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COUNTY ......y\.Vt l\",r,-,,-,
CITYfTOWN Wappinger
~~~~c:1368
~5~1~~R 172
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Timothy Jay MorQan
MIDDLE CURRENT SURNAME
CURRENT SURNAME
Lo
1. A. FULL NAME
11. A. FULL NAME
SUPPLEMENTAL FILE
FROM THE BRIDE
Susan Ann Rush
-.J
FIRST
FIRST MIDDLE
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENTSharlow
C. SURNAME AFTER MARRIAGE M 0 rg a n
(OPTIONAL. SEE REVERSE1 02-46-6623
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A.NY BDutchess
(STATE).L (COUNTY)
C. CHECK ONE CJ CITY U TOWN 0 VILLAGE
~~~CIFYWapplnger
D. STREET ADDREss13 Degarmo Hills Koad
1 ~o~m
ZIP
"-
N
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE115_48_1 088
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITYo{] TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 13 Degarmo Hills Road ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES"D NO
10 /24 /1957
MONTH DAY YEAR
3. A. AGE51
3B. DATE OF BIRTH
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE56 3B. DATE OF BIRTH 02 ;t 4
o YES "6 NO
)'952
YEAR
MONTH
DAY
4. EMPLOYMENT
A. USUAL OCCUPATION Bricklayer
B. TYPE OF INDUSTRY OR BUSINESS Construction
5. PLACE OF BIRTH Cold SprinQ, Ny
(CITY. STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME James Tunney Morqan
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Mildred Anne Thorpe
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
14. EMPLOYMENT
A. USUAL OCCUPATION Sales Associate
B. TYPE OF INDUSTRY OR BUSINESS Retail
15. PLACE OF BIRTHMassena, Ny
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAMEHugh Kenneth Sharlow
'B. COUNTRY OF BIR.JJ S A
17. MOTHER
A. MAIDEN NAME Harriet Sterling
B. COUNTRY OF BIRTHCanada
18. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES 19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT DEATH DIVORCE CIVIL ANNULMENT
1 0 0 1 0 0
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEAJ1i B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (g), 0 DEATH
C. DATE LAST MARRIAGE ENDED? 01 / 28 / 2002 C, DATE LAST MARRIAGE ENDED? 04 / 09 / 20u2
MONTH DAY YEAR MONTl;!.< DAY" YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? E1 YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
~
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE T1HE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE (MONTH, DAY, YEAR) (CITY/COUNTY. STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 01/28/2002 Dutchess County, New 0 ~ 1ST 04/09/2002 Poughkeepsie, Ny 0 ~
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH C 0
I duly swear/affirm; depose and say, that to the best of my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists
as to my right to enter into the ma estate. 0 i n A
21. SIGNATURE OF GROOM~ 22. SIGNATURE OF BRIDE~ ~ {. {)/J JYl _' ~ J ~.h ___
~ ~URR NAME -
DATE 11/17/2008
DEATH
23, SUBSCRIBED AND SWORN TO/AFFIRMED B
SIGNATURE OF TOWN OR CITY CLERK.
This license authorizes the marriage in New rk 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) J C. Masterson
TIME MONTH YEAR
SEAL SIGNATURE.' DATE 11/17/2008
"--- -J MA!l.ltiG.A~IDflEi~eS 08:40 AM 11
--v- LU Mlaall ush Rd, Wappingers Falls, NY 12590 PM
STREET CITYITOWN STATE ZIP
~~R~~RT:~~ 10~O~~N~~E~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY J
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 00 RELIGIOUS 1 zs..cIVIL
DATE AND AT THE TIME AND /f' 1dfK,;.-, i I ... ,;:-
PLACE INDICATED. . PM . l' J-;; f ~ :) 9 0 OTlHER, SPECIFY
29. OFFICIANT V,f1/^/.1, .-:::"', v ~~. rJ/~i(~' ;;s;:.:;: 1..'..-..; ,., Ir'..' A,~e. -< ~_...
NAME (PRINT)' i.JLI . .~ 1'../'1'" ,,-</ ;...- TITLE ~"~V'- ,jt/:""~~~'v~
SIGNATURE. f;//;1!i~~~- DATE' A/b11 .:J4 ~ J
MAILlNG(~~~ .;,\ . ;""'-IJ v~ d:>J~,- ~,\fV., (t, C ,., f\J...U.', f"'\r1::)O
IJ \""~~i/J.('<"" f<i-.. ,j N-tl"> '-~~~ J ~-J ~~1
STREET CITYfTOWN STATE
30. WITNESS TO ~EMONY
NAME (PRINT) 't?/lv i
by New York Domestic
MONTH
YEAR
18
2008
01
16 2009
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY U.~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF if40WN OF 0 VILlLAGE OF
SPECIFY t/; i1r'f}NC.~
SIGNATURE.
DOH-98 (D3/2006)