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COUNTY L..JUl~IIt::::;::;
CITYrrOWN Wappinger
~~~:~c:1368
~~~I~J~R 37
1 . A. FULL NAME
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
James Christopher DUQard
FIRST MIDDLE CURRENT SURNAME
~
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Courtney Cunningham Horan
FIRST MIDDLE CURRENT SURNAME
11. A. FULL NAME
a.
N
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C, SURNAME AFTER MARRIAGE Horan-DuQard
(OPTIONAL - SEE REVERSEl128_7 4-3223
D. SOCIAL SECURITY NUMBER
12. RESIDENCE ANY BDutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY tJ TOWN 0 VILLAGE
~~~CIFY Wapf>inger
D STREET ADDREss47 Fieldstone Loop
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSEl096_56_8590
D. SOCiAl SECURITY NUMBER
2 RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C CHECK ONE 0 CITY~ TOWN 0 VILLAGE
~~~CIFY PouQhkeepsie
o STREET ADDRESS 9 Kinderhook Dr. ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES"tJ NO
04 / 25 /1968
MONTH DAY YEAR
ZIP 12590
DYES 1:J NO
~82
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE26 38. DATE OF BIRTH 09 ~1
MONTH DAY
3. A. AGE41
38. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Warehouse ManaQer
B. TYPE OF INDUSTRY OR BUSINESS Direct Buy
5. PLACE OF BIRTH Manhattan, New York
(CITY, STATE I CouNTRY IF NOT USA)
14, EMPLOYMENT
A, USUAL OCCUPATION Service Manager
B. TYPE OF INDUSTRY OR BUSINESS Direct Buy
15. PLACE OF BIRTH Mount Kisco, New York
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Peter Michael Horan
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Nancianne Mattracion
B. COUNTRY OF BIRTHU S A
lB. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
6, FATHER
A. NAME Harold Charles Dugard
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Judith Ann Sedler
B. COUNTRY OF BIRTH USA
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
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C, DATE LAST MARRIAGE ENDED? / (
MONTH DAY YEAR
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
C. DATE LAST MARRIAGE ENDED?
MONTH DAY YEAR
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) (CITYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
a:'
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1ST
2ND
3RD
4TH
I duly swear/affirm, depose and sa
as to my right to enter into
o
o
o
o 0
o 0
o 0
o 0
pediment exists
1ST
2ND
3RD
4TH
t the information 1 provided is tru
This license auttiorizes the manriage 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 ceremon .
~ 24. TOWN OR CITY CLERK 25, A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) John C, Masterson
MONTH YEAR MONTH YEAR
SEAL SIGNATURE ~
'-v-I MA~~GlCfi~ 05 14 2009 07 12 2009
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER,
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED,
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B, COUNTY ~t'S'~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF K TOWN OF 0 VILLAGE OF
SPECIFY hs J K-~ //
SIGNATURE ~
MAILING A RES
p(
STREET
~o. WITNESS TO CERE~ONY .
NAME (PRINT)
NAME (PRINT)
SIGNATURE~