonv Edward Neff
'B. COUNTRY OF BIRTJ.:! s. A
17. MOTHER
A. MAIDEN NAME Sally Jean Delgado
B. COUNTRY OF BIRTJ.:! 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
o
o
o
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 11 / 16 / 2005
MONTt!.I DAY' . - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? r:J 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
11/16/2005 Jacksonville, NC ~
1ST
2ND
3RD
4TH
'ef that the information I provided is tru
o
o
o
ent exists
by New York Domestic
MONTH
YEAR
02:41 ~~ 07
11
2009
09
08 2009
28. PLACE WHERE MARRIAGE OCCUR~ .
A. STATE NEW YORK B. COUNTY ~\C"'~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF mOWN OF 0 VILLAGE OF
SPECIFY \> O~~ 't.t:e.~~\c:...,
31. WITNESS TO
NAME (PRINn
SIGNATURE~