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~IAIE UF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Steven Daniel Doughty
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYfTOWN Wappinger
DISTRICT1368 .
NUMBER
REGISTER22
NUMBER
1. A. FULL NAME
FIRST
a.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE>129_72_4216
D. SOCIAL SECURITY NUMBER
2 RESIDENCE A. NY B. Dutchess
(STATE).L. (COUNTY)
C. CHECK ONE Q CITY'U TOWN 0 VILLAGE
~~~CIFY Hyde Park
D. STREET ADDRESS 66 Garden ~t.
1~o38
>I
YES i;J NO
/1983
YEAR
ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
08 / 08
DAY
3. A. AGE 25
3B. DATE OF BIRTH
MONTH
4. EMPLOYMENT
A. USUAL OCCUPATION Police Officer
B. TYPE OF INDUSTRY OR BUSINESS Law Enforcement
5 PLACE OF BIRTH Rhinebeck, NY
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Dennis Hugh Doughty
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Michelle Rose DeMarie
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
DE8TH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(2) 0 DEATH
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
lD. 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
2ND
3RD
4TH
I duly swear/affirm, depose and say, that to the best of my k
as to my right to enter into the mama state.
21. SIGNATURE OF GROOM~
o
o
o
w
en
z
w
(.)
::i
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
1()9
:<-
9 0 OTHER, SPECIFY
TITLE
SIGNATURE~
DOH-98 (03/2006)
~ I A I t: I"ILt: NUMISt:H
(THIS SPACE FOR STA TE USE ONL Y)
l
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Allison Michelle Woods
--.J
11. A. FULL NAME
CURRENT SURNAME
FIRST
MIDDLE
B. BIRTH NAME (MAIDEN NAME)'5~UERht
C. SURNAME AFTER MARRIAGE g Y
(OPTIONAL - SEE REVERSEr] 08- f 4-488 f
D. SOCIAL SIi.CW1!TY NUMBER D I:-.
NY utclless
12. RESIDENCE A. B.
(STATE) >I (COUNTY)
C. CHECK O~I' t 0 CITY 0 TOWN 0 VILLAGE
AND v In on
SPECIFY Bd 1 Q58A
46 Rhynder::;" . L U
D. STREET ADDRESS ZIP >I
E. IS RE~~NCE WITHIN LIMITS OF CITY OR INCORPORATO'5VILLAGE)O 0 Y.198~O
13. A. AGE 3B. DATE OF BIRTH __
MONTH DAY YEAR
14. EMPLOYMENT T h
eac er
A. USUAL OCCUPATION Education
B. TYPE OF.INDljS,TRY O~fi\USINESS. hi'
t"'ougllKeepSle Y
15. PLACE OF BIRTH '
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
Michael Joseph Woods
A. NAME USA
B. COUNTRY OF BIRTH
17. MOTHER
Ellen Louise Burnett
A. MAIDEN NAME uSA
B. COUNTRY OF BIRTH I
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DlaORCE CIVIL A~ULMENT
D~TH
B. HOW DID LAST MARRIAGE END?
(3) 0 DIVORCE
(3) 0 ANNULMENT (2) 0 DEATH
/ /
- YEAR
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
1ST
2ND
3RD
o 0
o 0
o 0
o 0
/~~Mga' impediment exists
USE CURRENT NAME 04/09/2009
DATE
YEAR
10 CIVIL
28. PLACE WHERE MARRIAGE OCCUR~
A. STATE NEW YORK B. couN~Tclk?5S'
f!.. C. fk/~sr
61<9-/oc;
/
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF GYVILLAGE OF
SPECIFY wi ARPf~t? 5- ~S
/ d S-9 0
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT) ~€1b:;;cc Or
SIGNATURE ~ tJ,r...J<...l!.f'...ov
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