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COUNTY Dlltchess
CITYfTOWN Wappinger
~~~:~c: 1368
~~~~;~R 98
i::J I "" I ~ vr I~~ yy I vn~
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
M~th G3rre~RRENT SURNAME
(TH/S SPACE FOR STATE USE ONL Y)
.J
L D SUPPLEMENTAL FILE
FROM THE BRIDE
Tara ~Q,nI8Y Sar\QQf;r;\-SURNAME
1 . A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
0-
N
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 128-72-7567
2. RESIDENCE A. NV B. II, ,+,...hess
(llTATE) ~
C. CHECK ONE 0 CITY oIitI TOWN 0 VILLAGE
~~~CIFY Fiihkill
o STREET ADDRESS 318 T olAln View DrivE' ZIP 1 '590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ollI NO
MOOr~ / ~ / y1279
C. s~S~*tt~~~~~rt~W~~~s~arrett
D. SOCIAL SECURITY NUMBER 077 -62-9576
12. RESIDENCE A. NY B. DLlt,...h",SS
(STATE) lCOtliffi'j'
C. CHECK ONE 0 CllY l;j1l TOWN 0 VILLAGE
~~~CIFY Fishkill
D. STREET ADDRESS:i 1 R T nwn \/iF!w nrivF! ZIP 1 ?!1~O
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ollI NO
~H ~~AY 1 ~J~
13. A. AGE 33
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS SOfl1er" r.~n
15. PLACE OF BIRTH ~h1PJfJ;r6mJ;i~II~ ~~~r.tmrl
16. FATHER
3. A AGE 20
4. EMPLOYMENT
3B. DATE OF BIRTH
3B, DATE OF BIRTH
A. USUAL OCCUPATION General Manager
B. TYPE OF INDUSTRY OR BUSINESS Logistics Company
5. PLACE OF BIRTH FcIRY.:iQ,~~O~~~NO~tXA)
6. FATHER
A NAME Bruce James Garrett
B. COUNTRY OF BIRTH I I S A
7. MOTHER
A. MAIDEN NAME Deborah Lee D'Angelo
B. COUNTRY OF BIRTH I I S A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
A. NAME Robert Fredrick Sanborn Jr
'B. COUNTRY OF BIRTHII SA'
17. MOTHER
A. MAIDEN NAME Gail Annp LcRnr.r.n
B. COUNTRY OF BIRTH I I S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
DEATH
o
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
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
o
o
o
o
(3) 0 ANNULMENT (2) 0 DEATH
/ /
- YEAR
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
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
1ST 0 0 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 0 0
I duly swear/afflrln, depose and say, that to the best of my kn wledge and belief that the information I provided is true and that I declare tha1 no legal impediment exists
as to my right to enter into the mo/n~elstate. ~ \\
21. SIGNATURE OF GROOM~ /}~ 22. SIGNATURE OF BRIDE~ I ~ --IL.. V; ~~ L ~
USE USE CURRENT NAME
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the m/Yfiage in New ork State I the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to pertDrm m!ll'riage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is to be used only lor the purpose 01 a second or subsequent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
DATE 07/:iO/?OOR
~
{ SEAL }
'-.t-I
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
NAME (PRINT)
DAY
YEAR
TIME
MONTH
YEAR
MONTH
DATE
27 2008
07
30
2008
09
STR
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
OATE AND AT THE TIME AND
PLACE INDICATED.
28. PLACE WHERE MARRIAGE OCCUR~
A. STATE NEW YORK B. COUNTV~D,"Jr:/ttJp1.f,
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CllY OF ~OWN OF 0 VILLAGE OF
SPECIFY 7 J \)Q"dJ~ l' DA......
f7..... , I
29. OFFICIANT
NAME (PRINT)
NAME (PRINT)
SIGNATURE~
DOH-98 (03/2006)
NAME (PRINT)
SIGNATURE~