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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Kenneth John Licari
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYrrOWN Wappinger
~~~:~CRT 1368
~~~I~~~R 86
1. ,A. FULL NAME
FIRST
"-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 129-64-1966
2. RESIDENCE A NY s. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 11 B Sherwood Forest ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES'6 NO
10 / 23 / 1979
MONTH DAY YEAR
3. A. AGE 28
3B. DATE OF BIRTH
....
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4. EMPLOYMENT
A. USUAL OCCUPATION School Psychologist
B, TYPE OF INDUSTRY OR BUSINESS Education
5. PLACE OF BIRTH Newburgh. Nv
(CITY, STATE I COUNTRY IF NOT USA)
6, FATHER
A. NAME John Nicholas Licari
B. COUNTRY OF BIRTH USA
7. MOTHER
A, MAIDEN NAME Robin Drew
B, COUNTRY OF BIRTH USA
B. 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 ANNULMENT
/ /
(2) 0 DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D 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
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Yi
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Kathleen Mary Skidoell
MIDDLE CUI'l'RENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Li ca ri
(OPTIONAL - SEE REVERSE)055 70-1099
D. SOCIAL SECURITY NUMBER -
12 RESIDENCE A. NY sDutchess
(STATE) (COUNTY)
C, CHECK ONE 0 CITY't'J TOWN 0 VILLAGE
~~~CIFY Wappinoer
D. STREET ADDRESS 11 B Sherwood Forest
ZIP 12590
DYES '6 NO
;(983
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 25 3B. DATE OF BIRTH 02 ~4
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS Education
15. PLACE OF BIRTH Yonkers, Ny
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME William Allison Skidoell
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Patricia Ann Kaiser
B. COUNTRY OF BIRTHU S A
1B. NUMBER OF THIS MARRIAGE 1
19. 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?
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
(3) 0 ANNULMENT (2) 0 DEATH
/ /
~ YEAR
o 0 1ST 0 0
o 0 ~D 0 0
o 0 ~D 0 0
o 0 4TH 0 0
nowledge and belief that the information I provided is true and that I declare that no legal impediment exists
22 SIGNATURE OF BRIDE&d1..ou~~~o J 2
~:;: 09/10/2008
23. SUBSCRIBED AND SWORN TO/AFFIRMED B
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 (PRIND John ,Mast r on
TIME MONTH YEAR
SEAL SIGNATURE ~' DATE 07/10/2008
I.- -.J MAI).JI)I"G ,/\!;lDljlEReS
-v- LU IVI uOI sh Rd, Wappingers Falls, NY 12590
STREET CITYITOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 2.k[7. TYPE OF CEREMONY
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 RELIGIOUS 1 0 CIVIL
DATE AND AT THE TIME AND ,..., /) AM ,,/
PLACE INDICATED. .1 :..)0. .I--...s Oa 90 OTHER, SPECIFY
K F itl-; L1/ 111M J y t../ TITLE -r-Kc; U-ertrJ-
7~lJT;;~:r.~ DATE S;(:LS:/OY
:;VI!...- s It LJ~ .7n -l-Y I-~!.:v II, j: /:J-)9u
CITYrrOWN
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29. OFFICIANT
NAME (PRINT)
SIGNATURE ~
MAILING ADDRES
I ::,- t ()
STREET
30. WITNESS TO CEREMONY
NAME (PRIND
SIGNATURE~
STATE
by New York Domestic
MONTH
YEAR
02:56~~ 07
2008
09
08 2008
11
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. couNr;])0GheJS
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
)f:f CITY OF 0 TOWN 0) 0 VILLAGE OF
SPECIFY (0 U < j., k.lC-Je-f'J/(p
-' I
ZIP
31. WITNESS TO CEREMONY
NAME (PRIND
SIGNATURE~
~