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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Herbert Dexter Wilson
MIDDLE CURRENT SURNAME
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) M DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 08/ 02 / 1994 .
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S} ALIVE? &'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. STATElCOUNTRY, IF NOT USA) SELF SPOUSE
08/02/1994 Poughkeepsie. Ny 0 ~ 1ST
o 0 2ND
o 0 3RD
o 0 4TH
Y knowledge and belief that the information I provided is true
1ST
2ND
3RD
4TH
I duly swear/affirm. depose and S y, that to .the best of
as to my right to enter into the i r'ria~~
21. SIGNATURE OF GROOM~{" :,.l;1 {/
/ USE C RENT NAME
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME .
SIGNATURE 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 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) Jo . Masterson
TIME MONTH YEAR
SEAL SIGNATURE ~ .. DATE 12/29/2008
MAILING ADDRESS AM
'-v-I 20 Middle ush Rd. Wappinaers Falls. NY 12590 02:44PM 12
STREET CITYITO'WN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE YEAR 0 0 RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER. SPECIFY
COUNTY Dutchess
CITYITOWN Wappinger
~~~:~c~ 1368
~~~I~;~R 183
1. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 1 03-42-1576
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0(] TOWN 0 VILLAGE
~~~CIFY Fishkill
D STREET ADDRESS 400 Sunset Hill Rd. East ZIP 12524
E. IS RESIDENCE WITHIN liMITS OF CITY OR INCORPORATED VilLAGE? 0 YES"6 NO
11 / 21 / 1950
MONTH DAY YEAR
3. A AGE 58
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Buisness Owner
B. TYPE OF INDUSTRY OR BUSINESS TruckinQ
5. PLACE OF BIRTH Beacon, Ny
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Allen Wilson
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Francis Catherine Karszinski
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
DEATH
o
w
UJ
Z
W
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:i
IS I A II: t-ILI: NUMtll:H
(THIS SPACE FOR STATE USE ONLY)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Iris Christine Kano
MIDDLE CURRENT SURNAME
~
11. A. FUll NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Kano-Wilson
(OPTIONAL. SEE REVERSEl063_66_0507
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. NY 8 Dutchess
(STATE) J. (COUNTY)
C. CHECK ONE 0 CITY LJ TOWN 0 VILLAGE
~~~CIFY Fishkill
D STREET ADDRESS400 Sunset HIli Rd. East
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILlAGE?
13. A. AGE 45 38. DATE OF BIRTH 06 ~9
MONTH DAY
ZIP 12524
o YES '6 NO
)1'963
YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION County Supervisor
B. TYPE OF INDUSTRY OR BUSINESS Government
15. PLACE OF BIRTH New York
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Arno Kano
'8. COUNTRY OF BIRTHGermany
17. MOTHER
A. MAIDEN NAME Rosemarie Winschermann
B. COUNTRY OF 81RTHGermany
1B. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) d'DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 07 / 18 / 1988
MONTI1..I DAY - YEAR
D. ARE ANY FORMER SPOUSE(S} ALIVE? ['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, STATEJCOUNTRY, IF NOT USA) SELF SPOUSE
07/18/1988 Charlotte, North Carolina 0 ~
o 0
o 0
o 0
impediment exists
62-
DATE
12/29/2008
by New York Domestic
MONTH
YEAR
30
2008
02
27 2009
l~VIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEWYORK 8.COUNTY~~.,{G~CJ'.1
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY ;:::, ~ t.. I J / .
TITLE (,-4 COtJ...f J",cI) 'L
;J. ~//otf "
N. )v /02Jo~
STATE ZIP
31. WITNESS TO W~~l/ Iff 0'"' ~{
NAME (PRINT) A
c..J2L-
29. OFFICIANT
NAME (PRINT)
DATE
SIGNATURE~
DOH.9B (03/2006)
SIGNATURE~