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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Ahmp.rl T::II::It nwirl::lr
MIDDLE CURRENT SURNAME
o 0
o 0 2ND
o 0 3RD
o 0 4TH
knowledge and belief that the information I provided is. true a
USE
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) John C. Ma terson
{TIME MONTH YEAR
SEAL SIGNATURE ~. DATE 07/02/2008
'-v-' MA~~GrVfFcfaTe ush Rd, Wappingers Falls, NY 12590 12:59~~ 07 03 2008
STREET CITYITOWN STATE ZIP
~~~R~~~RT~~J lo~O~~~N~Zi~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY /
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 00 RELIGIOUS 1 [J;YCIVIL
DATE AND AT THE TIME AND c;.
PLACE INDICATED. a I doDo 9 0 OTHER. SPECIFY
COUNTY Dutchess
CITYfTOWN Wappinger
~~~~~c~ 1 368
~~~I~J~R 77
1 . A FULL NAME
FIRST
0..
N
B BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 068-94-5031
2. RESIDENCE A. NY B. nLJtchp.!=;!=;
(STATE) (COUNTY)
C. CHECK ONE 0 CITY olJ TOWN 0 VILLAGE
AND W .
SPECIFY appmger
D. STREET ADDRESS 1668 Route 9: Apt 1 G ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES -6 NO
3. A. AGE ?1 36. DATE OF BIRTH 10 / 14 / 1 ~R6
MONTH DAY YEAR
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4. EMPLOYMENT
A. USUAL OCCUPATION Student
B. TYPE OF INDUSTRY OR BUSINESS DCC
5. PLACE OF BIRTH Shebin EI-kom Egypt
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME T::II::It Fareed Dwidar
B. COUNTRY OF BIRTH Egypt
7. MOTHER
A MAIDEN NAME Nora Mahmoud Abdel-hady
B. COUNTRY OF BIRTH Egypt
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRtAGESWHICH 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
YEAR
MONTH DAY
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
21. SIGNATURE OF GROOM~
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I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Patricia Susan McGrath
MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)080-48 2019
D. SOCIAL SECURITY NUMBER -
12 RESIDENCE ANY B Putnam
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN ~ VILLAGE
~~~CIFY Cold Spring
D. STREET ADDREss9 Benedict Rd. ZIP 1 0516
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
13 A. AGE45 3B. DATE OF BIRTH 11 /-28 /1"962
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Highland Transit
B. TYPE OF INDUSTRY OR BUSINESS Transportation
15. PLACE OF BIRTH Cold Sprinq, NY
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Donald J. McGrath
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Ann Marie Cone
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 2
19. 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? 01 / 26 / 2006
MONTH DAY - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~ 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
1ST 01/26/2006 Pouqhkeepsie, NY
DEATH
o
r:1
by New York Domestic
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
MONTH
DAY
YEAR
08
31 2008
28. PLACE WHERE MARRIAGE OCCURRED
A STATE NEW YORK B COUNTY .hJ1'c.~e~)
o(:.F I Ckf!...
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~WN OF 0 VILLAGE OF
29. OFFICIANT
NAME (PRINT)
TITLE MM242.\AGe.
DATE~1 a.oof
SPECIFY liJAfel NGE.I<-
STATE ZIP
31. WITNESS TO CEREMONY
NAME (PRINT) d' ~ V (- I> {<1-- f-..... J f- _9-Ao- !:r--
SIGNATURE~