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COUNTY Dutchess
CITYfTOW}I Wappinger
DISTRICT 1 368 '
NUMBER
REGISTER 23
NUMBER
~ I A. II: U~ I~I: VV J UMI'\.
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Seth Christian Pierson
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Sandi Leigh Ferrier
MIDDLE CURRENT SURNAME
~
1, A. FULL NAME
1 L A FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
FIRST
c..
N
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Pierson
(OPTIONAL' SEE REVERSE)065-72-024 7
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. NY B. Dutchess
(STATE).L (COUNTY)
C. CHECK O~~ . 0 CITY U TOWN 0 VILLAGE
~~~CIFY vvapplnger
b1U Maloney Rd. 12603
D. STREET ADDRESS ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ ND
13 A AGE 22 3B DATE OF BIRTH 07 /19 ;t 86
MONTH DAY YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)617 -72-0353
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 appmger
D STREET ADDRESS 510 Maloney Rd.
120U3
ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES '6 NO
06 /26 /1987
DAY YEAR
3. A. AGE 21
3B. DATE OF BIRTH
MONTH
4. EMPLOYMENT
A. USUAL OCCUPATION EMT
B. TYPE OF INDUSTRY OR BUSINESS Emergency Medicine
5. PLACE OF BIRTH Columbus, OH
(CITY, STATE / COUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION Secretary
~uslness
B. TYPE OF INDUEiRY Orh~SINESS
15. PLACE OF BIRTH I DUg, eepSle, NY
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Bruce Paul Ferrier
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Wendy Lee Traver
B. COUNTRY OF BIRTH USA
1
1B. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIOORCE CIVIL AN~ULMENT
DEbTH
6. FATHER
A. NAME Christopher Douglas Pierson
8 COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Donna Joan Conway-Pierson
B. COUNTRY OF BIRTH France
6. 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 DIVORCE
(3) 0 ANNULMENT (2) 0 DEATH
/ /
- YEAR
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END?
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
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) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
w
en
z
w
()
:;
o 0 1ST 0 0
o 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
I that to the best of my knowledge and belief that the information I provided is tr~Qat I declar that no/legal Impediment eXists
nage state. ~ \ '-- I -
. SIGNATURE OF BRIDE ~ ~.~L,--d--^:. 1\ ----
E CURRENT ~ USE CURRENT~ME
23 SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME 04/09/2009
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
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 !l11 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 MONTH
SEAL SIGNATURE ~. DATE 04/09/2009
"-- -.J MAllJl)lG ,/I.t>ID~E.:1eS AM 04 10 2009 06 08 2009
-v- LU IVI uOl ush Rd, Wappingers Falls, NY 12590 12:17PM .
STREET CITYITOWN STATE ZIP
~~~R~~~Ri~~J 'O~O~~~N~~~ 26. SOLEMNIZATION OCCURRED 27 TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 ~ RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 3: 00 PM 4- 25-09 90 OTHER, SPECIFY
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and
as to my right to enter into the
21. SIGNATURE OF GROOM~
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTY Dutchess
29 OFFICIANT Daniel B Ward
NAME (PRINT) ~~
~~~~1,U~6~
St. John's Lutheran Church 55 Wilbur
STREET CITYfTOWN
30. WITNESS TO CEREMONY
Sean Hatfield
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
Pastor
TITLE
XI CITY OF 0 TOWN OF 0 VILLAGE OF
Poughkeepsie
DATE
4-25-09
SPECIFY
Blvd. Poughkeepsie, NY 12603
STATE ZIP
31. WITNESS TO CEREMONY
Sara Ferrier
NAME (PRINT)
SIGNATURE~
NAME (PRINT)
SIGNATURE~
DOH.9B (0312006)