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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Rich::mi Anthon\! Weatherwax Jr
FIRST MIDDLE J CURRENT SURNAME
COUNTY Dutchess
CITYfTOWN Wappinger
~~~~kCRT 1 368
~~~I~~~R 78
1. A. FULL NAME
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D SOCIAL SECURITY NUMBER 053-56-1659
2 RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Poughkeepsie
D STREET ADDRESS 21 Wayne Dr. ZIP 12601
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
0/ / 04 / 1970
MONTH DAY YEAR
3. A AGE ~R
3B. DATE OF BIRTH
4. EMPLOYMENT
A USUAL OCCUPATION New York State Trooper
B. TYPE OF INDUSTRY OR BUSINESS Police
5. PLACE OF BIRTH Nyack. NY
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A, NAME Richard Anthony Weatherwax
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Kathleen Marie Larkin
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 06 / 21 / 2007
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? [1YES 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
06/21/2007 Dutchess County, Ny
DEATH
o
w
en
z
w
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:i
~
{ } NAME (PRINT)
SEAL SIGNATURE ~
"-v-I MAI~~G ~PJ
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
w
~
oCt 29. OFFICiANT
o NAME (PRINT)
U. SIGNATURE ~
~ MAILING A RES
a: rl'?L
W STREET
o 30. WITNESS TO C
I
STATE FILE NUMBER
(TH/S SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Noreen Mar~ Winterfeldt
MIDDLE CURRENT SURNAME
..J
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE Weatherwax
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 117 -70-0495
12. RESIDENCE A, NY B Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY![l"I TOWN 0 VILLAGE
~~~CIFY Pouqhkeeosie
D. STREET ADDRESs21 Wayne Dr,
ZIP 12601
DYES rJ NO
/1'970
YEAR
E. is RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 38 3B. DATE OF BIRTH 04 /.20
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION New York State Trooper
B. TYPE OF INDUSTRY OR BUSINESS Police
15. PLACE OF BIRTH Rockville Centre, NY
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Charles R. Winterfeldt
. B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Mary W. Nolan
B. COUNTRY OF BIRTHU SA
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
(3) 0 ANNULMENT
/ ~
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END?
(3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
YEAR
~
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
TIME
MONTH
YEAR
MONTH
YEAR
AM
02:04PM 07
02
2008
08
30 2008
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A STATE NEW YORK B. COUNTY tI,~&I
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY OrS"~ Bar
STATE
31.
NAME (PRINT)
SIGNATURE~